PATIENT RESPONSE RECORD (continued) Data Field Element XML Element Attributes Description Valid Values Data Type Size Required Q37 None Are you eligible for a kidney Yes 1 Alphanumeric 1 Yes eligible-transplant transplant? No 2 character Each element must have a closing tag that I know 3 don’t is the same as the opening tag but with a NOT APPLICABLE X forward slash. This patient response data MISSING/DK M element should only occur once per patient. Example: Q38 None In the last 12 months, has a Yes 1 Alphanumeric 1 Yes explain-ineligible doctor or dialysis center staff No 2 character Each element must have a closing tag that explained to you why you are NOT APPLICABLE X is the same as the opening tag but with a not eligible for a kidney MISSING/DK M forward slash. This patient response data transplant? element should only occur once per patient. Example: Q39 None Peritoneal dialysis is dialysis Yes 1 Alphanumeric 1 Yes talk-peritoneal given through the belly and is No 2 character Each element must have a closing tag that usually done at home. In the NOT APPLICABLE X is the same as the opening tag but with a last 12 months, did either your MISSING/DK M forward slash. This patient response data kidney doctors or dialysis element should only occur once per center staff talk to you about patient. peritoneal dialysis? Example:
PATIENT RESPONSE RECORD (continued) XML Element Attributes Description Valid Values Data Type Field Size Data Element Required Q37 eligible-transplant Each element must have a closing tag that is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example: None Are you eligible for a kidney transplant? Yes 1 No 2 I don’t know 3 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes Q38 explain-ineligible Each element must have a closing tag that is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example: None In the last 12 months, has a doctor or dialysis center staff explained to you why you are not eligible for a kidney transplant? Yes 1 No 2 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes Q39 talk-peritoneal Each element must have a closing tag that is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example: None Peritoneal dialysis is dialysis given through the belly and is usually done at home. In the last 12 months, did either your kidney doctors or dialysis center staff talk to you about peritoneal dialysis? Yes 1 No 2 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes
ICH_SurveyAdminManual_Ver4_Feb2016.docx