PATIENT RESPONSE RECORD (continued) Data Field Element XML Element Attributes Description Valid Values Data Type Size Required Q59b-phone None Which groups best describes Samoan 1 Alphanumeric 1 Yes race-samoan-phone you? You may choose one or NOT APPLICABLE X character Each element must have a closing tag that more of the following. Are MISSING/DK M is the same as the opening tag but with a you… forward slash. This patient response data element should only occur once per patient. Example: Q59b-phone None Which groups best describes Other Pacific Alphanumeric 1 Yes race-otherpacificislander-phone you? You may choose one or Islander 1 character Each element must have a closing tag that more of the following. Are NOT APPLICABLE X is the same as the opening tag but with a MISSING/DK M you… forward slash. This patient response data element should only occur once per patient. Example: Q59b-phone None Which groups best describes NONE ABOVE 1 Alphanumeric 1 Yes race-noneofabove-pacific-phone you? You may choose one or NOT APPLICABLE X character Each element must have a closing tag that more of the following. Are MISSING/DK M is the same as the opening tag but with a you… forward slash. This patient response data element should only occur once per patient. Example:
PATIENT RESPONSE RECORD (continued) XML Element Attributes Description Valid Values Data Type Field Size Data Element Required Q59b-phone race-samoan-phone 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 Which groups best describes you? You may choose one or more of the following. Are you… Samoan 1 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes Q59b-phone race-otherpacificislander-phone 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 Which groups best describes you? You may choose one or more of the following. Are you… Other Pacific Islander 1 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes Q59b-phone race-noneofabove-pacific-phone 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 Which groups best describes you? You may choose one or more of the following. Are you… NONE ABOVE 1 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes
ICH_SurveyAdminManual_Ver4_Feb2016.docx