Part III. Identification

Chapter III Contents

 

Registry Information

Abstractor

Reporting Facility

ACoS Approved Flag

Patient Information

Name

Entering Names

Religious Names

Name Suffix

Mother's First Name

Medical Record Number

Social Security Number

Phone Number (Patient)

Address at Diagnosis

Number and Street at DX

City at Dx

State at DX

ZIP at DX

County at DX

Country at DX

Marital Status

Sex

Religion

Race and Ethnicity

Codes For Race Field

Spanish/Hispanic Origin

Date of Birth

Date of Birth Flag

Age at Diagnosis

Birthplace - Country

Birthplace - State

Occupation and Industry

Occupation

Industry

Children

Patient No Research Contact Flag

Height

Weight

Tobacco Use

Source Comorbidity

Case Identification

Date of First Contact

Date of First Contact Flag

Dates of Inpatient Admission and Inpatient Discharge

Date of Inpatient Admission Flag

Date of Inpatient Discharge Flag

Date of Diagnosis

Date of Diagnosis Flag

Vague Dates

Approximation

Place of Diagnosis

Class of Case

Type of Reporting Source

Type of Admission

Casefinding Source

Payment Source (Primary and Secondary) and Payment

Reporting Facility Referred From

Reporting Facility Referred To

Physicians

Phyaician License Numbers

Entering Physician NPI Codes

Secondary Diagnosis 1 - 10

Comorbidity/Complications

ICD Revision Comorbidities and Complications

Discovered By Screening

 

 

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