Page Comparison

Sequence

Name

Value

Comment

1

Set ID

1

Hard Coded

2

Patient ID

[Subject Volunteer ID]

Obtained from Volunteer Profile

3

Patient Identifier List

NULL

Not Required

4

Alternate Patient ID - PID

4.1 [Subject Screening Number]

4.2 [Subject Randomization Number]

Each sub-field will be separated with “^”

*Randomization number only present if subject is randomized

5

Patient Name

5.1 [Subject Last Name Initial]

5.2 [Subject First Name Initial]

5.3 [Subject Middle Name Initial]

Initials will be the first character (alpha, numeric or character) of the Subject First, Last and Middle name within the Volunteer Database in ClinSpark

If no middle initial = empty

Each sub-field will be separated with “^”

Example 1:

Image Removed

Image Added

|A^2^J^2^|

Example 2:

Image Removed

Image Added

|A^J^MJ^J^J|

6

Mother's Maiden Name

NULL

Not Required

7

Date/Time of Birth

[Subject Birth Date]

Format:

yyyyMMdd

8

Administrative Sex

[Subject Gender]

Male and Female which will be stored as ‘M' and 'F’

9

Patient Alias

NULL

Not Required

10

Race

[Subject Race Code]

Race Codes:

American Indian or Alaskan Native = I

Asian = A

Black or African American = B

Native Hawaiian or Other Pacific Islander = O

White = C

Other Race = O

Unknown = X

11

Patient Address

11.1 [Site Address]

11.2 NULL

11.3 [Site City]

11.4 [Site State]

11.5 [Site Postal Code]

Each sub-field will be separated with “^”

Obtained from Site Details

12

County Code

NULL

Not Required

13

Phone Number - Home

NULL

Not Required

14

Phone Number - Business

NULL

Not Required

15

Primary Language

NULL

Not Required

16

Marital Status

NULL

Not Required

17

Religion

NULL

Not Required

18

Patient Account Number

^^^C^^^

Hard Coded

Not Required