| CDE ID | CDE Description | | * 421 | EDRN Participant ID (Go To: 423) |
| * 423 | EDRN Protocol ID (Go To: 422) |
| * 422 | EDRN Site ID (Go To: 929) |
| * 929 | EDRN Staff ID of the person who collected the data: (Go To: 1319) |
| * 1319 | Date participant signed consent form (MM/DD/YYYY): (Go To: 4860) |
| * 4860 | Date participant signed an authorization for the release of their protected health information. (HIPAA)(MM/DD/YYYY) (Go To: 5147) |
| * 5147 | Date the participant signed a medical release form (MM/DD/YYYY) (Go To: 4922) |
| * 4922 | Has the participant authorized genetic testing? (Go To: 1097) |
| | | Permissible Values (value): | No (0) |
|
| | |
| | |
| | |
| | |
| 1097 | Comments (do not include any participant identifiers) (Go To: End of Form) |