Form:	DCP Eligibility v1.3

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 773)
* 773	Visit code (Go To: 423)
	Permissible Values (value): BLN1 (1)
	BLN2 (2)
	BLN3 (3)
	BLN4 (4)
* 423	EDRN Protocol ID (Go To: 422)
* 422	EDRN Site ID (Go To: 1056)
* 1056	Proposed study group (Go To: 807)
	Permissible Values (value): Cases group 1 (1)
	Control Group 2 (2)
* 807	Date of baseline visit: (Go To: 929)
* 929	EDRN Staff ID of the person who collected the data: (Go To: 794)
* 794	Date of birth: (What is your date of birth?) (Go To: 948)
* 948	Does the participant currently have cirrhosis? (Go To: 951)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 987)
* 987	Cirrhosis diagnosis based on: (Go To: 950)
	Permissible Values (value): Liver histology (1)
	Judgment of the treating physician (2) (Go To: 988)
* 988	Does the participant have an imaging test showing a cirrhotic liver with splenomegaly? (Go To: 989)
	Permissible Values (value): No (0)
	Yes (1)
* 989	Does the participant have a platelet count of less than 120 K/mm3? (Go To: 950)
	Permissible Values (value): No (0)
	Yes (1)
950	Year in which participant first met diagnostic criteria for cirrhosis: (Go To: 1718)
* 1718	Does the participant have chronic liver disease? (Go To: 1719)
	Permissible Values (value): No (0)
	Yes (1)
* 1719	Does the participant currently have esophageal varices? (Go To: 1720)
	Permissible Values (value): No (0)
	Yes (1)
* 1720	Does the participant currently have gastric varices? (Go To: 951)
	Permissible Values (value): No (0)
	Yes (1)
* 951	Does the participant currently have an undiagnosed hepatic mass? (Go To: 1103)
	Permissible Values (value): No (0)
	Yes (1)
* 1103	In the past five years has participant had cancer [other than basal/squamous cell skin cancer] confirmed by a doctor? (In the past five years have you had cancer [other than basal/squamous cell skin cancer] confirmed by a doctor?) (Go To: 954)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1104)
* 1104	In the past five years is hepatocellular carcinoma (HCC) the only type of cancer (other than basal/squamous cell skin cancer) the participant has had? (Go To: 954)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 995)
995	Date on which participant first met diagnostic criteria for hepatocellular carcinoma (HCC): (Go To: 961)
* 961	Has participant ever received therapy for hepatocellular carcinoma (HCC)? (Go To: 963)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 962)
* 962	Is participant currently receiving therapy for hepatocellular carcinoma (HCC)? (Go To: 963)
	Permissible Values (value): No (0)
	Yes (1)
* 963	Is participant enrolled in a clinical trial for hepatocellular carcinoma (HCC)? (Go To: 1206)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 964)
* 964	Were DCP data and blood obtained before the participant enrolled in the clinical trial for hepatocellular carcinoma (HCC)? (Go To: 1206)
	Permissible Values (value): No (0)
	Yes (1)
* 1206	Is pathology report for current hepatocellular carcinoma available? (Go To: 954)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 968)
968	Date of procedure that generated pathology report (MM/DD/YYYY): (Go To: 706)
706	Method of acquisition (Go To: 954)
	Permissible Values (value): Biopsy (1)
	Excised during surgery (2)
	Fine needle aspirate (3)
* 954	Number of liver imaging tests used to diagnose (HCC or cirrhosis) within the last six months: (Go To: 955)
* 955	Date of imaging test (MM/DD/YYYY): (Go To: 956)
* 956	Type of abdominal imaging: (Go To: 965)
	Permissible Values (value): Ultrasound (1)
	CT scan (2)
	Angiogram (3)
	MRI (4)
	Other, specify: (97) (Go To: 957)
957	Type of abdominal imaging (other, specify): (Go To: 965)
* 965	Number of lesions (Go To: 966)
966	Maximum diameter of largest lesion (in cm) (Go To: 958)
* 958	Evidence of arterial hypervascularization? (Go To: 959)
	Permissible Values (value): No (0)
	Yes (1)
* 959	Evidence of portal vein thrombosis? (Go To: 960)
	Permissible Values (value): No (0)
	Yes (1)
* 960	Evidence of metastases, including extrahepatic portal or hepatic vein? (Go To: 1057)
	Permissible Values (value): No (0)
	Yes (1)
* 1057	Does participant currently have ascites? (Go To: 1058)
	Permissible Values (value): No (0)
	Controlled (1)
	Uncontrolled (2)
* 1058	Does participant currently have encephalopathy? (Go To: 991)
	Permissible Values (value): No (0)
	Controlled (1)
	Uncontrolled (2)
* 991	Does participant have co-morbid medical conditions with life expectancy less than one year? (Go To: 1208)
	Permissible Values (value): No (0)
	Yes (1)
* 1208	Does participant require long-term immunosuppressive therapy for solid organ transplant? (Go To: 993)
	Permissible Values (value): No (0)
	Yes (1)
* 993	Has the participant had a prior solid organ transplant? (Go To: 1017)
	Permissible Values (value): No (0)
	Yes (1)
* 1017	Based on the judgment of the treating physician, what is the liver disease etiology? Check all that apply. (Go To: 994)
	Permissible Values (value): Alcoholic liver disease (1)
	Alpha-1 antitrypsin deficiency (2)
	Autoimmune (3)
	Hemochromatosis (4)
	Hepatitis B (5) (Go To: 1020)
	Hepatitis C (6) (Go To: 1018)
	Non-alcoholic fatty liver (7)
	Primary biliary cirrhosis (8)
	Primary sclerosing cholangitis (9)
	Wilsons disease (10)
	Cryptogenic (11)
	Refused (88)
	Other, specify: (97) (Go To: 1023)
1023	Based on the judgement of the treating physician, what is the liver disease etiology (other, specify)? (Go To: 994)
1020	Hepatitis B surface antigen (HBsAg) (Go To: 1091)
	Permissible Values (value): Positive (1)
	Negative (2)
	Not done (3)
1091	Was Hepatitis B DNA detectable? (Go To: 1092)
	Permissible Values (value): No (0)
	Yes (1)
	Not done (3)
1092	Was Hepatitis B e-antigen detectable? (Go To: 1093)
	Permissible Values (value): No (0)
	Yes (1)
	Not done (3)
1093	Mode of Hepatitis B contraction: (Go To: 1094)
	Permissible Values (value): Transfusion (1)
	IV drug use (2)
	Maternal-fetal transmission (3)
	Tattoos (4)
	Other, specify: (7) (Go To: 1098)
	Unknown/refused (9)
1098	Mode of hepatitis B contraction (other, specify): (Go To: 1094)
1094	Length of infection: when was Hepatitis B contracted? (Go To: 994)
	Permissible Values (value): Within the last 5 years (1)
	Within the last 10 years (2)
	Within the last 15 years (3)
	Within the last 20 years (4)
	Within the last 25 years (5)
	Within the last 30 years or more (6)
	Unknown/refused (9)
1018	HCV Ab (Go To: 1019)
	Permissible Values (value): Positive (1)
	Negative (2)
	Not done (3)
	Unknown/refused (9)
1019	HCV RNA (Go To: 1088)
	Permissible Values (value): Positive (1) (Go To: 1095)
	Negative (2)
	Not done (3)
	Unknown/refused (9)
1095	Viral load (Hepatitis C RNA) value: (Go To: 1096)
1096	Viral load (Hepatitis C RNA) unit: (Go To: 1088)
	Permissible Values (value): IU/ml (1)
	Copies/ml (2)
1088	Genotype unit (Hepatitis C): (Go To: 1089)
	Permissible Values (value): 1 (1)
	2 (2)
	3 (3)
	4 (4)
	5 (5)
	6 (6)
	Unknown/refused (9)
	Not done (33)
1089	Mode of Hepatitis C contraction: (Go To: 1090)
	Permissible Values (value): Transfusion (1)
	IV drug use (2)
	Maternal-fetal transmission (3)
	Tattoos (4)
	Other, specify: (7) (Go To: 1099)
	Unknown/refused (9)
1099	Mode of hepatitis C contraction (other, specify): (Go To: 1090)
1090	Length of infection: when was Hepatitis C contracted? (Go To: 994)
	Permissible Values (value): Within the last 5 years (1)
	Within the last 10 years (2)
	Within the last 15 years (3)
	Within the last 20 years (4)
	Within the last 25 years (5)
	Within the last 30 years or more (6)
	Unknown/refused (9)
* 994	Has participant received hemodialysis twice within the past week? (Go To: 1187)
	Permissible Values (value): No (0)
	Yes (1)
* 1187	Does the participant have a history of intrinsic renal disease? (Go To: 1097)
	Permissible Values (value): No (0)
	Yes (1)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)