Texas Cancer Registry Cancer Reporting Handbook

June 2011 Page 55

DEMOGRAPHICS AND PATIENT INFORMATION

Date of Admit/Date of First Contact (NAACCR Item #580)
Description
The date of first admission/contact with the reporting facility for diagnosis and/or treatment of
this
cancer. If previously diagnosed/treated elsewhere, the date of first admission to your facility with
diagnoses of active cancer.
Explanation
This data item allows the facility to document the first contact with the patient. It can be used to
measure the time between admission and when the case is abstracted and the length of time
between
the first contact and treatment.
Coding Instructions
1. Punctuation marks (slashes, dashes, etc.) are not allowed in any date field.
2. Enter the date of the first admission to your facility for a diagnosis and/or treatment of this
reportable cancer or, if previously diagnosed/treated elsewhere, the date of the first admission to
your facility with active cancer or receiving cancer treatment.
3. Date format is:
a. YYYYMMDD
Example: The patient is first seen at this facility on January 4, 2011. Record the date of admit:
20110104
4. A date must be entered in this field. If the patient was never an inpatient, enter the date of the
first
outpatient visit e.g., biopsy, x-ray, laboratory test, or emergency room visit at your facility with
active cancer.
5. For autopsy-only or death certificate-only cases, use the date of death as the date of first
contact.
6. For read only or pathology only cases, enter the date the specimen was collected. These
are
cases where a specimen is sent to be read by the pathology department and the patient is never
seen
or admitted at the reporting facility. These cases are reportable if the pathology department
generates revenue for the reporting facility and is NOT a free standing entity. The class of case
should be coded to 43 and the reporting source would be 3.
Note: FORDS instructions (see FORDS pg 95) differ from TCR instructions. FORDS requires
that
for analytic cases Date of First Contact is the date the patient qualifies as an analytic case Class
of
Case 00-22. If the patient was admitted for non cancer-related reasons, the Date of First Contact
is
the date the cancer was first suspected during the hospitalization. TCR will continue to instruct
that
the date be recorded as the admit date if the diagnosis is made at the reporting facility. It is
understood
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that ACoS facilities will continue to follow the rules according to FORDS.
Examples:
a. A patient is admitted to the hospital on January 31, 2011, with chest pains. On February 2,
2011, a
CT scan shows that the patient has a lung mass consistent with malignancy. Record the date of
first
contact as 20110131.
b. A patient has a biopsy in a staff physicians office on March 17, 2011, and the specimen is sent
to
the reporting facilitys pathology department on that same day. The pathologist reads the
specimen
as malignant melanoma. The patient enters the same reporting facility on March 21, 2011, for a
wide re-excision. Record the date of first contact as 20110317.
c. A patient has a lymph node biopsy at a small hospital on May 15, 2011. The specimen is sent
to
your hospital to be evaluated in your pathology department. The pathologist reports diffuse large
bcell
lymphoma. The patient never enters your hospital. Record 20110515 as the date of first contact.
Registry/Accession Number (NAACCR Item #550) (FORDS pg. 37)
Description
A registry or accession number is a unique number assigned to identify each patient regardless of
the
number of primary cancers.
Explanation
This data item serves as a reference number to protect the identity of the patient.
Coding Instructions
1. The first four digits identify the calendar year the patient was first seen at the facility with a
reportable diagnosis. The following five digits identify the numerical order in which the case was
entered into the registry. Each years accession/registry number will start with 00001.
Example:
2011000001 would indicate the first 2011 case reported from a facility.
2. SCL automatically assigns a registry number according to the year of admission. This field can
be
edited to assign the correct registry number if the patient has a previous primary.
3. Do not assign a new registry number to a patient previously reported to the TCR with a new
primary cancer. Within a registry, all primaries for an individual must have the same accession
number. SCL users will need to refer to the SCL Users Guide for instructions on entering
multiple
primaries.
Reporting Facility Number (NAACCR Item #540)
Description
Identifies the facility or institution reporting the case.
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Explanation
This data item is used for monitoring data submissions, ensuring the accuracy of data, and for

identifying areas for special studies.

Coding Instructions
1. Enter the three-digit facility number assigned by the TCR.
2. If you do not know your facility number, contact your Health Service Region office or the
Central
Office in Austin. See page 21 for contact information.
Type of Reporting Source (NAACCR Item #500) (SEER pgs. 18-20)
Description
This data item identifies the source documents used to abstract the case being reported. This will
not
necessarily be the document that identified the case but the document that provided the best
information.
Explanation
This field provides the source of the documents used to report the case, e.g., inpatient or
outpatient
charts, cases diagnosed in physicians offices, patients diagnosed at autopsy, pathology report
only,
or diagnosed by death certificate only.
Coding Instructions
1. Enter the code for the source of the facility and/or documents used to abstract the case.
Code Label Source Documents Priority
1 Hospital inpatient;
Managed health plans with
comprehensive, unified
medical records
-Hospital inpatient
-Offices/facilities with unit record
HMO physician office or group
HMO affiliated free-standing
laboratory, surgery, radiation or
oncology clinic
Includes outpatient services of HMOs and
large multi-specialty physician group
practices with unified records
1
2 Radiation Treatment Centers
or Medical Oncology Centers
(hospital-affiliated or
independent)
-Facilities with a stand alone medical record
Radiation treatment centers
Medical oncology centers (hospitalaffiliated
or independent)
There were no source documents from code
1.
2

3 Laboratory Only (hospitalaffiliated

or independent)
-Laboratory with stand alone medical record
There were no source documents from codes
1, 2, 8, or 4.
5
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Code Label Source Documents Priority

4 Physicians Office/Private
Medical Practitioner (LMD )
-Physicians office that is NOT an HMO or
large multi-specialty physician group
practice. There were no source documents
from codes 1, 2 or 8.
4
5 Nursing/Convalescent
Home/Hospice
-Nursing or convalescent home or a hospice.
There were no source documents from
codes 1, 2, 8, 4, or 3.
6
6 Autopsy Only -Autopsy
The cancer was first diagnosed on
autopsy. There are no source documents
from codes 1, 2, 8, 4, 3, or 5.
7
7 Death Certificate Only -Death certificate is the only source of
information; follow-back activities did not
identify source documents from codes 1, 2,
8, 4, 3, 5 or 6. If another source document is
subsequently identified, the Type of
Reporting Source code must be changed to
the appropriate code in the range of 1, 2, 8,
4, 3 or 6.
8
8 Other hospital outpatient
units/surgery centers
-Other hospital outpatient units/surgery
centers. Includes but not limited to,
outpatient surgery and nuclear medicine
services.
There are no source documents from codes
1 or 2.
3
Note: Assign codes in priority order: 1, 2, 8, 4, 3, 5, 6, 7 if more than one source is used.
Definitions:

Comprehensive, unified medical record: A hospital or managed health care system that
maintains a
single record for each patient. That record includes all encounters in affiliated locations.
Stand-alone medical record: An independent facility; a facility that is not part of a hospital or
managed care system. An independent medical record containing only information from
encounters
with that specific facility.
Managed health plan: Any facility where all of the diagnostic and treatment information is
maintained in one unit record. The abstractor is able to use the unit record when abstracting the
case.
Examples: HMOs or other health plans such as Kaiser, Veterans Administration, or military
facilities.
Physician office: Examinations, tests and limited surgical procedures may be performed in a
physicians office. If called a surgery center, but cannot perform surgical procedures under
general
anesthesia, code as a physician office.
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Surgery center: Surgery centers are equipped and staffed to perform surgical procedures under
general anesthesia. The patient usually does not stay overnight.
Unit record: The office or facility stores information for all of a patients encounters in one
record.
Examples:
a. A patient is admitted to your facility and expires before any treatment is rendered. An autopsy
is
performed and cancer is found in the lung. Code the reporting source to 6 (autopsy only). The
autopsy report is the only document used for your cancer information. The patient was not
known
to have cancer prior to the autopsy.
b. A patient is admitted to your hospital and is diagnosed with lung cancer. Code the
reporting source to 1 (Facility Inpatient/ Outpatient or Clinic). All documents in the medical
record
are used to gather the cancer information.
Medical Record Number (NAACCR Item #2300) (FORDS pg. 40)
Description
The number assigned to a patients medical record by the reporting facility.
Explanation
This number identifies the individual patients within a reporting facility. It allows a reporting
facility
to easily locate a patients health information. This health information is referenced when
abstracting
or updating a cancer case or to help identify multiple reports and primaries on the same patient.
Coding Instructions
1. Enter the eleven digit medical record number used to identify the patient's first admission with
active cancer and/or on cancer treatment. Medical record numbers with less than 11 digits and
alpha
characters are acceptable.

2. If a number is not available (outpatient clinic charts or ER visit reports), enter OP in this field.
See the list below for other optional medical record identifiers.
3. Optional medical record identifiers:
Code Definition
ER Emergency Room patient without a medical record number
OP Outpatient without a medical record number
RT Radiation Therapy department patient without a medical record number
SU One-day surgery unit patient without a medical record number
UNK Medical record number unknown
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Class of Case (NAACCR Item #610) (FORDS pgs. 91-92)

Description
Class of case identifies the role of the reporting facility in the patients diagnosis and treatment.
Explanation
This data item divides case records into analytic and non-analytic categories. The class of case
determines which cases should be included in the analysis of the facilitys cancer experience.
Note: All reporting facilities must report their non-analytic cases to the TCR, regardless of their
approval status with the ACoS.
A. Analytical cases (codes 00-22): Diagnosed at the reporting facility and/or received any of the
first
course of treatment at the reporting facility. Abstracting for class of case 00 through 14 is to be
completed within six months of diagnosis. This allows for treatment information to be
documented in
the patients medical record. Abstracting for class of case 20 through 22 is to be completed
within six
months of first contact with the reporting facility. These cases are analyzed because the facility
was
involved in the diagnostic and therapeutic decision-making.
Note: A facility network clinic or outpatient center belonging to the facility is considered part of
the
facility.
B. Non-analytical cases (codes 30-49 and 99): Diagnosed and received all of the first course of
treatment at another facility, or cases which were diagnosed and/or received all or part of the first
course of treatment at the reporting facility prior to the registrys reference date (reference date
applies to ACoS facilities, facilities striving for ACoS certification, or facilities that follow ACoS
standards and do not seek certification). Abstracting for non-analytical cases should be
completed
within six months of first contact with reporting facility. Non-analytical cases (classes 30-49 and
99)
are usually excluded from a facilitys routine treatment or survival statistics.
Note: Per TCR reporting guidelines, non-analytical cases are reportable by all facilities for cases
diagnosed January 1, 1995 and forward when there is documentation of active cancer or if the
patient
is receiving cancer directed therapy.
Note: Non-analytical cases, classes 49 and 99, are to be used solely by the central registry.
Coding Instructions

1. The code structure for this item was revised in 2010. The data field is now a two digit code.
2. Code the Class of Case that most precisely describes the patients relationship to the facility.
3. Code 00 applies only when it is known the patient went elsewhere for treatment. If that
information
is not available, code Class of Case 10.
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4. Code 34 or 36 if the diagnosis is benign or borderline (Behavior 0 or 1) for any site diagnosed
before 2004 or for any site other than meninges (C70_), brain (C71_), spinal cord, cranial nerves,
and
other parts of central nervous system (C72_), pituitary gland (C751) craniopharyngeal duct
(C752),
and pineal gland (C753) that were diagnosed in 2004 or later.
5. Code 34 or 36 for carcinoma in situ of the cervix (CIS) and intraepithelial neoplasia grade III
(8077/2 or 8148/2) of the cervix (CIN III), prostate (PIN III), vulva (VIN III), vagina (VAIN III),
and
anus (AIN III).
6. A staff physician (codes 10-12, 41) is a physician who is employed by the reporting facility,
under
contract with it, or a physician who has routine practice privileges there.
Class of Case Definitions
Analytic Cases
Class 00* Initial diagnosis at the reporting facility AND all treatment or a decision not to treat
was done ELSEWHERE.
Cases include:
Patients who choose to be treated elsewhere.
Patients referred elsewhere for treatment due to lack of special equipment;
proximity of a patients residence to the treatment center; financial, or rehabilitative
considerations, etc.
Class 10* Initial diagnosis AND PART OR ALL of first course treatment or a decision not to
treat done at the reporting facility, NOS.
Note: ACoS facilities should include cases in which patients are diagnosed at the
reporting facility prior to the registrys reference date and all or part of the first
course of treatment was received at the reporting facility after the registrys
reference date.
Class 11 Initial diagnosis by staff physician AND PART of first course treatment was done at
the reporting facility.
Class 12 Initial diagnosis by staff physician AND ALL first course treatment or a decision
not to treat was done at the reporting facility.
Class 13* Initial diagnosis AND PART of first course treatment was done at the reporting
facility.
Class 14* Initial diagnosis AND ALL first course treatment or a decision not to treat was done
at the reporting facility.
Class 20* Initial diagnosis elsewhere AND ALL OR PART of first course treatment was done
at the reporting facility, NOS.
Class 21* Initial diagnosis elsewhere AND PART of treatment was done at the reporting
facility.

Class 22* Initial diagnosis elsewhere AND ALL treatment or a decision not to treat was done
at the reporting facility.
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Non-Analytic Cases
Patient appears in person at reporting facility
Classes of Case not required by CoC to be abstracted. May be required by Cancer Committee,
state
or regional registry, or other entity.
Class 30* Initial diagnosis and all first course treatment elsewhere AND reporting facility
participated in DIAGNOSTIC WORKUP (for example, consult only, staging workup
after initial diagnosis elsewhere).
Class 31* Initial diagnosis and all first course treatment elsewhere AND reporting facility
provided in-transit care.
Class 32* Diagnosis AND all first course treatment provided elsewhere AND patient presents
at reporting facility with disease RECURRENCE OR PERSISTENCE.
Class 33* Diagnosis AND all first course treatment provided elsewhere AND patient presents
at reporting facility with disease HISTORY ONLY.
Note: TCR required these cases only if the patient has active disease or is receiving
cancer directed therapy at the time seen.
Class 34 Type of case not required by CoC to be accessioned (for example, a benign colon
tumor) AND initial diagnosis AND part or all of first course treatment done by
reporting facility.
Class 35 Case diagnosed before programs Reference Date, AND initial diagnosis AND
PART OR ALL of first course treatment by reporting facility.
Class 36 Type of case not required by CoC to be accessioned (for example, a benign colon
tumor) AND initial diagnosis elsewhere AND part or all of first course treatment by
reporting facility.
Class 37 Case diagnosed before programs Reference Date, AND initial diagnosis elsewhere
AND all or part of first course treatment by facility.
Class 38* Initial diagnosis established by autopsy at the reporting facility, cancer not suspected
prior to death.
Patient Does Not Appear in Person at Reporting Facility
Class 40 Diagnosis AND all first course treatment given at the same staff physicians office.
Class 41 Diagnosis and all first course treatment given in two or more different staff physician
offices.
Class 42 Non-staff physician or non-CoC approved clinic or other facility, not part of
reporting facility, accessioned by reporting facility for diagnosis and/or treatment by
that entity (for example, hospital abstracts cases from an independent radiation
facility).
Class 43* Pathology or lab specimens only.
Class 49* Death certificate only.
Note: Used by central registries only.
Unknown Relationship to Reporting Facility
Class 99 Case not required by CoC to be abstracted; Of unknown relationship to facility (not
for use by CoC approved cancer programs for analytic cases).
Note: Used by central registries only.

*Indicates Class of Case codes appropriate for abstracting cases from non-hospital sources such
as
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physician offices, ambulatory surgery centers, freestanding pathology laboratories, radiation

therapy
centers. When applied to these types of facilities, the non-hospital source is the reporting facility.
The
codes are applied the same way as if the case were reported from a hospital.
By using Class of Case codes in this manner for non-hospital sources, the central cancer registry
is
able to retain information reflecting the facilitys role in managing the cancer consistent with the
way
it is reported from hospitals. Using Class of Case in conjunction with Type of Reporting Source
(500)
which identifies the source documents used to abstract the cancer being reported, the central
cancer
registry has two distinct types of information to use in making consolidation decisions.
Class of Case Examples
Code Reason
00 Reporting facility admits patient due to dizziness and falling. The patient receives clinical
workup which includes CT and MRI of the brain. The results are positive for brain
metastasis. The patient is discharged to another hospital for treatment for lung cancer
with brain metastasis.
10 Patient is diagnosed with lung cancer at the reporting facility. Due to age and co
morbidities the decision was made not to treat.
11 A patient is diagnosed with melanoma in a staff physicians office. He has a wide
excision at the reporting facility, and then is treated with interferon at another facility.
12 A diagnosis of prostate cancer is made in a staff physicians office. The patient receives
radiation therapy at the reporting facility, and no other treatment is given.
13 A patient is diagnosed with colon cancer at the reporting facility and undergoes a
hemicolectomy there. She then receives chemotherapy at an outside clinic.
14 Reporting facility admits patient with hemoptysis. Workup reveals adenocarcinoma. The
patient undergoes surgery followed by radiation therapy at the reporting facility. The
patient did not receive any other treatment.
20 Patient was diagnosed with primary breast cancer at another facility. The patient then
comes to the reporting facility for surgery. It is unknown if she received any other
treatment.
21 Patient diagnosed at another facility with breast cancer and received neo-adjuvant
chemotherapy. She now presents to the reporting facility for modified radical
mastectomy.
22 Patient had a biopsy at another facility and the diagnosis was breast cancer. She
underwent a mastectomy at the reporting facility and did not receive any further
treatment.
32 Patient was diagnosed and treated for primary bladder cancer prior to admission to
reporting facility. Reporting facility admits patient for cystectomy for recurrent bladder
cancer.

38 Patient admitted to reporting facility with chest pain and expires. Autopsy performed at
reporting facility identifies patient has pancreatic cancer.
43 A physician does a skin biopsy in his office and sends the biopsy specimen to a reading
pathology/lab. The diagnosis is malignant melanoma. The pathology/lab facility is
responsible for reporting the case.
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Last Name (NAACCR Item #2230) (FORDS pg. 42)

Description
Identifies the last name of the patient.
Explanation
This data item is used as a patient identifier.
Coding Instructions
1. Enter the last name of the patient in CAPITAL LETTERS. Blanks, spaces, hyphens,
apostrophes, and punctuation marks are allowed.
Examples:
a. Record De Leon with a space as DE LEON
b. Record OHara with an apostrophe as OHARA
c. If Janet Smith marries Fred Jones and changes her name to Smith-Jones record SMITHJONES
with the hyphen.
2. Do not leave the data field blank. If the patients last name is not known, enter UNKNOWN in
this field. This should be done only as a last resort. Every resource should be exhausted to obtain
this
information.
Note: Document in Text Remarks - Other Pertinent Information: Last name unknown.
First Name (NAACCR Item #2240) (FORDS pg. 43)
Description
Identifies the first name of the patient.
Explanation
This data item is used to differentiate between patients with the same last name.
Coding Instructions
1. Enter the first name of the patient in CAPITAL LETTERS.
2. Spaces, hyphens and apostrophes are allowed. Do not use other punctuation or leave blank.
3. This field may be updated if the name changes.
4. If the patients first name is unknown, enter UNKNOWN. Do not leave the field blank.
This should be done only as a last resort. Every resource should be exhausted to obtain this
information.
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Note: Document in Text Remarks - Other Pertinent Information: First name unknown.
Middle Name (NAACCR Item #2250) (FORDS pg. 44)
Description
Identifies the middle name or middle initial of the patient.
Explanation
This data item is used to differentiate between patients with identical first and last names.
Coding Instructions

1. Enter the middle initial if the complete middle name is not provided.
2. Blanks, spaces, hyphens and apostrophes are allowed. Do not use other punctuation.
3. This field may be updated if the name changes.
4. If the patient does not have a middle name or initial, or it is unknown, leave blank. Do not
code
UNK for unknown or NA for not applicable.
Maiden Name (NAACCR Item #2390)
Description
Identifies the female patients who are or have been married.
Explanation
This data item is useful for matching multiple records for the same patient and is useful in
identifying
Spanish/Hispanic origin.
Coding Instructions
1. Enter the maiden name of female patients who are or have been married if the information is
available. Blanks, spaces, hyphens, apostrophes, and punctuation marks ARE allowed.
2. If the patient does not have a maiden name, or it is unknown, leave blank.
Alias Name (NAACCR Item #2280)
Description
Records an alternate name or AKA (also known as) used by the patient, if known. Note that
maiden name is entered in Name-Maiden [2390].
Explanation
A patient may use a different name or nickname. These different names are aliases. This item is
useful for matching multiple records on the same patient.
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Coding Instructions
1. If the patient does not use an alias leave blank. Do not record the patients first and last name
again.
2. Record the alias last name followed by a blank space and then the alias first name.
3. Mixed case, embedded spaces, hyphens and apostrophes are allowed.
4. No other special characters are allowed.
Examples:
a. Ralph Williams uses the name Bud Williams. Record Williams Bud in the NAME-ALIAS
field.
b. Janice Smith uses the name Janice Brown. Record Brown Janice in the NAME-ALIAS field.
c. Samuel Clemens uses the name Mark Twain. Record Twain Mark in the NAME-ALIAS field.
Street Address (NAACCR Item #2330) (FORDS pg. 45)
Description
Identifies the patients address (number and street) at the time of diagnosis.
Explanation
Allows for the analysis of cancer clusters, environmental studies, or health services research and
is
useful for epidemiology purposes. A patients physical address takes precedence over a post
office
box. If a patient has multiple primary tumors the address may be different if diagnosed at
different

times. Do not update this field if the patient moves after diagnosis.
Note: ACoS facilities are required to provide information for this field regardless of class of
case.
Coding Instructions
1. Enter the number and street of the patients residence at the time the cancer is diagnosed in 60
characters or less. If the address contains more than 60 characters, omit the least important
element,
such as the apartment or space number.
2. Do not omit elements needed to locate the address in a census tract, such as house number,
street,
direction or quadrant, and street type (street, drive, lane, road, etc.).
3. Punctuation marks are limited to periods, slashes, hyphens and pound signs in this field.
4. Only use the post office box or the rural mailing address when the physical address is not
available. Post office box addresses do not provide accurate geographical information for
analyzing cancer incidence. Every effort should be made to obtain complete valid address
information.
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5. Abbreviate as needed using standard address abbreviations listed in the U.S. Postal Service
National Zip Code and Post Office Directory published by the U.S. Postal Service (USPS).
These
include but are not limited to:
ABBREV. DEFINITION ABBREV. DEFINITION ABBREV. DEFINITION
APT Apartment FL Floor S South
AVE Avenue N North SE Southeast
BLDG Building NE Northeast SQ Square
BLVD Boulevard NW Northwest ST Street
CIR Circle PLZ Plaza STE Suite
CT Court PK Park SW Southwest
DEPT Department PKWY Parkway UNIT Unit
DR Drive RD Road W West
E East RM Room
Example:
Patients street address is 1232 Southwest Independence Apartment 400. Record: 1232 SW
Independence Apt 400
Patients with an Unknown Address:
6. If the patients address is not available in the medical record, record NO ADDRESS or
UNKNOWN. Do not leave blank. These cases should be rare and every effort should be made to
obtain a valid address. The address data fields for these cases should be recorded as the city
Unknown, the state as ZZ, the zip code should be 99999 and the FIPS as 999. Do not record
the
reporting facilitys city, state, zip and FIPS.
Note: Document in Text Remarks - Other Pertinent Information: Patient address is unknown. Be
aware that an excessive amount of unknown addresses will result in additional efforts by TCR
staff to
obtain a valid address which may include contacting the reporting facility or managing/following
physician

7. Log onto http://zip4.usps.com/zip4/welcome.jsp for help in completing address information,

Persons with More than One Residence:
These include snowbirds who live in the south for the winter months, sunbirds who live in the
north
during the summer months. This also includes persons with vacation residences which they
occupy
for a portion of the year.
8. Code the residence where the patient spends the majority of time (usual residence).
9. If the usual residence is not known or the information is not available, code the residence the
patient specifies at the time of diagnosis.
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Persons with No Usual Residence:

Homeless people and transients are examples of persons with no usual residence.
10. Code the patients residence at the time of diagnosis as unknown.
Note: Under pertinent information document that patient is homeless. An unknown address is not
the
same as homeless.
Temporary Residents:
11. Code the place of usual residence rather than the temporary address for:
a. Migrant workers
b. Persons temporarily residing with family during cancer treatment
c. Military personnel on temporary duty assignment
d. Boarding school students below the college level (code the parents residence)
12. Code the residence where the student is living while attending college.
13. Code the address of the institution for Persons in Institutions.
a. Persons who are incarcerated
b. Persons who are physically or mentally handicapped or mentally ill who are residents of
homes, schools, hospitals, or wards.
c. Residents of nursing and rest homes
d. Long-term residents of other hospitals such as Veterans Administration (VA) hospitals
Persons in the Armed Forces and on Maritime Ships (Merchant Marine):
14. Armed ForcesFor military personnel and their family members, code the address of the
military installation or surrounding community as stated by the patient.
15. Personnel Assigned to Navy, Coast Guard, and Maritime ShipsThe US Census Bureau
has
detailed rules for determining residency for personnel assigned to these ships. The rules refer to
the
ships deployment, port of departure, destination, and its homeport. Refer to US Census Bureau
Publications for detailed rules at www.census.gov.
Address at DxSupplemental (NAACCR Item #2335) (FORDS pg. 46)
Description
Provides the ability to store additional address information such as the name of a place or facility
(a
nursing home or name of an apartment complex).
Explanation

A registry may receive the name of a facility instead of a proper street address containing the
street
number, name, direction, or other elements necessary to locate an address on a street file for the
purpose of geocoding.
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Coding Instructions
1. Do not use this data item to record the number and street address of the patient.
2. Do not update this data item if the patients address changes.
3. If this address space is not needed, leave blank.
City (NAACCR Item #70) (FORDS pg. 47)
Description
Identifies the name of the city or town in which the patient resides at the time of diagnosis. Do
not
update this field if the patient moves after being diagnosed.
Explanation
Allows for the analysis of cancer clusters, environmental studies, or health services research and
is
useful for epidemiology purposes.
Coding Instructions
1. Enter the city of residence at the time the cancer is diagnosed. If the patient resides in a rural
area,
record the name of the city used in the mailing address.
2. Do not use punctuation, special characters, or numbers. The use of capital letters is preferred
by
the USPS; it also guarantees consistent results in queries and reporting.
3. If the patient has multiple primaries, the address may be different for subsequent primaries.
Note: Every effort should be made to record the patients address from resources available in
your
facility. If the patients address is not available do not leave blank. The address data fields for
these
cases should be recorded Unknown in the street address, Unknown in the city, ZZ in the state,
99999 in the zip code and 999 in the FIPS data field. Do not record the reporting facilitys city,
state, zip and FIPS for unknown addresses.
State (NAACCR Item #80) (FORDS pgs. 48-49)
Description
Identifies the patients state of residence at the time of diagnosis/admission. This field should not
be
updated if the patient moves after being diagnosed.
Explanation
It allows for analysis of geographic and environmental studies and inclusion in state and national
cancer publications/studies.
Coding Instructions
1. Record the appropriate two-letter abbreviation for state of residence at the time of diagnosis.
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2. If the patient is a resident of Canada, record the appropriate two-letter abbreviation for the

country of residence at time of diagnosis/admission. If the province or territory of Canada is

known,
record the abbreviation. See page 71 for a list of Canadian Provinces/Territories.
3. If the patient is a foreign resident, other than Canada, record either XX or YY depending on
the
circumstance. Refer to the table below for specific instructions.
4. If the patient has multiple primaries, the state of residence may be different for subsequent
cases.
Note: Every effort should be made to record the patients address from resources available in
your
facility. If the patients address is not available do not leave blank. The address data fields for
these
cases should be recorded as Unknown in the street address, Unknown in the city, ZZ in the
state,
99999 in the zip code and 999 in the FIPS data field. Do not record the reporting facilitys city,
state, zip and FIPS for unknown addresses.
Code Definition
TX If the state in which the patient resides at the time of diagnosis and treatment is Texas,
then use the USPS code for the state of Texas.
US Resident of United States, NOS (state/commonwealth/territory/possession unknown)
CD Resident of Canada, NOS; Use the specific abbreviation of Canadian
Provinces/Territories if this information is provided.
XX Resident of a country other than the U.S. (including its territories, commonwealths, or
possessions) and Canada, and the country is known.
YY Resident of a country other than the U.S. (including its territories, commonwealths, or
possessions) and Canada, and the country is unknown.
ZZ Residence unknown.
Examples:
a. A patients country of residence is documented as France; record XX in the state field.
b. Documentation in the patients medical record states the patient is a resident of a foreign
country and no other address documentation provided; record YY in the state field.
c. The patients medical record states the patient lives in the United States or in a territory,
commonwealth, or possession of the United States and no other address documentation is
provided; record US in the state field.
d. If every valid attempt has been made to obtain the address and it is still unknown, record ZZ in
the state field.
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Canadian Provinces/Territories:
Province/Territory Abbreviation Province/Territory Abbreviation
Alberta AB Nunavut NU
British Columbia BC Ontario ON
Manitoba MB Prince Edward Island PE
New Brunswick NB Quebec QC
Newfoundland and
Labrador
NF Saskatchewan SK

Northwest Territories NT Yukon YT

Nova Scotia NS
State and Territory Abbreviations:
(Refer to the ZIP Code directory for further listings).
State State State
Alabama AL Kentucky KY North Dakota ND
Alaska AK Louisiana LA Ohio OH
Arizona AZ Maine ME Oklahoma OK
Arkansas AR Maryland MD Oregon OR
California CA Massachusetts MA Pennsylvania PA
Colorado CO Michigan MI Rhode Island RI
Connecticut CT Minnesota MN South Carolina SC
Delaware DE Mississippi MS South Dakota SD
District of Columbia DC Missouri MO Tennessee TN
Florida FL Montana MT Texas TX
Georgia GA Nebraska NE Utah UT
Hawaii HI Nevada NV Vermont VT
Idaho ID New
Hampshire NH Virginia VA
Illinois IL New Jersey NJ Washington WA
Indiana IN New Mexico NM West Virginia WV
Iowa IA New York NY Wisconsin WI
Kansas KS North
Carolina NC Wyoming WY
Other U.S. Territories
American Samoa AS
Guam GU
Puerto Rico PR
Virgin Islands VI
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Zip Code (NAACCR Item #100) (FORDS pg. 50)

Description
Identifies the postal code of the patients address at the time of diagnosis/admission. If the patient
has
multiple tumors, the postal code may be different for each tumor.
Explanation
It allows for the analysis of cancer clusters, geographic or environmental studies and health
services
research.
Coding Instructions
1. Enter the patient's zip code at time of diagnosis/admission. Enter the nine-digit extended zip
code
if known. If recording the full nine-digit zip code, no dash should be placed between the first
five
and the last four digits. The five-digit zip code is allowed if this is all the information available.
Blanks follow the five-digit code if the four-digit extension is not coded.

2. If the zip code is not available, refer to the National Zip Code Directory or to the USPS Web
site,
http://zip4.usps.com/zip4/welcome.jsp This website is useful in obtaining missing address
information in order to record a complete address.
3. If the patient is a resident of a foreign country at the time of diagnosis, record 88888 for the
zip
code.
Note: Every effort should be made to record the patients address from resources available in
your
facility. If the patients address is not available do not leave blank. The address data fields for
these
cases should be recorded as Unknown in the street address, Unknown in the city, ZZ in the
state,
99999 in the zip code and 999 in the FIPS data field. Do not record the reporting facilitys city,
state, zip and FIPS for unknown addresses.
Code Definition
123456789 The patients nine-digit U.S. extended postal code. Do not record dashes.
88888 Permanent address in a country other than Canada, United States, or U.S. possessions.
99999 Resident of the United States (including its possessions, etc.) or Canada and the
postal code cannot be verified using the National Zip Code Directory of the USPS
Web site at http://zip4.usps.com/zip4/welcome.jsp
99999 After every effort is made to obtain a valid address the information remains unknown.
M6G2S8 The patients valid six character Canadian postal code left justified followed by three
blanks.
Examples:
a. A patients country of residence is documented as France; record 88888 in the zip code field.
b. A patients address is in Canada and the zip code cannot be verified; record 99999 in the zip
code field.
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c. A patients address is not documented in the medical record and remains unknown after
researching all your facilitys resources; record 99999 in the zip code field.
Fips County Code at Diagnosis (NAACCR Item #90) (FORDS pg. 51)
Description
Identifies the county of the patients residence at the time of diagnosis. If the patient has multiple
tumors, the county codes may be different for each tumor.
Explanation
This data item may be used for epidemiological purposes (for example: to measure the cancer
burden
in a particular geographical area).
Coding Instructions
1. Enter the appropriate three-digit code for the county of residence. Use codes issued by the
Federal
Information Processing Standards (FIPS) publication, Counties and Equivalent Entities of the
United
States, Its Possessions, and Associated areas. This publication is available at:
www.epa.gov/enviro/html/codes/state.html.

2. Refer to Appendix C for the list of Texas FIPS county codes.

3. If the patient has multiple tumors, the FIPS county codes may be different for each tumor.
4. For facilities using SCL, the FIPS code will automatically display when the city and zip is
entered.
5. Do not update this data item if the patients county of residence changes after diagnosis.
6. ACoS facilities following the FORDS guideline to code the country of residence in this data
field
for non-U.S. residents, CD and XX will be accepted by the TCR Edits.
Note: Every effort should be made to record the patients address from resources available in
your
facility. If the patients address is not available do not leave blank. The address data fields for
these
cases should be recorded as Unknown in the street address, Unknown in the city, ZZ in the state,
99999 in the zip code and 999 in the FIPS data field. Do not record the reporting facilitys city,
state, zip and FIPS for unknown addresses.
Code Description Definition
001507 County at diagnosis Valid Texas FIPS code
998 Outside state/country &
code is unknown
Known town, city, state, or country of residence, but
county code not known AND a resident outside the
state of Texas (must meet all criteria)
999 Unknown county The county is unknown and not documented in the
patients medical record
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Social Security Number (NAACCR Item #2320) (FORDS pg. 41)

Description
Identifies the patient by social security number.
Explanation
This item is used by the TCR in internal processes such as linking for resolution of duplicate
primaries and consolidation.
Coding Instructions
1. Every effort should be made to obtain the social security number. Research all resources from
your facility for this information.
2. Enter the patients nine-digit social security number in this field.
3. If the social security number is unavailable or unknown, enter all 9's in this field. Document in
Text Remarks-Other Pertinent Information that the social security information is unavailable.
4. A patients Medicare number may not be identical to the persons social security number.
5. Do not put dashes or slashes in this field.
Note: Social security numbers are used for Medicare benefits. Suffix A on a social security
number
indicates the number is the patient's Medicare number. Other suffixes identify another person's
Medicare number under which the patient may be entitled to receive benefits. Take caution to
enter
the patient's social security number and not the spouse's or guardians number.
The following are not allowed:

 First 3 digits= 000 or 666

Fourth and fifth digits= 00
Last four digits= 0000
First digit= 8 or 9 (except for 9999999999)
Date of Birth (NAACCR Item #240) (FORDS pg. 60; SEER pgs. 28)
Description
Identifies the patients century, year, month, and day of birth.
Explanation
This item is used by the TCR to match records, and to calculate age at diagnosis.
Coding Instructions
1. Punctuation marks (slashes, dashes, etc.) are not allowed.
2. The patients date of birth must be entered. Cases cannot be processed without the date of
birth.
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3. Date format is:

a. YYYYMMDD - when the complete date is known and valid
Example: The patients date of birth is June 28, 1983. Code the date of birth as 19830628.
b. YYYYMM - when the year and month are known and valid, and the day is unknown.
Example: The patient was born in November of 1981, but the day is unknown. Code 198111.
c. YYYY when the year is known and valid but the month and day are unknown.
Example: The record indicates the patient was born in 1978 but no month or day is given.
Code 1978.
Note: If the complete date of birth is not available, documentation must be provided in Other
Pertinent Information. For example: Medical records indicate only month and year of date of
birth.
4. If only the age of the patient is known, calculate the year of birth from age and year of
diagnosis
and leave the day and month of birth unknown.
Example: A 50 year old patient diagnosed in 2010 is calculated to have been born in 1960.
5. The year of birth must be recorded. TCR will not accept unknown year of birth. Every effort
must
be made to obtain this information as it is critical for analysis.
Code Definition
YYYYMMDD The date of birth is the year, month and day the patient was born. The first four
digits are the year, the third and fourth digits are the month, the fifth and sixth
digits are the month, and the seventh and eighth digits are the day.
Place of Birth (NAACCR Item #250) (FORDS pg. 59; SEER pg. 35)
Description
Identifies the patients place of birth.
Explanation
Birthplace is used to ascertain ethnicity, identify special populations at risk for certain types of
cancers, and for epidemiological analyses.
Coding Instructions
1. Record the patients place of birth (if available) using the SEER Geo-codes in Appendix G. If
the

place of birth is unknown, code to 999. If a patient has multiple tumors, all records should
contain the
same code.
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2. Use the most specific code.

Race 1 (NAACCR Item #160) (FORDS pg. 63; SEER pgs. 33-37)
Description
Identifies the primary race of the person.
Explanation
Racial origin captures information used in research and cancer control activities comparing stage
at
diagnosis and/or treatment by race. The full coding system should be used to allow accurate
national
comparisons. Race is defined by specific physical, hereditary and cultural traditions or origins,
not
necessarily by birthplace, place of residence, or citizenship.
Coding Instructions
1. Record the two-digit code to identify the primary race(s) of the patient in fields race 1, race 2,
race 3, race 4, and race 5. The five race fields allow for coding of multiple races consistent with
the
Census 2000.
2. Race is analyzed with Spanish/Hispanic Origin. Both items must be recorded. If the patient
has
multiple tumors, all records should have the same race code.
3. Race 1 is the field used to compare with race data on cases diagnosed prior to January 1, 2001.
4. If a persons race is a combination of white and any other race(s), code the appropriate other
race(s) first and code white (01) in the next race field.
5. If a persons race is a combination of Hawaiian and any other race(s), code race 1 as 07,
Hawaiian, and code the other race(s) in race 2, race 3, race 4, and race 5 as appropriate.
6. If no race is stated in the medical record or available from other sources in your facility,
review the documentation for a statement of a race category such as patient described as a
Japanese female.
7. Persons of Spanish or Hispanic origin may be of any race, although persons of Mexican,
Central American, South American, Puerto Rican, or Cuban origin are usually white. Do NOT
code a patient stated to be Hispanic or Latino as 98 (Other Race) in race 1 and 88 in race 2 - race
5.
8. Code 03 should be used for any person stated to be Native American or (western hemisphere)
Indian, whether from North, Central, South or Latin America.
9. Death certificate information may be used to supplement ante mortem race information only
when
race is unknown in the patient record or when the death certificate information is more specific.
10. In using the patient name to determine race:
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a. Do not code race from name alone, especially for females with no maiden name given.
b. A Spanish name alone may not be used to determine the race code. A statement about

race or place of birth must be documented.

11. If the patients race is determined on the basis of the races of relatives, there is no priority to
coding race, other than to code non-white first.
12. If only one race is reported for a person, race 2-race 5 must be coded to 88.
13. If race 1 is coded to 99, unknown, race 2-race 5 must also be coded 99, unknown.
14. A unique race code (other than 88 or 99) can be coded only once in race 1 through race 5.
15. Document the specified race code in the Text Remarks - Other Pertinent Information field.
A more specific race that is not included in the list of race codes such as 96 Other Asian, 97
Pacific Islander, or 98 Other Race should be documented as well.
Codes for Race Codes 1 - 5
Code Race Code Race
01 White 17 Pakistani
02 Black 20 Micronesian, NOS
03 American Indian, Aleutian, Eskimo
(includes all indigenous populations of
the Western hemisphere)
21 Chamorran
04 Chinese 22 Guamanian, NOS
05 Japanese 25 Polynesian, NOS
06 Filipino 26 Tahitian
07 Hawaiian 27 Samoan
08 Korean 28 Tongan
*
10 Vietnamese 30 Melanesian, NOS
11 Laotian 31 Fiji Islander
12 Hmong 32 New Guinean
13 Kampuchean (Cambodian) 96 Other Asian, including Asian, NOS
and Oriental, NOS
14 Thai 97 Pacific Islander, NOS
15 Asian Indian or Pakistani, NOS 98 Other
16 Asian Indian 99 Unknown
The White category usually includes Mexican, Puerto Rican, Cuban, Arab, and all other
Caucasians including those from Europe and the Middle East.
The Black category includes the designation African-American.
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Examples:
Race Code Explanation
01 -A patient was born in Mexico of Mexican parentage.
-A patient stated to be German-Irish.
-A person from Iran or Saudi Arabia.
-An immigrant from Sweden.
02 A black female patient.
Note: A specific race code (other than blank or 99) must not occur more than once.
For example, do not code Black in race 1 for one parent and Black in race 2 for the
other parent.
04 A patient is of Chinese and Korean ancestry. Code 04, Chinese in Race 1. Code 08,

Korean, in Race 2.
05 A patient has a Japanese father and a Caucasian mother. Code 05 Japanese in Race
1 and 01 White in Race 2.
07 A patients race is a combination of Hawaiian and any other race(s). Code 07,
Hawaiian, in Race 1 and Race 2Race 5 as appropriate.
11 A patient is stated to be Asian. The place of birth is Laos. Code Race 1 as 11,
Laotian, because it is more specific than 96, Asian, NOS.
99 A patients race is unknown. Code Race 1 as Unknown, code 99. Race 2Race 5
must also be coded 99. If a patient has a Spanish last name and she is stated to be a
native of Indiana, code to 99, Unknown, because nothing is known about her race.
Race 2, Race 3, Race 4, Race 5 (NAACCR Items #161, 162, 163, 164) (FORDS pgs. 6669;
SEER
pgs. 33-37)
Description
Identifies the patients additional races. Race is defined by specific physical, heredity, and
cultural
traditions or origins, not necessarily by birthplace, place of residence, or citizenship.
Explanation
Racial origin captures information used in research and cancer control activities comparing stage
at
diagnosis and/or treatment by race. The full coding system should be used to allow accurate
national
comparisons.
Coding Instructions
1. Record the two-digit code to identify a multi-racial patient.
2. Race is analyzed with Spanish/Hispanic Origin. Both items must be recorded. All primaries
for
the same patient should have the same race code.
3. All resources in the facility must be used to determine the race of the patient.
4. If more than the Race 1 code is entered, and if any race is 99, then all race codes (Race 1, 2, 3,
4
and 5) must be 99. If more than the Race 1 code is entered, and if any race codes (for Race 2, 3,
4 and
5) are 88 (no further race documented), then all subsequent race codes must also be 88.
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5. If a persons race is a combination of Hawaiian and any other race(s), code Race 1 as 07
Hawaiian and code the other race(s) in Race 2, Race 3, Race 4, and Race 5 as appropriate.
6. If no race is stated in the medical record or available from other sources in your facility,
review
the documentation for a statement of a race category such as patient described as a Hispanic
female.
7. Persons of Spanish or Hispanic origin may be of any race, although persons of Mexican,
Central
American, South American, Puerto Rican, or Cuban origin are usually white. Do NOT code a
patient
stated to be Hispanic or Latino as 98 (Other Race) in Race 1 and 88 in Race 2Race 5.

8. Code 03 should be used for any person stated to be Native American or (western hemisphere)
Indian, whether from North, Central, South, or Latin America.
9. Death certificate information may be used to supplement ante mortem race information only
when
race is coded unknown in the patient record or when the death certificate information is more
specific.
11. In using the patient name to determine race:
a. Do not code race from name alone, especially for females with no maiden name given.
b. A Spanish name alone may not be used to determine the race code. A statement about race or
place of birth must be documented.
12. If the patients race is determined on the basis of the races of relatives, there is no priority to
coding race, other than to code the non-white first.
13. If only one race is reported for a person, Race 2Race 5 must be coded to 88.
14. If race 1 is coded to unknown 99, Race 2Race 5 must also be coded unknown 99.
15. A unique race code (other than 88 or 99) can be coded only once in Race 1 through Race 5.
16. Document the specified race code in the Text Remarks - Other Pertinent Information text
field. A
more specific race that is not included in the list of race codes such as 96 Other Asian, 97 Pacific
Islander, or 98 Other Race should be documented as well.
Spanish/Hispanic Origin (NAACCR Item #190) (FORDS pg. 69; SEER pg. 40)
Description
Identifies persons of Spanish or Hispanic origin. If a patient has multiple tumors, all records
should
have the same code.
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Explanation
This is used to identify whether or not the person should be classified as Hispanic for purposes
of
calculating cancer rates. Hispanic populations have different patterns of occurrence of cancer
from
other populations that may be included in the 01 (White) category of race.
Coding Instructions
1. The information is coded from the medical record or is based on Spanish/Hispanic names.
2. Review all sources available to determine the correct code, including stated Hispanic ethnicity.
3. Origin on the death certificate, birthplace and information about life history and language
spoken
should be considered.
4. Coding Spanish surname or origin is not dependent on race. A person of Spanish descent may
be
white, black, or any other race.
5. Portuguese, Brazilians and Filipinos are not presumed to be Spanish or non-Spanish.
a. Assign code 7 when the patient is Portuguese, Brazilian, or Filipino and their name appears on
a
Hispanic surname list.
b. Assign code 0 when the patient is Portuguese, Brazilian, or Filipino and their name does NOT
appear on a Hispanic surname list.

Note: Refer to the list of Spanish/Hispanic surnames on the TCR website at:
http://www.dshs.state.tx.us/tcr/publications/2008crhb/web/2006HB-AppxM.pdf.
Code Description
0 Non-Spanish; non-Hispanic (includes Portuguese and Brazilian)
1 Mexican (includes Chicano, NOS)
2 Puerto Rican
3 Cuban
4 South or Central American (except Brazil)
5 Other specified Spanish/Hispanic (includes European; excludes Dominican Republic)
6 Spanish, NOS, Hispanic, NOS; Latino, NOS. There is evidence, other than surname or
maiden name that the person is Hispanic, but he/she cannot be assigned to any category
of 15.
7 Spanish surname only. The only evidence of the persons Hispanic origin is surname or
maiden name and there is no other information the person is not Hispanic. Ordinarily
for central registry use only.
8 Dominican Republic (effective with diagnosis on or after 1/1/2005)
9 Unknown whether Spanish or not; not stated in patient record
Note: Use code 0 if patient has a Spanish/Hispanic name and there is reason to believe he/she is
not
Hispanic, for example, patient is Filipino or patient is a woman with a Hispanic married name
but she
is known to be non-Hispanic.
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6. Use codes 15 if specific ethnicity is known.

7. Use code 6 when you know the patient is Hispanic but cannot classify him/her to codes 15.
8. Use code 7 if race in the medical record is classified as White and he/she has a
Spanish/Hispanic
last name. Ordinarily used at the central registry level.
9. Use code 9 when Spanish/Hispanic origin is not documented or is unknown.
Examples:
a. Patients last name is Gonzales and the medical record states the patient was born in Mexico;
code to 1.
b. Patients medical record states race as Hispanic, without mention of whether his/her origin
was Mexico, Puerto Rico, Cuba, etc.; code to 6.
c. Patients medical record states patient is White/Caucasian and the last name is Gonzales; code
to 7.
Sex (NAACCR Item #220) (FORDS pg. 70; SEER pg. 44)
Description
Identifies the gender of the patient at the time of diagnosis.
Explanation
This data item is used to compare cancer rates and outcomes by site.
Coding Instructions
1. Record the patients gender as indicated in the medical record.
2. The code must be gender-specific to the primary site.
Example: The patient must be coded as male for a prostate cancer, or female for ovarian
primary.

3. If the patient has multiple tumors the sex must be the same for all records.
Code Definition
1 Male
2 Female
3 Other (Hermaphrodite)
(Intersexed)
4 Trans-sexual
9 Not Stated/Unknown
Note: Trans-sexual is defined as surgically altered gender.
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Note: Transgendered is defined as a person who identifies with or expresses a gender identity
that
differs from the one which corresponds to the persons sex at birth. Assign code 4 for
Transgendered.
Text Usual Industry (NAACCR Item #320)
Description
Text area for information about the patients usual industry, also known as usual kind of
business/industry
Explanation
Used to identify work-related health hazards; identifies industrial groups or worksite-related
groups
in which cancer screening or prevention activities may be beneficial.
Definition
Type of business or industry where the patient worked in his or her usual occupation. Examples
include manufacturing of tires, dry cleaning services, training of dogs, hospital.
Instructions
1. Document the patients usual (longest held) industry to the extent that the information is
available
in the medical record.
2. Be descriptive and specific.
Examples
Inadequate: Automobile industry
Adequate: Automobile manufacturing
Inadequate: Mine
Adequate: Copper mine
Inadequate: Retail
Adequate: Retail bookstore
3. When recording government agencies record the level (federal, state, county, municipal) and
the
division.
Example
Inadequate: Census
Adequate: U.S. Census Bureau
4. Be complete. If the primary activity of the industry is unknown, record the name of the
company
(with city or town) in which the patient worked the most number of years before diagnosis.

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Example
Inadequate: ABC, Inc.
Adequate: ABC, Inc., Kyle, TX
5. If the patients usual industry is unknown, document Unknown in the text field. This should
be
used only as a last resort.
Text Usual Occupation (NAACCR Item #310)
Description
Text area for information about the patients usual occupation, also known as usual type of job or
work.
Explanation
Used to identify work-related health hazards; identifies occupational groups in which cancer
screening or prevention activities may be beneficial.
Definition
Type of job the patient was engaged in for the longest time. It is not necessarily the highest paid
job
nor the job considered the most prestigious, but the one that accounted for the greatest number of
working years. Examples include police officer, bank teller, or nurse.
Exception
If a patient has been a homemaker for most of her adult life, but has ever worked outside the
home,
report the occupation held outside the home.
Instructions
1. Document the patients usual occupation, the kind of work performed during most of the
patients
working life before diagnosis of this tumor, to the extent that the information is available in the
medical record. Make sure the recorded usual occupation matches the recorded insustry.
2. Be descriptive, specific and complete: Record the word or words which most clearly describe
the
kind of work or type of duties performed by the patient.
Examples
Inadequate: Teacher
Adequate: Preschool teacher, high school teacher
Inadequate: Laborer
Adequate: Residential bricklayer
Inadequate: worked in a warehouse, worked in a shipping department
Adequate: warehouse forklift operator
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Inadequate: Engineer
Adequate: Chemical engineer, Railroad engineer
Inadequate: Self-employed
Adequate: Self-employed auto mechanic
3. If the patients usual occupation is not known, document Unknown in the text field. This
should

be used only as a last resort.

Commonly confused occupations
Contractor vs. skilled worker
a. A contractor mainly obtains contracts and supervises work
b. A skilled worker works with his or her own tools as a carpenter, plasterer, plumber or
electrician.
Machine operator vs. machinist vs. mechanic
a. A machine operator operates machines.
b. A machinist sets up and operates machines.
c. A mechanic repairs, installs, and adjusts machines.
Text Remarks - Other Pertinent Information (NAACCR Item #2680)
Description
Includes text area for information that is coded on the patients disease and adequate or
appropriate
space is not provided for supporting text. Overflow or problematic coding issues can be
documented
in this text field.
Explanation
Information documenting the disease process should be entered manually from the medical
record
and not be generated from coded values. Such documentation should include additional staging
information, additional treatment documentation, documentation of race and sex, history of the
disease, comments regarding lack of information in the medical record and cause of death. The
name
of the following physicians should also be noted here. See the Text Documentation Section for
detailed instructions.
Physician Follow Up (NAACCR Item #2470)
Description
Identifies the physician currently responsible for the patients medical care. The TCR requires
the
physicians state license number.
Explanation
The follow-up (or following) physician is the first contact for obtaining information on the
patients status. This information may be used for outcome studies.
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Coding Instructions
1. Record the state license number of the physician currently responsible for the patients care.
Physician license numbers for Texas can be found at the following web site:
www.docboard.org/tx/df/txsearch.htm
2. Cancer reporters using third party software must check with their vendor to ensure the
physicians
state license number transmits to the TCR.
3. This field must be populated for cases diagnosed 2006 and forward. If the information is
unknown
code 99999 and document in Text Remarks - Other Pertinent Information that the follow up
physician is unknown.

Note: Beginning in 2011 CoC will no longer require data item 2470, Following Physician. TCR
will
continue to require this data item.
Sequence Number (NAACCR Item #380) (SEER pgs. 54-57)
Description
Indicates the chronological sequence of all reportable neoplasms (malignant and non-malignant)
over
the lifetime of the patient regardless of when or where the case was diagnosed. Each neoplasm is
assigned a different number. Sequence number 00 indicates patient has only one reportable
malignant
neoplasm. Reportable neoplasms not included in the facility registry are also allotted a sequence
number. For example, an ACoS registry may contain a single record for a patient with a sequence
number of 02 because the first reportable neoplasm occurred before the facilitys reference date.
Explanation
This data item is used to distinguish among cases having the same registry numbers, to select
patients
with only one primary tumor for certain follow-up studies and to analyze factors involved in the
development of multiple tumors.
Coding Instructions
1. Codes 0059 and 99 indicate reportable cases of malignant or in situ behavior.
2. Code 00 if the patient has a single reportable primary. If the patient develops a subsequent
reportable primary, change the code for the first primary from 00 to 01, and number subsequent
primaries sequentially.
3. If two or more reportable primaries are diagnosed simultaneously, assign the lowest sequence
number to the diagnosis with the worst prognosis. If no difference in prognosis is evident, the
decision is arbitrary.
a. Base the prognosis decision on the primary site, histology, and extent of disease for each of the
primaries
b. If there is no difference in prognosis, the sequence numbers may be assigned in any order
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June 2011 Page 86

4. Codes 6088 indicate non-malignant neoplasms (benign and borderline) that are reportable by
agreement cases (e.g., those cases required by state registries). All benign or borderline
neoplasms
diagnosed/admitted to your facility should be sequenced according to this guideline. This
includes
benign and borderline CNS neoplasms.
5. Code 60 if the patient has a single non-malignant primary. If the patient develops a subsequent
non-malignant primary, change the code for the first primary from 60 to 61, and number
subsequent
non-malignant primaries sequentially (62, 63).
6. Sequence numbers should be reassigned in the database if the facility learns later of an
unaccessioned tumor that would affect the sequence.
7. The Sequence Number refers to the number of malignant or non-malignant primaries in the
patients lifetime.
Malignant Neoplasms
One Primary More Than One Primary Sequence Unknown

00 One primary only 01 First of two or more primaries 99 Unspecified

02 Second of two or more primaries
03 Third of three or more primaries
Non-Malignant Neoplasms
One Primary More Than One Primary Sequence Unknown
60 One primary only 61 First of two or more primaries 88 Unspecified
62 Second of two or more primaries
63 Third of three or more primaries
Note: Squamous and/or basal cell carcinoma of the skin (except genital sites) are no longer
considered when assigning the appropriate sequence number.
Examples:
a. A person is diagnosed with one malignant primary. Code the sequence number to 00.
b. A person was diagnosed with lung cancer in 2001. A colon cancer is diagnosed in 2011. Code
the
sequence number of the colon cancer to 02 and change the sequence number of the lung cancer
to 01.
c. A person was diagnosed with breast cancer in April 2010 and metastasis to the lungs in June
2011.
Since the lung is a metastatic site and not a second primary, it would not be abstracted. Code the
sequence number of the breast cancer to 00.
d. A person was diagnosed with signet ring cell carcinoma of the bladder in 2004. In 2011, this
person developed a benign meningioma in the temporal area of the brain. Code the bladder to
sequence number 00, and code the brain to sequence number 60.
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e. A person was diagnosed with carcinoma of the stomach in 2003, squamous cell carcinoma of
the
left forearm (a non-reportable neoplasm) in 2005, and non-Hodgkins lymphoma in 2011. Code
the sequence number of the stomach to 01. The sequence number of the left forearm would not
be
sequenced, abstracted or reported. Code the sequence number of the lymphoma to 02.
f. A person was diagnosed with a benign meningioma in June 2007. MRI at your facility in 2011
shows no change. Code the sequence number to 60 for the benign meningioma.
Other Primary Tumors (Site, Morphology, Date) NAACCR Item #2220)
Description
State-specific data field to capture information on other reportable tumors.
Explanation
Records tumor specific information on other reportable tumors in the patients lifetime.
Coding Instructions
1. Record the site, morphology, and date of diagnosis of other primaries. Do not include
metastatic
lesions or the primary currently being reported in this field. Do not leave this area blank due to
lack
of specific information. Record the information you have available.
Examples:
a. The patient had a history of duct cell carcinoma of the left breast in 2005 and is admitted in
2011

for adenocarcinoma of the lung. Complete an abstract on the lung tumor, and document duct cell
carcinoma of left breast in 2005 in this field.
b. The patient has a history of prostate cancer, no date or specific morphology is given. Patient is
admitted in 2011 with a malignant melanoma of left leg. Document: history of prostate cancer,
unknown date.
2. This field may be left blank if the sequence number is 00 for a malignant neoplasm or 60 for a
non-malignant neoplasm.
Primary Payer at Diagnosis (NAACCR Item #630) (FORDS pgs. 71-72)
Description
Identifies the patients primary payer/insurance carrier at the time of initial diagnosis and/or
treatment.
Explanation
This item is used in financial analysis and as an indicator for quality and outcome analyses. Joint
Commission on Accreditation of Healthcare Organizations (JCAHO) requires the patient
admission
page to document the type of insurance or payment structure that will cover the patient while
being
cared for at the hospital.
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Coding Instructions
1. Record the type of insurance reported on the patients admission page.
2. If more than one payer or insurance carrier is listed on the patients admission page, record the
first.
3. If the patients payer or insurance carrier changes, do not change the initially recorded code.
4. Consult with your facilitys billing department if the primary payer information is unclear.
Code Label Definition
01 Not insured Patient has no insurance and is declared a charity
write-off
02 Not insured, self pay Patient has no insurance and is declared
responsible for charges
10 Insurance, NOS Type of insurance unknown or other than types
listed in codes 20, 21, 31, 35, 60-68
20 Private Insurance: Managed Care,
HMO, or PPO
An organized system of prepaid care for a group of
enrollees usually within a defined geographic area.
Generally formed as one of four types: a group
model, an independent physician association
(IPA), a network, or a staff model. Gate-keeper
model is another term for describing this type of
insurance.
21 Private Insurance: Fee-for-Service An insurance plan that does not have negotiated
fee structure with the participating hospital. Type
of insurance plan not coded as 20.
31 Medicaid State government administered insurance for
persons who are uninsured, below the poverty

level, or covered under entitlement programs.

Medicaid other than described in code 35.
35 Medicaid-Administered through a
Managed Care plan
Patient is enrolled in Medicaid through a Managed
Care program (e.g. HMO or PPO). The managed
care plan pays for all incurred costs.
60 Medicare without supplement,
Medicare, NOS
Federal government funded insurance for persons
who are 62 years of age or older, or are chronically
disabled (social security insurance eligible). Not
described in codes 61, 62, or 63.
61 Medicare with supplement, NOS Patient has Medicare and another type of
unspecified insurance to pay costs not covered by
Medicare.
62 Medicare-Administered through a
Managed Care plan
Patient is enrolled in Medicare through a Managed
Care plan (e.g. HMO or PPO). The Managed Care
plan pays for all incurred costs.
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Code Label Definition

63 Medicare with private supplement Patient has Medicare and private insurance to pay
costs not covered by Medicare.
64 Medicare with Medicaid eligibility Federal government Medicare insurance with State
Medicaid administered supplement.
65 TRICARE Department of Defense program providing
supplementary civilian-sector hospital and medical
services beyond a military treatment facility to
military dependents, retirees, and their dependents.
Formally CHAMPUS (Civilian Health and
Medical Program of the Uniformed Services)
66 Military Military personnel or their dependents treated at a
military facility
67 Veterans Affairs Veterans treated in Veterans Affairs facilities
68 Indian/Public Health Services Patient who receives care at an Indian Health
Services facility or at another facility and medical
costs are reimbursed by the Indian Health Service
Patient receives care at a Public Health Service
facility or at another facility, and medical costs are
reimbursed by the Public Health Service
99 Insurance status unknown It is unknown from the patients medical record
whether or not the patient is insured.
Examples:
a. An indigent patient is admitted with no insurance coverage. Code the Primary Payer at
Diagnosis as 01.

b. A patient is admitted for treatment and the patient admission page states the primary insurance
carrier is an HMO. Code the Primary Payer at Diagnosis as 20.
c. A 65-year old male patient is admitted for treatment and the patient admission page states the
patient is covered by Medicare with additional insurance coverage from a PPO. Code the
Primary Payer at Diagnosis as 62.
d. Patient comes to your facility originally diagnosed with prostate cancer in 2000. Now he has
bone
metastasis. Code the Primary Payer at Diagnosis as 99 because the information from the
facility where originally diagnosed is not available.
Comorbidities and Complications #1 - #10 (NAACCR Item #3110, 3120, 3130, 3140, 3150,
3160,
3161, 3162, 3163, and 3164) (FORDS pgs 73-83)
Description
Records the patients preexisting medical conditions, factors influencing health status, and/or
complications during the patients hospital stay for the treatment of this cancer using ICD-9-CM
codes. All are considered secondary diagnoses.
Revised September 2011 Page 89
Texas Cancer Registry Cancer Reporting Handbook
June 2011 Page 90

Explanation
Preexisting medical conditions, factors influencing health status, and/or complications may affect
treatment decisions and influence patient outcomes. Information on Comorbidities is used to
adjust
outcome statistics when evaluating patient survival and other outcomes. Complications may be
related to the quality of care.
Coding Instructions
1. Use only ICD-9-CM codes.
2. Secondary diagnoses are found on the discharge abstract or coding summary. Information
from the
billing department at your facility may be consulted when a discharge abstract is not available.
3. Code the secondary diagnoses in the sequence in which they appear on the discharge abstract
or
are recorded by the billing department at your facility.
4. Report the secondary diagnoses for this cancer using the following priority rules:
a. Surgically treated patients
i. following the most definitive surgery of the primary site
ii. following other non-primary site surgeries
b. Non-surgically treated patients:
i. following the first treatment encounter/episode
c. In cases of non-treatment:
i. following the last diagnostic/evaluative encounter
5. If there was an unplanned re-admission following surgical discharge, check for an ICD-9-CM
E
code and record, space allowing, as additional Comorbidities and Complications
6. If no secondary diagnoses were documented, then code 00000 in the first data item, and leave
the
remaining Comorbidities and Complications data items blank. Do not leave the first data item

blank.
7. If fewer than 10 secondary diagnoses are listed, then code the diagnoses listed, and leave the remaining
Comorbidities and Complications data items blank.
8. For non analytic cases code the first data item 00000 and leave the remaining data items blank.
ICD-9-CM
Or
ICD-10-CM
Code Definition, Specific Instructions
Both 00000 No comorbid conditions or complications.
Code only the first field and leave the
remaining fields blank.
ICD-9-CM 00100-13980, Comorbid conditions: Omit the decimal point
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24000-99990 between the third and fourth characters.

ICD-9-CM E8700-E8799,
E9300-E9499
Complications: Omit the decimal point
between the fourth and fifth characters
ICD-9-CM V0720-V0739,
V1000-V1590,
V2220-V2310,
V2540, V4400V4589, V5041V5049
Factors affecting health status: Omit the
decimal point between the fourth and fifth
characters

Examples
Code Reason (ICD-9-CM)
49600 COPD (ICD-9-CM code 496)
25001 Type 1 diabetes mellitus (ICD-9-CM code 250.01)
E8732 The patient was inadvertently exposed to an overdose of external beam radiation
(ICD-9-CM code E873.2)
V1030 The patient has a personal history of breast cancer (ICD-9-CM code V10.3)
Source Comorbidity (Non-NAACCR Standard Data Item 9970) (Source CDC/NPCR-CER)
Description
This data item records the data source from which comorbidities/complications (NAACCR Data
Items 3110, 3120, 3130, 3140, 3150, 3160, 3161, 3162, 3163, and 3164) were collected.
Coding Instructions
1. Do not leave this data item blank. If no comorbid condition or complications are identified in
the
patients record use code 0.
Code Description
0 No comorbid condition or complication identified/Not Applicable
1 Collected from facility face sheet
2 Linkage to facility/hospital discharge data set
3 Linkage to Medicare/Medicaid data set
4 Linkage with another claims data set

5 Combination of two or more sources above

9 Other source
Height (Non-NAACCR Standard Item 9960) (Source CDC/NPCR-CER)
Description
Height is required for breast, colorectal and CML when chemotherapy and/or other drugs were
given,
and should be entered when available for all other sites/histologies.
Coding Instructions
1. Different tumors for the same patient may have different values.
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Revised September 2011 Page 92

2. Height should be collected from source records once for each cancer.
3. Height should be taken from the Nursing Interview Guide, Flow Chart, or Vital Stats section
from
the patients hospital medical record or physician office record.
4. The height entered should be that listed at or around the time of diagnosis. If no height was
listed
on the date of diagnosis, use the height recorded on the date closest to the date of diagnosis and
before treatment was started.
5. Enter height as a 2 digit number measured in inches. Round all inches values to the nearest
whole
number; values with decimal place x.5 and greater should be rounded up (code 62.5 inches as 63
inches).
6. Do not leave this field blank. If the information is not available use code 99 (Unknown).
Note: An online conversion calculator is available at http://manuelsweb.com/ft_in_cm.htm.
Code Description
XX Exact number in inches (up to 98 inches)
98 98 inches or greater
99 Unknown height
Weight (Non-NAACCR Standard Data Item 9961) (Source CDC/NPCR-CER)
Description
Weight is required for breast, colorectal and CML when chemotherapy and/or other drugs were
given, and should be entered when available for all other sites/histologies.
Coding Instructions
1. Different tumors for the same patient may have different values.
2. Weight should be collected from source records once for each cancer.
3. Weight should be taken from the Nursing Interview Guide, Flow Chart, or Vital Stats section
from
the patients medical record or physician office record.
4. The weight entered should be that listed on the date of diagnosis. If no weight was listed on
the
date of diagnosis, please use the weight recorded on the date closest to the date of diagnosis and
before treatment was started.
5. Enter the weight as a 3 digits number measured in pounds. Round values to the nearest whole
number. Values with decimal place x.5 should be rounded up (Code 155.5 pounds as 156). Code
a
weight of less than 100 pounds with a leading 0 (Code 95 pounds as 095)

6. Do not leave this field blank. If the information is not available use code 999 (Unknown).
Note: An online conversion calculator is available at http://manuelsweb.com/kg_lbs.htm.
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Revised September 2011 Page 93

Code Description
XXX Exact weight in pounds
999 Unknown weight
Tobacco Use Cigarettes (N0N-NAACCR Standard Data Item 9965) (Source CDC/NPCR-CER)
Description
Records the patients past or current cigarette smoking. This data item is required for all
sites/histologies as available. This should be recorded from sections such as the Nursing
Interview
Guide, Flow Chart, Vital Stats, Nursing Assessment Section, or other available source from the
patients hospital medical record or physician office record.
Coding Instructions
1. If the medical record only indicates No, use code 9 (Unknown/not stated/no smoking
specifics
provided) rather than code 0 (Never used).
2. If the medical record indicates None, use 0 (Never used).
3. Do not leave this field blank. If there is no information use code 9 (Unknown).
Code Description
0 Never used
1 Current user (as of date of diagnosis)
2 Former user, quit within one year of the date of diagnosis
3 Former user, quit more than one year prior to the date of diagnosis
4 Former user, unknown when quit
9 Unknown/not stated/no smoking specifics provided
Tobacco Use Other Smoke (Non-NAACCR Standard Data Item 9966) (Source CDC/NPCRCER)
Description
Records the patients past or current use of smoking tobacco products other than cigarettes
(pipes,
cigars, kreteks). This data item is required for all sites/histologies as available. This should be
recorded from sections such as the Nursing Interview Guide, Flow Chart, Vital Stats, Nursing
Assessment Section, or other available source from the patients hospital medical record or
physician
office record.
Coding Instructions
1. If the medical record only indicates No, use code 9 (Unknown/not stated/no smoking
specifics
provided) rather than code 0 (Never used).
2. If the medical record indicates None, use 0 (Never used).
3. Do not leave this field blank. If there is no information use code 9 (Unknown)
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Code Description
0 Never used

1 Current user (as of date of diagnosis)

2 Former user, quit within one year of the date of diagnosis
3 Former user, quit more than one year prior to the date of diagnosis
4 Former user, unknown when quit
9 Unknown/not stated/no smoking specifics provided
Tobacco Use Smokeless (Non-NAACCR Standard Data Item 9967) (Source CDC/NPCR-CER)
Description
Records the patients past or current use of smokeless tobacco products (chewing tobacco, snuff,
etc.)
This data item is required for all sites/histologies as available. This should be recorded from
sections
such as the Nursing Interview Guide, Flow Chart, Vital Stats, Nursing Assessment Section, or
other
available source from the patients hospital medical record or physician office record.
Coding Instructions
1. If the medical record only indicates No, use code 9 (Unknown/not stated/no smoking
specifics
provided) rather than code 0 (Never used).
2. If the medical record indicates None, use 0 (Never used).
3. Do not leave this field blank. If there is no information use code 9 (Unknown).
Code Description
0 Never used
1 Current user (as of date of diagnosis)
2 Former user, quit within one year of the date of diagnosis
3 Former user, quit more than one year prior to the date of diagnosis
4 Former user, unknown when quit
9 Unknown/not stated/no smoking specifics provided
Tobacco Use NOS (Non-NAACCR Standard Data Item 9968) (Source CDC/NPCR-CER)
Description
Records the patients past or current use of tobacco when tobacco use is indicated but type is not
specified. This data item is required for all sites/histologies as available. This should be recorded
from sections such as the Nursing Interview Guide, Flow Chart, Vital Stats, Nursing Assessment
Section, or other available source from the patients hospital medical record or physician office
record.
Coding Instructions
1. If the medical record only indicates No, use code 9 (Unknown/not stated/no smoking
specifics
provided) rather than code 0 (Never used).
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2. If the medical record indicates None, use 0 (Never used).

3. Do not leave this field blank. If there is no information use code 9 (Unknown).
Code Description
0 Never used
1 Current user (as of date of diagnosis)
2 Former user, quit within one year of the date of diagnosis
3 Former user, quit more than one year prior to the date of diagnosis

4 Former user, unknown when quit

9 Unknown/not stated/no smoking specifics provided
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