CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Intake Medical History
Sub-Domain: Additional Proposed Instruments
CRF: Intake Medical History
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Additional Notes (Question Text) | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | Source | Form Set | Form | Field | Domain | CDASH Variable | CDASH Definition | CDASH Label | Controlled Terminology | Prompt | Essentiality | Question Text | CDASH imp guidance | SDTM IG target | csDSR | PhenX | Data Type | CRF Completion Inst | SDTMIG Target Var | SDTMIG Target Map | Codelist Name | PVs | Pre Pop Value | Query Display | List Style |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C19800 | Medical history endocrine menarche indicator | MedHistEndcrnMenarcheInd | Indicator of start of menarche | Indicator of start of menarche | If female, start of her period (menarche)? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
Only to be answered if participant/subject is female. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19832 | Psychiatric anxiety onset date | PsychAnxOnstDate | Date of onset of anxiety | Date of onset of anxiety | If Yes, date of onset | Date or Date & Time |
The date should be recorded in the format YYYY/MM, and only answered if Psychiatric question #1 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19768 | Medical history pulmonary difficulty ingestion relatedness indicator | MedHistPlDfltcyIngesRltdnsInd | Indicator of difficulty breathing relation to meal times | Indicator of difficulty breathing relation to meal times | If Yes, is difficulty breathing related to meal times? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
Only answered if Pulmonary question #1 is answered Yes |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19779 | Medical history asthma pulmonary assessment indicator | MedHistAsthmaPulAssesInd | Indicator of history of asthma | Indicator of history of asthma | History of asthma? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | ||||||||||||||||||||||||||||
| C19811 | Medical history abdominal liver problem indicator | MedHistAbdmnlLiverProbInd | Indicator of history of liver problem | Indicator of history of liver problem | Ever have a liver problem? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | ||||||||||||||||||||||||||||
| C19790 | Medical history pulmonary current intermittent positive pressure breathing use status | MedHistPlCrntIPPBUseStatus | Status of current Intermittent Positive Pressure Breathing (IPPB) use | Status of current Intermittent Positive Pressure Breathing (IPPB) use | Are you currently using IPPB?: | Daily;Only when ill;Don't use;Unknown | Daily;Only when ill;Don't use;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19822 | Medical history musculoskeletal joint dislocation mechanism type | MedHistMusclJointDislmechTyp | Type of joints and mechanism dislocated | Type of joints and mechanism dislocated | If Yes, specify joints dislocated and mechanism | Alphanumeric |
Answer for all applicable joints dislocated |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C05460 | Seizure indicator | SeizInd | Indicator of seizure activity | Indicator of seizure activity | Seizure | Yes;No | Yes;No | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-07-20 10:21:25.65 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19801 | Medical history endocrine menarche onset date | MedHistEndcrnMenarcheOnstDate | Date of start of onset of menarche | Date of start of onset of menarche | If Yes, date of onset | Date or Date & Time |
The date should be recorded in the format YYYY/MM and only answered if Endocrine question #3 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19833 | Psychiatric depression indicator | PsychDepressInd | Indicator of history of depression | Indicator of history of depression | Depression: | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19769 | Medical history pulmonary aspiration diagnosis indicator | MedHistPlmnryAspirDiagInd | Indicator of history of aspiration | Indicator of history of aspiration | History of aspiration? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19780 | Medical history asthma pulmonary medication taken indicator | MedHistAsthmaPulMedsTakenInd | Indicator of steroid pills or liquid medication taken for asthma | Indicator of steroid pills or liquid medication taken for asthma | If Yes, steroid pills or liquid medication for asthma? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19812 | Medical history abdominal liver problem enzyme elevation indicator | MedHistAbdmnlLivProbEnzElInd | Indicator of elevation in liver enzyme | Indicator of elevation in liver enzyme | If Yes, was this an elevation in the liver enzyme (AST/ALT) only? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19791 | Medical history pulmonary antibiotics use frequency | MedHistPlmnryAntibiotUseFreq | Frequency of antibiotic use | Frequency of antibiotic use | How many times have you required antibiotics for a cold or pneumonia in the last year? | None;Once;2 times;3 times;4 times;<5 times | None;Once;2 times;3 times;4 times;<5 times | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19823 | Medical history musculoskeletal joint dislocation trauma type | MedHistMusclskltlJointDislocTaumaTyp | Type of joint dislocation trauma | Type of joint dislocation trauma | If Yes, specify joints dislocated and mechanism | Major trauma;Minor trauma (slip and fall) | Major trauma;Minor trauma (slip and fall) | Alphanumeric |
Answer for all applicable joints dislocated |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C14116 | Learning disability or attention deficit diagnosis indicator | LearnDisableADHDDiagnosInd | Whether the participant/subject was ever given formal diagnosis of any learning disability or diagnosed with ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder) | Whether the participant/subject was formally diagnosed with learning disability, attention deficit disorder, or attention deficit hyperactivity disorder. | Is there a learning disability? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19802 | Medical history endocrine Vitamin D deficiency indicator | MedHistEndcrnVtmnDDefInd | Indicator of history of vitamin D deficency | Indicator of history of vitamin D deficency | Any history of vitamin D deficiency? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19834 | Psychiatric depression onset date | PsychDepressOnstDate | Date of onset of depression first | Date of onset of depression first | If Yes, date of onset | Date or Date & Time |
The date should be recorded in the format YYYY/MM, and only answered if Psychiatric question #2 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19770 | Medical history pulmonary aspiration swallowing assessment indicator | MedHistPlAspirSwallAssInd | Indicator of swallowing studies completed | Indicator of swallowing studies completed | Any swallowing study done? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19781 | Medical history asthma pulmonary inhalers use indicator | MedHistAsthmaPlInhalUseInd | Indicator of steroid inhalers used for asthma | Indicator of steroid inhalers used for asthma | If Yes, steroid inhalers (Qvar, Flovent)? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19813 | Medical history genito-urinary urinary tract infections indicator | MedHistGenitoUTIInd | Indicator of history of urinary tract infections | Indicator of history of urinary tract infections | Frequent urinary tract infections? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19792 | Medical history cardiovascular heart arrhythmia indicator | MedHistCardioHeartArrhymInd | Indicator of history of heart arrhythmia | Indicator of history of heart arrhythmia | Is there a history of heart arrhythmia? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19824 | Medical history musculoskeletal scoliosis diagnosis indicator | MedHistScolDiagnInd | Indicator of scoliosis | Indicator of scoliosis | Scoliosis: | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19760 | Medical history strabismus diagnosis indicator | MedHistStrbsmsDiagInd | Indicator of medical history of strabismus | Indicator of medical history of strabismus | Strabismus | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19803 | Dual X-ray absorptiometry scanner performed indicator | DEXAScanPerfInd | Indicator of DEXA scan performed | Indicator of DEXA scan performed | Any DEXA scan performed? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19835 | Pain indicator | PainInd | Indicator of pain present | Indicator of pain present | Pain? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19771 | Medical history pulmonary aspiration swallowing assessment completion date | MedHistPlAspirSwallAssCompDt | Date of swallowing study completed | Date of swallowing study completed | If Yes, date swallowing study done | Date or Date & Time |
The date should be recorded in the format YYYY/MM. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19782 | Medical history asthma pulmonary inhalers use frequency | MedHistAsthmaPlInhalUseFreq | Frequency of use of steroid inhalers used for asthma | Frequency of use of steroid inhalers used for asthma | If Yes, how often? | Daily;Monthly;Yearly | Daily;Monthly;Yearly | Alphanumeric |
Only answered if Pulmonary question #7 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19814 | Medical history musculoskeletal broken bones indicator | MedHistMusclskltlBrknBonesInd | Indicator of broken bones | Indicator of broken bones | Broken bones? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19793 | Medical history cardiovascular heart arrhythmia diagnosis date | MedHistCardioHeArrhDiagDt | Date of first detection of heart arrhythmia | Date of first detection of heart arrhythmia | If Yes, date first detected | Date or Date & Time |
The date should be recorded in the format YYYY/MM and only answered if Cardiovascular question #1 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19825 | Medical history musculoskeletal scoliosis diagnosis date | MedHistMusclskltlScolDiagDt | Date of first detection of scoliosis | Date of first detection of scoliosis | If Yes, date first detected | Date or Date & Time |
The date should be recorded in the format YYYY/MM, and only answered if Musculoskeletal question #3 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19761 | Medical history glaucoma diagnosis indicator | MedHistGlcmaDiagInd | Indicator of history of Glaucoma | Indicator of history of Glaucoma | Glaucoma | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19804 | Dual X-ray absorptiometry scanner performed date | DEXAScanPerfDt | Date of DEXA scan performed | Date of DEXA scan performed | If Yes, date performed | Date or Date & Time |
The date should be recorded in the format YYYY/MM and only answered if Endocrine question #5 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19836 | Pain anatomic site text | PainAntmicSiteTxt | Anatomic Site of body pain | Anatomic Site of body pain | If Yes, area of body: | Alphanumeric |
Only answered if Pain question #1 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
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| C19772 | Medical history pulmonary function test assessment indicator | MedHistPFTAssessInd | Indicator of pulmonary function tests completed | Indicator of pulmonary function tests completed | Any pulmonary function tests done? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19783 | Medical history pulmonary bilevel positive airway pressure indicator | MedHistPlmnryBiPAPInd | Indicator of bilevel positive airway pressure | Indicator of bilevel positive airway pressure | BiPAP currently? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19815 | Medical history musculoskeletal total broken bones count | MedHistMusclTtlBrknBonesCt | Number of toral bones broken | Number of toral bones broken | If Yes, total number of broken bones: | Numeric Values |
Only answered if Musculoskeletal question # 1 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19794 | Medical history cardiovascular enlarged heart diagnosis indicator | MedHistCardioEnlrgdHetDiagInd | Indicator of history of enlarged heart | Indicator of history of enlarged heart | Is there a history of an enlarged heart? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19826 | Seizure onset Date | SeizOnstDate | Date of onset of seizures | Date of onset of seizures | If Yes, date of onset | Date or Date & Time |
The date should be recorded in the format YYYY/MM, and only answered if Neurologic question #1 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19762 | Medical history myopia diagnosis indicator | MedHistMyopiaDiagInd | Indicator of history of myopia | Indicator of history of myopia | Myopia | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19805 | Medical history endocrine osteoporosis indicator | MedHistEndcrnOstprsisInd | Indicator of history of osteoporosis | Indicator of history of osteoporosis | Any history of osteoporosis? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | ||||||||||||||||||||||||||||
| C19837 | Pain position indicator | PainPostnInd | Indicator of pain within a certain position of the body | Indicator of pain within a certain position of the body | Pain with certain position? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19773 | Medical history pulmonary function test assessment date | MedHistPFTAssessDt | Date of pulmonary function test completed | Date of pulmonary function test completed | If Yes, date done | Date or Date & Time |
The date should be recorded in the format YYYY/MM. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19784 | Medical history pulmonary bilevel positive airway pressure frequency | MedHistPlmnryBiPAPFreq | Frequency of bilevel positive airway pressure | Frequency of bilevel positive airway pressure | If Yes, how many hours a day? | 0-4 hours/day;5-16 hours/day;>16 hours/day | 0-4 hours/day;5-16 hours/day;>16 hours/day | Alphanumeric |
Only answered if Pulmonary question #1 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19816 | Medical history musculoskeletal total broken bones type | MedHistMusclskltlBrknBonesTyp | Type of bones broken | Type of bones broken | If Yes, specify bones broken and mechanism broken: | Femur;Tibia/Fibia;Radius/Ulna;Vertebral body;Humerus;Carpal | Femur;Tibia/Fibia;Radius/Ulna;Vertebral body;Humerus;Carpal | Alphanumeric |
Choose all that apply |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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| C19795 | Medical history cardiovascular enlarged heart diagnosis date | MedHistCardioEnlrgdHeDiagDt | Date of first detection of enlarged heart | Date of first detection of enlarged heart | If Yes, date first detected | Date or Date & Time |
The date should be recorded in the format YYYY/MM and only answered if Cardiovascular question #2 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19827 | Seizure type | NeuroSeizTyp | Type of seizures had | Type of seizures had | What kind of seizure | Grand Mal;Partial Complex;Absence;Ferbile;Don't know | Grand Mal;Partial Complex;Absence;Ferbile;Don't know | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19763 | Medical history cataracts diagnosis indicator | MedHistCatrctsDiagInd | Indicator of history of cataracts | Indicator of history of cataracts | Cataracts | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19806 | Medical history endocrine diabetes indicator | MedHistEndcrnDiabetInd | Indicator of diabetes | Indicator of diabetes | Ever have diabetes? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19838 | Pain position text | PainPosTxt | The free-text field related to 'Pain Position indicator' Indicator of pain within a certain position of the body | The free-text field related to 'Pain Position indicator' Indicator of pain within a certain position of the body | If Yes, specify | Alphanumeric |
Only answered if Pain question #2 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |