CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Miscellaneous Sickle Cell-related CDEs

Displaying 1 - 50 of 491
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
C01565 Blood pressure systolic measurement BldPressrSystMeasr Measurement of pressure of the participant's/subject's blood against the artery walls during systole (the contraction phase) in millimeters of mercury (mmHg) Measurement of pressure of the participant's/subject's blood against the artery walls during systole (the contraction phase) in millimeters of mercury (mmHg) Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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0 300 millimeter of mercury 2004289 DeBaun Forms
C55780 Imaging vessel studied text ImagVessStudTxt Text describing any and all of the subject's vessels that were studied. Text describing any and all of the subject's vessels that were studied. Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-31 12:30:51.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

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C13888 Thrombolysis In Myocardial Infarction (TIMI) scale - individual vessel score TIMIScaleIndVesselScore The score related to the Thrombolysis In Myocardial Infarction (TIMI) scale individual vessel. The score related to the Thrombolysis In Myocardial Infarction (TIMI) scale individual vessel. 0;1;2;3;0;1;2;3;0;1;2;3 No perfusion;Perfusion past the initial occlusion, but no distal branch filling;Perfusion with incomplete or slow distal branch filling;Full perfusion with filling of all distal branches;No perfusion;Perfusion past the initial occlusion, but no distal branch filling;Perfusion with incomplete or slow distal branch filling;Full perfusion with filling of all distal branches;No perfusion;Perfusion past the initial occlusion, but no distal branch filling;Perfusion with incomplete or slow distal branch filling;Full perfusion with filling of all distal branches Numeric values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C13192 Questionnaire for Verifying Stroke Free Status (QVSFS) - stroke status QVSFSStrokeStatus Were you ever told by a physician that you had a stroke? Were you ever told by a physician that you had a stroke? Questionnaire for Verifying Stroke Free Status (QVSFS) - numbness status No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C19904 Symptom disease lab data known disease other text SymptSignDisLabDataOTH Text of other symptoms, signs, known diseases, and lab data Text of other symptoms, signs, known diseases, and lab data Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-09 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

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DeBaun Forms
C14024 Vasospasm criterion value VasoCriterionVal Indicates vasospasm criterion value Indicates vasospasm criterion value Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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C08173 Ischemic hemorrhagic or vascular pathology indicator IschHemVasclPathInd Indicator of the presence of ischemic, hemorrhagic, or vascular pathology Indicator of the presence of ischemic, hemorrhagic, or vascular pathology Yes;No;Unknown;Not assessed Yes;No;Unknown;Not assessed Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C56421 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Examinee visual hearing aid prescription lens used indicator WASIIIExVisHeaAidPreLensUseInd The indicator relating to the examine used his/her prescription lenses during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The indicator relating to the examine used his/her prescription lenses during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Used;Not used Used;Not used Alphanumeric Adult;Pediatric Supplemental 1.00 2017-06-12 11:54:51.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C13921 Imaging other carotid ultrasound result ImgOthrCarotidUltrasoundReslt Indicates other carotid ultrasound findings Indicates other carotid ultrasound findings Turbulence;Spectral broadening Turbulence;Spectral broadening Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C13464 Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - total score PSOMSNETotalScore The total score on the Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). The total score on the Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 10 DeBaun Forms
C50680 Examiner name ExaminerName The name of the person performing the exam. The name of the person performing the exam. Alphanumeric Adult;Pediatric Supplemental 1.00 2016-12-12 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

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C14685 Pediatric Migraine Disability Assessment (MIDAS) - headache frequency PedMIDASHeadFreq Headache frequency, as part of migraine disability assessment (MIDAS) questionnaire-pediatric form. Headache frequency, as part of migraine disability assessment (MIDAS) questionnaire-pediatric form. Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

C56439 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Full Scale IQ 2 percentile rank value WASIIIFullScale2PrcntRankVal The percentile rank the subject placed in with respect to Full Scale IQ for two subtests (Vocabulary and Matrix Reasoning), as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The percentile rank the subject placed in with respect to Full Scale IQ for two subtests (Vocabulary and Matrix Reasoning), as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-12 13:04:39.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 100 percent
C12477 Imaging other incidental finding type ImgOthrIncidentalFindTyp The type of other incidental findings found within the image studies The type of other incidental findings found within the image studies PVL;Other white matter intensities;Venous malformations;Vascular malformations;Other, specify PVL;Other white matter intensities;Venous malformations;Vascular malformations;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C18720 Imaging visual analysis location performed other text ImgVisAnlysisLocPerfOTH The free-text field related to 'Imaging visual analysis location performed type' specifying other text. Location where visual analysis of the imaging data are performed The free-text field related to 'Imaging visual analysis location performed type' specifying other text. Location where visual analysis of the imaging data are performed Alphanumeric Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

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C13953 Consensus on Grading Intracranial Flow Obstruction (COGIF) - follow-up indicator COGIFFollowupInd Indicates the consensus on grading intracranial flow obstruction (COGIF) follow-up Indicates the consensus on grading intracranial flow obstruction (COGIF) follow-up Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C18891 Imaging vessel angiography collateral status anatomic other text ImgVessAngioCollatStatAntOTH The free-text field related to 'Imaging vessel angiography collateral status anatomic site' specifying other text. Indicates vessel angiography collateral status location The free-text field related to 'Imaging vessel angiography collateral status anatomic site' specifying other text. Indicates vessel angiography collateral status location Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

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C14002 Extracranial stenosis collateral artery anatomic site ExtracranStenCollArtAntmicSite The site of parallel arteries having extracranial stenosis. The site of parallel arteries having extracranial stenosis. OA;ACA;VA Ophthalmic artery;Anterior cerebral artery;Vertebral artery Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C02203 Off study reason OffStdyRsn Primary reason participant/ subject is no longer participating in study (i.e., is not being followed and will not receive intervention/treatment). Primary reason participant/ subject is no longer participating in study (i.e., is not being followed and will not receive intervention/treatment). Completed study;Refused further participation (or withdrew consent);Lost to follow-up (or cannot be located);Died;Completed study;Refused further participation (or withdrew consent);Lost to follow-up (or cannot be located);Died Completed study;Refused further participation (or withdrew consent);Lost to follow-up (or cannot be located);Died;Completed study;Refused further participation (or withdrew consent);Lost to follow-up (or cannot be located);Died Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

2979313 DeBaun Forms
C56390 Conners Continuous Performance Test 3rd Edition (CPT3) - Impulsivity perseveration count ConnersCPT3ImpPersCt The number of random or anticipatory responses, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). The number of random or anticipatory responses, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-09 15:39:31.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0
C13900 Imaging probe frequency ImgProbeFreq Indicates imaging probe frequency (Hz) Indicates imaging probe frequency (Hz) Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

Hertz
C13236 National Institutes of Health Stroke Scale (NIHSS) - Visual field score NIHSSLvlConscVisuFldScore Visual fields assessed using the NIH Stroke Scale (NIHSS) Visual fields assessed using the NIH Stroke Scale (NIHSS) 0;1;2;3;UN;0;1;2;3;UN No visual loss;Partial hemianopia;Complete hemianopia;Bilateral hemianopia (blind including cortical blindness);Unexaminable (intubated/paralyzed);No visual loss;Partial hemianopia;Complete hemianopia;Bilateral hemianopia (blind including cortical blindness);Unexaminable (intubated/paralyzed) Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C21487 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span forward subtest trial score WAISIVDSFTrlScore Score for the digit span forward subtest, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest Score for the digit span forward subtest, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest 0;1;0;1;0;1 0;1;0;1;0;1 Numeric Values Adult;Pediatric Supplemental 2.00 2018-07-30 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C14035 VMR response result VMRResponseReslt Indicates vasomotor response (VMR) response result Indicates vasomotor response (VMR) response result Abnormal;Normal;Abnormal;Normal Abnormal;Normal;Abnormal;Normal Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C10567 Imaging radio frequency coil type ImgRFCoilTyp Type of radio frequency (RF) coil(s) used for the body part scanned Type of RF coil(s) used for the body part scanned Head coil;Neck coil;Spine array;Body coil (transmit);Double-cone;Circular;Figure 8;Other, specify Head coil;Neck coil;Spine array;Body coil (transmit);Double-cone;Circular;Figure 8;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

Multiple Pre-Defined Values Selected

C56433 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Perceptual Reasoning confidence interval upper bound value WASIIIPercRsngConfIntrvlUppVal The upper bound of the subject's Perceptual Reasoning confidence interval, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The upper bound of the subject's Perceptual Reasoning confidence interval, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-12 12:55:22.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

C13932 Intima media thickness (IMT) mean near-wall measurement IMTMeanNearWallMeasr Indicates mean intima media thickness (IMT) near-wall measurement (mm) Indicates mean intima media thickness (IMT) near-wall measurement (mm) Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

millimeter
C00023 Hand preference type HandPrefTyp Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively. Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively. Left hand;Right hand;Both hands;Unknown;Forced right Left hand;Right hand;Both hands;Unknown;Forced right Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

2180147 DeBaun Forms
C54610 Brief Test of Executive Function Second Edition (BRIEF 2) - Task completion total raw scale score BRIEF2TskCmpltnTtlRwSclScore Total score of the raw scale for the task completion function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) Total score of the raw scale for the task completion function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) Numeric Values Adult;Pediatric Supplemental 1.00 2017-03-22 09:57:02.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

C16188 Vaccine received indicator VaccRcvdInd Indicates whether participant/subject received the vaccine Indicates whether participant/subject received the vaccine Yes;No;Unknown;Not Asked Yes;No;Unknown;Not Asked Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C12488 Imaging subcortical cyst indicator ImgSubCorticalCystInd Indicator of whether subcortical cysts are found in the image studies Indicator of whether subcortical cysts are found in the image studies Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C12499 Imaging T2 weighted white matter abnormality site type ImgT2WWMAbnrmlySiteTyp The type of anatomical site of the white matter abnormality on T2 weighted images The type of anatomical site of the white matter abnormality on T2 weighted images Frontal;Parietal;Temporal;Cerebellar WM;Deep WM;Diffuse;Occipital;Periventricular Frontal;Parietal;Temporal;Cerebellar WM;Deep WM;Diffuse;Occipital;Periventricular Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C19166 Special care unit admittance indicator SCUAddmittanceInd Indicator for the admittance of participant to special care unit, including any Intensive Care or Step-Down Unit Indicator for the admittance of participant to special care unit, including any Intensive Care or Step-Down Unit No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2014-05-29 13:03:57.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C14013 Intracranial stenosis mean velocity criterion value IntracranStenoMnVlctyCriterVal Indicates intracranial stenosis mean velocity criterion Indicates intracranial stenosis mean velocity criterion Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

C02494 Imaging study date and time ImgStdyDateTime Date (and time, if applicable and known) the radiologic study was obtained. Date (and time, if applicable and known) the radiologic study was obtained. Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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C56410 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Block Design T score WASIIIBDTScore The T score converted from the raw score that the subject received on the Block Design subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) . The T score converted from the raw score that the subject received on the Block Design subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) . Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-12 11:23:35.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

20 80
C13911 Imaging plaque texture text ImgPlaqTextureTxt Indicates plaque texture Indicates plaque texture Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

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C13247 National Institutes of Health Stroke Scale (NIHSS) Supplemental - Limb ataxia status NIHSSSupLimbAtaxiaStatus The indicator to determine if ataxia is present in the limbs The indicator to determine if ataxia is present in the limbs 0;1;2;UN Absent;Present in one limb;Present in two limbs;Amputation or joint fusion, explain Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C21498 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span backward subtest total raw score WAISIVDSBTtlScore Total raw score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest Total raw score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest Numeric Values Adult;Pediatric Supplemental 1.00 2015-07-22 11:32:44.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 16
C14462 Reflex plantar right response result RflxPlntrRtRespnsReslt The results from reflex plantar response on the right side The results from reflex plantar response on the right side Flexor;Extensor;Equivocal;Cannot Assess;Other, specify Flexor;Extensor;Equivocal;Cannot Assess;Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2012-10-05 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

DeBaun Forms
C10933 Imaging lesion found type ImgLesnFoundTyp Type of lesions found within the imaging study Type of lesions found within the imaging study Grey matter hyperintensity;Infarct;Malformation;Other, specify;WM hyperintensity Grey matter hyperintensity;Infarct;Malformation;Other, specify;WM hyperintensity Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C18611 Imaging field of view axis 2 measurement ImgFieldViewAxis2Measr Axis 2 of the image that is visible through the camera at a particular position in orientation and space in millimeters Axis 2 of the image that is visible through the camera at a particular position in orientation and space in millimeters Numeric Values Adult;Pediatric Supplemental 1.00 2013-09-12 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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millimeter
C13943 Imaging B-mode result ImgBModReslt Indicates B mode Indicates B mode Normal;Occlusion;Stenosis Normal;Occlusion;Stenosis Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C01052 Loss of consciousness indicator LOCInd The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). Yes;No;Suspected;Unknown Yes;No;Suspected;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C54693 PROMIS - Global Health carry out physical activity scale PROMISGlbHlthCrryOutPHysActScl Scale related to an individual's rating of his/her ability to carry out everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair, as part of the PROMIS Global Health Scale related to an individual's rating of his/her ability to carry out everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair, as part of the PROMIS Global Health 1;2;3;4;5;1;2;3;4;5 Excellent;Very good;Good;Fair;Poor;Excellent;Very good;Good;Fair;Poor Alphanumeric Adult;Pediatric Supplemental 1.00 2017-04-07 15:34:25.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C17524 Friedreich's Ataxia Rating Scale (FARS) - neurological exam peripheral deep tendon reflex ankle jerk right score FARSPNSNeuExDTenRAnkJRtScore Score for right-side ankle jerk in the peripheral nervous system section of the neurological exam, as part of the Friedreich's Ataxia Rating Scale (FARS). Score for right-side ankle jerk in the peripheral nervous system section of the neurological exam, as part of the Friedreich's Ataxia Rating Scale (FARS). 0;1;2;3;4;0;1;2;3;4;0;1;2;3;4 0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia;0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia;0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C01701 Lab specimen collection date and time LabSpecmnCollDateTime Date (and time if applicable and known) when the specimen was collected Date (and time if applicable and known) when the specimen was collected Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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2004004 DeBaun Forms LB LBDTC

Specimen Collection Date

Collection Date

What was the date of the lab specimen collection?

LBDTC Char Record the date when specimen collection was done using this format (DD-MON-YYYY). Prompt
C55781 Imaging statistical test significance level outline text ImagStatTestSigLevOutTxt Text outlining the statistical test(s) and significance levels for comparison between the test and control groups of the imaging study. Text outlining the statistical test(s) and significance levels for comparison between the test and control groups of the imaging study. Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-31 12:39:11.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

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C13889 Thrombolysis In Myocardial Infarction (TIMI) scale - global score TIMIScaleGlobalScore Indicates TIMI perfusion scale global score Indicates TIMI perfusion scale global score 0;1;2;3;0;1;2;3;0;1;2;3 No perfusion;Perfusion past the initial occlusion, but no distal branch filling;Perfusion with incomplete or slow distal branch filling;Full perfusion with filling of all distal branches;No perfusion;Perfusion past the initial occlusion, but no distal branch filling;Perfusion with incomplete or slow distal branch filling;Full perfusion with filling of all distal branches;No perfusion;Perfusion past the initial occlusion, but no distal branch filling;Perfusion with incomplete or slow distal branch filling;Full perfusion with filling of all distal branches Numeric values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C13194 Questionnaire for Verifying Stroke Free Status (QVSFS) - painless weakness status QVSFSPainlsWeaknsStatus Have you ever had sudden painless weakness on one side of your body? Have you ever had sudden painless weakness on one side of your body? Questionnaire for Verifying Stroke Free Status (QVSFS) No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
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