| Short Name: | charge_medical_history |
|---|---|
| Version: |
CHARGE Medical History
CHARGE Medical History (May 2007) defined by the MIND Institute's CHARGE Study (CHildhood Autism Risks from Genetics and the Environment) at the University of California, Davis
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http://ndar.nih.gov/ndarpublicweb/Documents/CommonMeasures/CHARGE_Medical_History.pdf| ElementName | DataType | Size | Required | ElementDescription | ValueRange | Notes | Aliases |
|---|---|---|---|---|---|---|---|
| subjectkey | GUID | Required | The NDAR Global Unique Identifier (GUID) for subjects which identifies a subject in NDAR | NDAR* | GUID, SubjectKey_GUID | ||
| src_subject_id | String | 20 | Required | The site or study's subject identification | Charge_medicalhist_SRC_Subject_ID, IBISID, MedicalHx_SubjectID | ||
| interview_date | Date | Required | Date on which the interview/genetic test/sampling/imaging was completed | Required field | MedicalHx_interview_date, Date_taken, Charge_medicalhist_interview_date | ||
| interview_age | Integer | Required | Age in months at the time of the interview/test/sampling/imaging. | 0 :: 1200 | Age is rounded to chronological month If the research participant is 15 days old at time of interview the appropriate value would be 0 months if the participant is 16 days old the value would be 1 month | Candidate_Age_in_Months, Charge_medicalhist_interview_age | |
| comments_misc | String | 255 | Optional | Miscellaneous comments on study, interview, methodology relevant to this form data | Charge_medicalhist_comments_misc, med_psych_hist_q17_birth_defects, MedicalHx_misc_comments | ||
| diag_aofc | Integer | Recommended | Age of First Concern(in months) | 0 :: 1200 | Charge_medicalhist_diag_aofc, medicalhist_aofc | ||
| diag_aofcnk | String | 50 | Recommended | Age of First Concern - NK | Charge_medicalhist_diag_aofcnk | ||
| diag_fconcern | String | 255 | Recommended | First Concerns | Charge_medicalhist_diag_fconcern, medicalhist_firstconcern | ||
| diag_diagnosis | String | 255 | Recommended | Diagnosis | Autism; PDD-NOS; Asperger's; ADHD; Language Disorder; Other; None | medicalhist_diagnosis, Charge_medicalhist_diag_diagnosis | |
| diag_ageatdiag | Integer | Recommended | Age at diagnosis(in months) | 0 :: 1200 | -999 = Not known (NK) | Charge_medicalhist_diag_ageatdiag, medicalhist_age_at_diag | |
| diag_ageatdiagnk | String | 50 | Recommended | Age at diagnosis - NK | Charge_medicalhist_diag_ageatdiagnk | ||
| diag_diagnosismadeby | String | 50 | Recommended | Diagnosis made by | Physician; Psychologist; Other; NK | medicalhist_diagnosis_made_by, Charge_medicalhist_diag_diagnosismadeby | |
| postnatal_temp | String | 50 | Recommended | Temperament | Easy; Difficult/Irregular; Passive; NK | medicalhist_postnatal_temperament, Charge_medicalhist_postnatal_temp | |
| postnatal_eyecontact | String | 50 | Recommended | Eye Contact: | Normal; Difficult to Engage; NK | Charge_medicalhist_postnatal_eyecontact, medicalhist_postnatal_eyecontact | |
| postnatal_sleeppattern | String | 50 | Recommended | Sleep Pattern: | Regular/Predictable; Irregular/Unpredictable; NK; | medicalhist_postnatal_sleeppattern, Charge_medicalhist_postnatal_sleeppattern | |
| postnatal_feedbottle | String | 50 | Recommended | Feeding: Bottle | Yes; No | Charge_medicalhist_postnatal_feedbottle | |
| postnatal_feedbottleform | String | 255 | Recommended | Feeding: Formula | Charge_medicalhist_postnatal_feedbottleform, medicalhist_postnatal_feed_formula_type | ||
| postnatal_feedbr | String | 50 | Recommended | Feeding: Breast | Yes; No | Charge_medicalhist_postnatal_feedbr | |
| postnatal_feedbrlngth | Integer | Recommended | Feeding: Length | Charge_medicalhist_postnatal_feedbrlngth, medicalhist_postnatal_feedduration | |||
| postnatal_wtgainpoor | String | 50 | Recommended | Poor Weight Gain | Yes; No; NK | Charge_medicalhist_postnatal_wtgainpoor, medicalhist_postnatal_wtgainpoor | |
| postnatal_colic | String | 50 | Recommended | Colic/Difficult to Soothe | Yes; No; NK | medicalhist_postnatal_colic, Charge_medicalhist_postnatal_colic | |
| develop_grossm | String | 50 | Recommended | Gross Motor: | Early; Average; Late; NK | medicalhist_develop_grossm, Charge_medicalhist_develop_grossm | |
| develop_finem | String | 50 | Recommended | Fine Motor: | Early; Average; Late; NK | Charge_medicalhist_develop_finem, medicalhist_develop_finem | |
| develop_lang | String | 50 | Recommended | Language | Early; Average; Late; NK | Charge_medicalhist_develop_lang, medicalhist_develop_lang | |
| develop_social | String | 50 | Recommended | Social | Early; Average; Late; NK | Charge_medicalhist_develop_social, medicalhist_develop_social | |
| develop_selfhelp | String | 50 | Recommended | Self-Help | Early; Average; Late; NK | Charge_medicalhist_develop_selfhelp, medicalhist_develop_selfhelp | |
| develop_regression | String | 50 | Recommended | Developmental Regression: | Yes; No; NK | Charge_medicalhist_develop_regression, medicalhist_develop_regression | |
| develop_regressionage | Integer | Recommended | Age(In mnths) | 0 :: 1200 | medicalhist_develop_regressionage, Charge_medicalhist_develop_regressionage | ||
| develop_regressionskillloss | String | 255 | Recommended | Skills Lost | medicalhist_develop_regression_skill_loss, Charge_medicalhist_develop_regressionskillloss | ||
| currmed_prescription | String | 255 | Recommended | Prescription (Medication, Dose, Frequency, Reason) | tsi_med_his_q_5_medications_describe, medicalhist_currmed_prescription, Charge_medicalhist_currmed_prescription | ||
| currmed_overcounter | String | 255 | Recommended | Over the Counter (Medication, Dose, Frequency, Reason) | medicalhist_currmed_overcounter, Charge_medicalhist_currmed_overcounter | ||
| currmed_supplement | String | 255 | Recommended | Supplements (Herbal, Vitamin, etc.) (Supplement, Dose, Frequency, Reason) | Charge_medicalhist_currmed_supplement, medicalhist_currmed_supplement | ||
| rev_headmicroph | String | 50 | Recommended | Microcephaly | Yes; No; NK | NK=NOT KNOWN/UNKNOWN | Charge_medicalhist_rev_headmicroph, medicalhist_head_microph |
| rev_headmacroph | String | 50 | Recommended | Macrocephaly | Yes; No; NK | NK=NOT KNOWN/UNKNOWN | medicalhist_head_macroph, Charge_medicalhist_rev_headmacroph |
| rev_headstructab | String | 50 | Recommended | Structural abnormalities | Yes; No; NK | Charge_medicalhist_rev_headstructab, medicalhist_head_struct_ab | |
| rev_headstructabdesc | String | 255 | Recommended | Structural abnormalities: Describe | neuro_screen_q19_other_physical_abnormalities, medicalhist_head_struct_abdesc, Charge_medicalhist_rev_headstructabdesc | ||
| rev_headmeningitis | String | 50 | Recommended | Meningitis | Yes; No; NK | med_psych_hist_q16_has_child_ever, Charge_medicalhist_rev_headmeningitis, medicalhist_head_meningitits | |
| rev_headmeningitisage | Integer | Recommended | Meningitis: Age(in months) | 0 :: 1200 | medicalhist_head_meningitits_age, Charge_medicalhist_rev_headmeningitisage | ||
| rev_headmeningitisorg | String | 255 | Recommended | Meningitis: Organism | Charge_medicalhist_rev_headmeningitisorg, medicalhist_head_meningitits_org | ||
| rev_headencephalitis | String | 50 | Recommended | Encephalitis | Yes; No; NK | medicalhist_head_encephalitis, Charge_medicalhist_rev_headencephalitis | |
| rev_headencephalitisage | Integer | Recommended | Encephalitis: Age(in months) | 0 :: 1200 | medicalhist_head_encephalitis_age, Charge_medicalhist_rev_headencephalitisage | ||
| rev_headencephalitisorg | String | 255 | Recommended | Encephalitis: Organism | Charge_medicalhist_rev_headencephalitisorg, medicalhist_head_encephalitis_org | ||
| rev_headfebseiz | String | 50 | Recommended | Febrile Seizures | Yes; No; NK | medicalhist_head_feb_seiz, Charge_medicalhist_rev_headfebseiz, med_psych_hist_q15_c_fever_seizures | |
| rev_headfebseizages | String | 255 | Recommended | Febrile Seizures: Age(S) | Charge_medicalhist_rev_headfebseizages | ||
| rev_headseizure | String | 50 | Recommended | Seizures | Yes; No; NK | NK=NOT KNOWN/UNKNOWN | med_psych_hist_q15_seizures_convulsions, Charge_medicalhist_rev_headseizure, medicalhist_head_seizure |
| rev_headseizureonset | String | 255 | Recommended | Seizures: Onset | medicalhist_head_seizure_onset, Charge_medicalhist_rev_headseizureonset | ||
| rev_headseizurecontrol | String | 50 | Recommended | Seizures: Controlled | Yes; No; NK | Charge_medicalhist_rev_headseizurecontrol, medicalhist_head_seizure_control | |
| rev_headeeg | String | 50 | Recommended | EEG | Yes; No; NK | Charge_medicalhist_rev_headeeg, medicalhist_head_eeg | |
| rev_headeegresult | String | 255 | Recommended | EEG: Results | medicalhist_head_eeg_result, Charge_medicalhist_rev_headeegresult | ||
| rev_headimagestudy | String | 50 | Recommended | Imaging Studies | Yes; No; NK | Charge_medicalhist_rev_headimagestudy, medicalhist_head_image_study | |
| rev_headimagestudytype | String | 50 | Recommended | Imaging Studies: Type | US; CT; MR; PET; EEG | Charge_medicalhist_rev_headimagestudytype, medicalhist_head_image_studytype | |
| rev_headimagestudyresult | String | 255 | Recommended | Imaging Studies: Results | Normal; Abnormal | Charge_medicalhist_rev_headimagestudyresult, medicalhist_head_image_studyresult, tsi_med_his_q_8_brain_MRI_results | |
| rev_headother | String | 255 | Optional | Other/Comments | Charge_medicalhist_rev_headother, medicalhist_head_other | ||
| rev_eyeimpair | String | 50 | Recommended | Visual impairments | Yes; No; NK | medicalhist_eye_impair, Charge_medicalhist_rev_eyeimpair | |
| rev_eyestrabismus | String | 50 | Recommended | Strabismus | Yes; No; NK | medicalhist_eye_strabismus, Charge_medicalhist_rev_eyestrabismus | |
| rev_eyeoter | String | 255 | Optional | Other/Comments: | Charge_medicalhist_rev_eyeoter, medicalhist_eye_other | ||
| rev_eartest | String | 50 | Recommended | Hearing Testing: | Yes; No; NK | medicalhist_ear_test, Charge_medicalhist_rev_eartest | |
| rev_eartestages | String | 255 | Recommended | Hearing Testing: Age(S) | Charge_medicalhist_rev_eartestages | ||
| rev_eartestresult | String | 50 | Recommended | Hearing Testing: Result | Normal; Abnormal | medicalhist_ear_test_result, Charge_medicalhist_rev_eartestresult | |
| rev_eartestfinding | String | 255 | Recommended | Hearing Testing: Findings | medicalhist_ea_rtest_finding, audiology_test_results, Charge_medicalhist_rev_eartestfinding | ||
| rev_earab | String | 50 | Recommended | Ext. Ear Abnormalities | Yes; No; NK | Charge_medicalhist_rev_earab, medicalhist_ear_ext_abn | |
| rev_earabdesc | String | 255 | Recommended | Ext. Ear Abnormalities: Abnormalities | Charge_medicalhist_rev_earabdesc, medicalhist_ear_ext_abndesc | ||
| rev_earrecuotitis | String | 50 | Recommended | Recurrent Otitis Media | Yes; No; NK | Charge_medicalhist_rev_earrecuotitis, medicalhist_ear_recurrent_otitis | |
| rev_earrecuotitisyear | Integer | Recommended | Recurrent Otitis Media: #Year | Charge_medicalhist_rev_earrecuotitisyear | |||
| rev_earrecuotitisage | Integer | Recommended | Recurrent Otitis Media: Age of Onset(in months) | 0 :: 1200 | Charge_medicalhist_rev_earrecuotitisage, medicalhist_ear_recur_otitis_age | ||
| rev_earpetube | String | 50 | Recommended | PE Tubes | Yes; No; NK | Charge_medicalhist_rev_earpetube, medicalhist_ear_pe_tube | |
| rev_earpetubeset | String | 255 | Recommended | PE Tubes: Sets | Charge_medicalhist_rev_earpetubeset, medicalhist_ear_pe_tube_set | ||
| rev_earother | String | 255 | Optional | Other/Comments | medicalhist_ear_other, Charge_medicalhist_rev_earother | ||
| rev_nosesmellprob | String | 50 | Recommended | Problems with Smell | Yes; No; NK | medicalhist_nose_smell_prob, Charge_medicalhist_rev_nosesmellprob | |
| rev_noseother | String | 255 | Optional | Other/Comments | medicalhist_nose_other, Charge_medicalhist_rev_noseother | ||
| rev_mouthcleftlip | String | 50 | Recommended | Is there a cleft lip and/or cleft palate? | Yes; No; NK | Charge_medicalhist_rev_mouthcleftlip, medicalhist_mouth_cleftlip | |
| rev_mouthcleftpalate | String | 50 | Recommended | Cleft Palate | Yes; No; NK | medicalhist_mouth_cleftpalate, Charge_medicalhist_rev_mouthcleftpalate | |
| rev_mouthspeechdiff | String | 50 | Recommended | Speech Difficulties | Yes; No; NK | medicalhist_mouth_speechdiff, Charge_medicalhist_rev_mouthspeechdiff | |
| rev_mouthnasalreg | String | 50 | Recommended | Nasal Regurgitation | Yes; No; NK | Charge_medicalhist_rev_mouthnasalreg, medicalhist_mouth_nasalreg | |
| rev_mouthother | String | 255 | Optional | Other/Comments | medicalhist_mouth_other, Charge_medicalhist_rev_mouthother | ||
| rev_teethneonatal | String | 50 | Recommended | Neonatal Teeth | Yes; No; NK | Charge_medicalhist_rev_teethneonatal, medicalhist_teeth_neonatal | |
| rev_teethdentalab | String | 50 | Recommended | Dental abnormalities | Yes; No; NK | medicalhist_teeth_dental_ab, Charge_medicalhist_rev_teethdentalab | |
| rev_teethdentalabdesc | String | 255 | Recommended | Dental abnormalities: Describe | Charge_medicalhist_rev_teethdentalabdesc, medicalhist_teeth_dental_abdesc | ||
| rev_teethdentalabother | String | 255 | Optional | Other/Comments | Charge_medicalhist_rev_teethdentalabother, medicalhist_teeth_dental_abother | ||
| rev_neckspinalab | String | 50 | Recommended | Spinal abnormalities | Yes; No; NK | medicalhist_neck_spinal_ab, Charge_medicalhist_rev_neckspinalab | |
| rev_neckother | String | 255 | Optional | Other/Comments | medicalhist_neck_other, Charge_medicalhist_rev_neckother | ||
| rev_orthofracture | String | 50 | Recommended | Fractures | Yes; No; NK | medicalhist_ortho_fracture, Charge_medicalhist_rev_orthofracture | |
| rev_orthofractureno | Integer | Recommended | Fractures: Number | medicalhist_ortho_fractureno, Charge_medicalhist_rev_orthofractureno | |||
| rev_orthofractureloc | String | 255 | Recommended | Fractures: Location | Charge_medicalhist_rev_orthofractureloc | ||
| rev_orthojointdislocate | String | 50 | Recommended | Joint Dislocation | Yes; No; NK | Charge_medicalhist_rev_orthojointdislocate, medicalhist_ortho_joint_dislocate | |
| rev_orthojointdislocatelist | String | 255 | Recommended | Joint Dislocation: Joints | Charge_medicalhist_rev_orthojointdislocatelist | ||
| rev_orthoosteomylitis | String | 50 | Recommended | Osteomylitis | Yes; No; NK | medicalhist_ortho_osteomylitis, Charge_medicalhist_rev_orthoosteomylitis | |
| rev_orthoother | String | 255 | Optional | Other/Comments | Charge_medicalhist_rev_orthoother, medicalhist_ortho_other | ||
| rev_skinbirthmark | String | 50 | Recommended | Birthmarks (e.g., café-au-lait spots, white spots) | Yes; No; NK | medicalhist_skin_birthmark, Charge_medicalhist_rev_skinbirthmark | |
| rev_skineczema | String | 50 | Recommended | Eczema | Yes; No; NK | Charge_medicalhist_rev_skineczema, medicalhist_skin_eczema | |
| rev_skinabcesses | String | 50 | Recommended | Skin Infections/Abcesses | Yes; No; NK | Charge_medicalhist_rev_skinabcesses, medicalhist_skin_abcesses | |
| rev_skinabcessesnumtreat | String | 255 | Recommended | Skin Infections/Abcesses: Number/Treatment | medicalhist_skin_abcesses_num_treat, Charge_medicalhist_rev_skinabcessesnumtreat | ||
| rev_skinother | String | 255 | Optional | Other/Comments | medicalhist_skin_other, Charge_medicalhist_rev_skinother | ||
| rev_pulbreathab | String | 50 | Recommended | Abnormal Breathing | Yes; No; NK | Charge_medicalhist_rev_pulbreathab, medicalhist_pulm_breath_ab | |
| rev_pulasthma | String | 50 | Recommended | Asthma | Yes; No; NK | Charge_medicalhist_rev_pulasthma, medicalhist_pulm_asthma | |
| rev_pulasthmatrigg | String | 255 | Recommended | Asthma: Triggers | Charge_medicalhist_rev_pulasthmatrigg, medicalhist_pulm_asthma_trigg | ||
| rev_pullungmalfunc | String | 50 | Recommended | Lung Malformations | Yes; No; NK | medicalhist_pulm_lung_malfunc, Charge_medicalhist_rev_pullungmalfunc | |
| rev_pulpneumoniafreq | String | 50 | Recommended | Frequent Pneumonia | Yes; No; NK | Charge_medicalhist_rev_pulpneumoniafreq, medicalhist_pulm_pneumonia_freq | |
| rev_pulpneumoniafreqages | String | 255 | Recommended | Frequent Pneumonia: Ages(S) | medicalhist_pulm_pneumonia_freq_onset, Charge_medicalhist_rev_pulpneumoniafreqages | ||
| rev_pulaspiration | String | 50 | Recommended | Aspiration | Yes; No; NK | medicalhist_pulm_aspiration, Charge_medicalhist_rev_pulaspiration | |
| rev_pulother | String | 255 | Optional | Other/Comments | Charge_medicalhist_rev_pulother, medicalhist_pulm_other | ||
| rev_cardiomalfunc | String | 50 | Recommended | Cardiac Malformation | Yes; No; NK | medicalhist_cardio_malform, Charge_medicalhist_rev_cardiomalfunc | |
| rev_cardiomalfunclesion | String | 255 | Recommended | Cardiac Malformation: Lesion | medicalhist_cardio_malform_lesion, Charge_medicalhist_rev_cardiomalfunclesion | ||
| rev_cardiocyanosis | String | 50 | Recommended | Cyanosis | Yes; No; NK | medicalhist_cardio_cyanosis, Charge_medicalhist_rev_cardiocyanosis | |
| rev_cardioother | String | 255 | Optional | Other/Comments | medicalhist_cardio_other, Charge_medicalhist_rev_cardioother | ||
| rev_gastrodysphagia | String | 50 | Recommended | Dysphagia | Yes; No; NK | medicalhist_gastro_dysphagia, Charge_medicalhist_rev_gastrodysphagia | |
| rev_gastroreflux | String | 50 | Recommended | Reflux | Yes; No; NK | Charge_medicalhist_rev_gastroreflux, medicalhist_gastro_reflux | |
| rev_gastrorefluxmed | String | 50 | Recommended | Reflux: Medication Required | Yes; No; NK | Charge_medicalhist_rev_gastrorefluxmed, medicalhist_gastro_reflux_med | |
| rev_gastroother | String | 50 | Recommended | Other feeding difficulties | Yes; No; NK | medicalhist_gastro_other, Charge_medicalhist_rev_gastroother | |
| rev_gastrohernia | String | 50 | Recommended | Hernia | Yes; No; NK | medicalhist_gastro_hernia, Charge_medicalhist_rev_gastrohernia | |
| rev_gastroherniatype | String | 255 | Recommended | Hernia: Type | medicalhist_gastro_hernia_type, Charge_medicalhist_rev_gastroherniatype | ||
| rev_gastroothercom | String | 255 | Optional | Other/comments | Charge_medicalhist_rev_gastroothercom, medicalhist_gastro_other_com | ||
| rev_genitorenalmalfunc | String | 50 | Recommended | Renal Malformation | Yes; No; NK | Charge_medicalhist_rev_genitorenalmalfunc, medicalhist_genito_rena_lmalfunc | |
| rev_genitorenalmalfunctype | String | 255 | Recommended | Renal Malformation: Type | Charge_medicalhist_rev_genitorenalmalfunctype, medicalhist_genito_rena_lmalfunctype | ||
| rev_genitouti | String | 50 | Recommended | UTI | Yes; No; NK | Charge_medicalhist_rev_genitouti, medicalhist_genito_uti | |
| rev_genitoutinum | Integer | Recommended | UTI: Number | Charge_medicalhist_rev_genitoutinum, medicalhist_genito_utinum | |||
| rev_genitourinediscolor | String | 50 | Recommended | Discolored Urine | Yes; No; NK | Charge_medicalhist_rev_genitourinediscolor, medicalhist_genitourinediscolor | |
| rev_genitourinediscolorage | Integer | Recommended | Discolored Urine: Age(in months) | 0 :: 1200 | Charge_medicalhist_rev_genitourinediscolorage, medicalhist_genito_discolor_urine_age1 | ||
| rev_genitourinecolor | String | 50 | Recommended | Discolored Urine: Color | medicalhist_genito_urine_color1, Charge_medicalhist_rev_genitourinecolor | ||
| rev_genitocryptorchidism | String | 50 | Recommended | Cryptorchidism | Yes; No; NK | Charge_medicalhist_rev_genitocryptorchidism, medicalhist_genito_cryptorchidism | |
| rev_genitocryptorchidismtype | String | 50 | Recommended | Cryptorchidism: Type | Left; Right; Bilateral | Charge_medicalhist_rev_genitocryptorchidismtype, medicalhist_genito_cryptorchidism_loc | |
| rev_genitoother | String | 255 | Optional | Other/comments | Charge_medicalhist_rev_genitoother, medicalhist_genito_other | ||
| rev_endoprecocious | String | 50 | Recommended | Precocious Puberty | Yes; No; NK | medicalhist_endo_precocious, Charge_medicalhist_rev_endoprecocious | |
| rev_endoprecociousage | Integer | Recommended | Precocious Puberty: Age(in months) | 0 :: 1200 | Charge_medicalhist_rev_endoprecociousage, medicalhist_endo_precocious_age | ||
| rev_endohypothyroidism | String | 50 | Recommended | Hypothyroidism | Yes; No; NK | medicalhist_endo_hypothyroidism, Charge_medicalhist_rev_endohypothyroidism | |
| rev_endohyperthyroidism | String | 50 | Recommended | Hyperthyroidism | Yes; No; NK | medicalhist_endo_hyperthyroidism, Charge_medicalhist_rev_endohyperthyroidism | |
| rev_endoobesity | String | 50 | Recommended | Obesity | Yes; No; NK | Charge_medicalhist_rev_endoobesity, medicalhist_endo_obesity | |
| rev_endodiabetes | String | 50 | Recommended | Diabetes | Yes; No; NK | medicalhist_endo_diabetes, Charge_medicalhist_rev_endodiabetes | |
| rev_endodiabetestype | String | 50 | Recommended | Diabetes: Type | I; II | medicalhist_endo_diabetes_type, Charge_medicalhist_rev_endodiabetestype | |
| rev_endodiabetesage | Integer | Recommended | Diabetes: Age(in months) | 0 :: 1200 | medicalhist_endo_diabetes_age, Charge_medicalhist_rev_endodiabetesage | ||
| rev_endopancreasinsuff | String | 50 | Recommended | Pancreatic Insufficiency | Yes; No; NK | medicalhist_endo_pancreas_insuff, Charge_medicalhist_rev_endopancreasinsuff | |
| rev_endohypoglycemia | String | 50 | Recommended | Hypoglycemia | Yes; No; NK | medicalhist_endo_hypoglycemia, Charge_medicalhist_rev_endohypoglycemia | |
| rev_endoother | String | 255 | Optional | Other/comments | Charge_medicalhist_rev_endoother, medicalhist_endo_other | ||
| rev_hemanemia | String | 50 | Recommended | Anemia | Yes; No; NK | Charge_medicalhist_rev_hemanemia, medicalhist_hem_anemia | |
| rev_hemanemiatype | String | 255 | Recommended | Anemia: Type | Charge_medicalhist_rev_hemanemiatype, medicalhist_hem_anemia_type | ||
| rev_hembleeddisorder | String | 50 | Recommended | Bleeding disorder | Yes; No; NK | Charge_medicalhist_rev_hembleeddisorder, medicalhist_hem_bleed_disorder | |
| rev_hembleeddisordertype | String | 255 | Recommended | Bleeding disorder: Type | Charge_medicalhist_rev_hembleeddisordertype, medicalhist_hem_bleed_disorder_type | ||
| rev_immunorecurinfection | String | 50 | Recommended | Recurrent Infections((>2 pneum or sinus infect/yr, >8 OM /yr, absesses)) | Yes; No; NK | medicalhist_immuno_recur_infection, Charge_medicalhist_rev_immunorecurinfection | |
| rev_immunosepsis | String | 50 | Recommended | Sepsis | Yes; No; NK | medicalhist_immuno_sepsis, Charge_medicalhist_rev_immunosepsis | |
| rev_immunosepsisage | Integer | Recommended | Sepsis: Age(in months) | 0 :: 1200 | medicalhist_immuno_sepsis_age, Charge_medicalhist_rev_immunosepsisage | ||
| rev_immunosepsisorg | String | 255 | Recommended | Sepsis: Organism | medicalhist_immuno_sepsis_org, Charge_medicalhist_rev_immunosepsisorg | ||
| rev_immunoosteo | String | 50 | Recommended | Osteomyelitis | Yes; No; NK | medicalhist_immuno_osteo, Charge_medicalhist_rev_immunoosteo | |
| rev_immunoosteoage | Integer | Recommended | Osteomyelitis: Age(in months) | 0 :: 1200 | Charge_medicalhist_rev_immunoosteoage, medicalhist_immuno_osteo_age | ||
| rev_immunoosteoloc | String | 255 | Recommended | Osteomyelitis: Location | medicalhist_immuno_osteo_loc, Charge_medicalhist_rev_immunoosteoloc | ||
| rev_immunoosteolocorg | String | 255 | Recommended | Osteomyelitis: Organism | Charge_medicalhist_rev_immunoosteolocorg, medicalhist_immuno_osteo_org | ||
| rev_immunoigdeficiency | String | 50 | Recommended | Ig Deficiency | Yes; No; NK | Charge_medicalhist_rev_immunoigdeficiency, medicalhist_immuno_ig_deficiency | |
| rev_immunocellimmunedef | String | 50 | Recommended | Cell Mediated Immune Def. | Yes; No; NK | medicalhist_immuno_cell_mediate_def, Charge_medicalhist_rev_immunocellimmunedef | |
| rev_immunoenvallergy | String | 50 | Recommended | Environmental Allergies | Yes; No; NK | Charge_medicalhist_rev_immunoenvallergy, medicalhist_immuno_env_allergy | |
| rev_immunoenvallergytype | String | 255 | Recommended | Environmental Allergies: Type | Charge_medicalhist_rev_immunoenvallergytype, medicalhist_immuno_env_allergy_type | ||
| rev_immunomedallergy | String | 50 | Recommended | Medication Allergies | Yes; No; NK | medicalhist_immuno_med_allergy, Charge_medicalhist_rev_immunomedallergy, tsi_med_his_q_6_allergies | |
| rev_immunomedallergymed | String | 255 | Recommended | Medication Allergies: Medications | Charge_medicalhist_rev_immunomedallergymed, tsi_med_his_q_6_allergies_describe, medicalhist_immuno_med_allergy_med1 | ||
| rev_immunoimmunization | String | 50 | Recommended | Immunizations | Up to date; Behind; None; NK | Charge_medicalhist_rev_immunoimmunization, medicalhist_immuno_immunization_status | |
| rev_immunoimmunizdtap | String | 255 | Recommended | DTaP | Up to date; Behind; None; NK | Charge_medicalhist_rev_immunoimmunizdtap, medicalhist_immuno_immuniz_DTap | |
| rev_immunoimmunizipv | String | 255 | Recommended | Immunizations: IPV | Up to date; Behind; None; NK | Charge_medicalhist_rev_immunoimmunizipv, medicalhist_immuno_immuniz_IPV | |
| rev_immunoimmunizhib | String | 255 | Recommended | Immunizations: HIB | Up to date; Behind; None; NK | medicalhist_immuno_immuniz_HIB, Charge_medicalhist_rev_immunoimmunizhib | |
| rev_immunoimmunizmmr | String | 255 | Recommended | Immunizations: MMR | Up to date; Behind; None; NK | Charge_medicalhist_rev_immunoimmunizmmr, medicalhist_immuno_immuniz_MMR | |
| rev_immunoimmunizhepb | String | 255 | Recommended | Immunizations: HepB | Up to date; Behind; None; NK | Charge_medicalhist_rev_immunoimmunizhepb, medicalhist_immuno_immuniz_HepB | |
| rev_immunoimmunizhepa | String | 255 | Recommended | Immunizations: HepA | Up to date; Behind; None; NK | Charge_medicalhist_rev_immunoimmunizhepa, medicalhist_immuno_immuniz_HepA | |
| rev_immunoimmunizvari | String | 255 | Recommended | Immunizations: Varicella | Up to date; Behind; None; NK | Charge_medicalhist_rev_immunoimmunizvari, medicalhist_immuno_immuniz_Vari | |
| rev_immunoimmunizprev | String | 255 | Recommended | Immunizations: Prevnar | Up to date; Behind; None; NK | medicalhist_immuno_immuniz_Prev, Charge_medicalhist_rev_immunoimmunizprev | |
| rev_immunoinfluenzvacc | String | 255 | Recommended | Influenza Vaccines | Yes; No; NK; None | medicalhist_immuno_influenz_vacc, Charge_medicalhist_rev_immunoinfluenzvacc | |
| rev_immunoinfluenzvacc1d | Integer | Recommended | Influenza Vaccine 1 Day | Charge_medicalhist_rev_immunoinfluenzvacc1d, medicalhist_immuno_influenz_vacc1d | |||
| rev_immunoinfluenzvacc1m | Integer | Recommended | Influenza Vaccine 1 Month | Charge_medicalhist_rev_immunoinfluenzvacc1m, medicalhist_immuno_influenz_vacc1m | |||
| rev_immunoinfluenzvacc1y | Integer | Recommended | Influenza Vaccine 1 Year | medicalhist_immuno_influenz_vacc1y, Charge_medicalhist_rev_immunoinfluenzvacc1y | |||
| rev_immunoinfluenzvacc2d | Integer | Recommended | Influenza Vaccine 2 Day | medicalhist_immuno_influenz_vacc2d, Charge_medicalhist_rev_immunoinfluenzvacc2d | |||
| rev_immunoinfluenzvacc2m | Integer | Recommended | Influenza Vaccine 2 Month | Charge_medicalhist_rev_immunoinfluenzvacc2m, medicalhist_immuno_influenz_vacc2m | |||
| rev_immunoinfluenzvacc2y | Integer | Recommended | Influenza Vaccine 2 Year | medicalhist_immuno_influenz_vacc2y, Charge_medicalhist_rev_immunoinfluenzvacc2y | |||
| rev_immunoinfluenzvacc3d | Integer | Recommended | Influenza Vaccine 3 Day | medicalhist_immuno_influenz_vacc3d, Charge_medicalhist_rev_immunoinfluenzvacc3d | |||
| rev_immunoinfluenzvacc3m | Integer | Recommended | Influenza Vaccine 3 Month | Charge_medicalhist_rev_immunoinfluenzvacc3m, medicalhist_immuno_influenz_vacc3m | |||
| rev_immunoinfluenzvacc3y | Integer | Recommended | Influenza Vaccine 3 Year | Charge_medicalhist_rev_immunoinfluenzvacc3y, medicalhist_immuno_influenz_vacc3y | |||
| rev_immunoinfluenzvacc4d | Integer | Recommended | Influenza Vaccine 4 Day | medicalhist_immuno_influenz_vacc4d, Charge_medicalhist_rev_immunoinfluenzvacc4d | |||
| rev_immunoinfluenzvacc4m | Integer | Recommended | Influenza Vaccine 4 Month | Charge_medicalhist_rev_immunoinfluenzvacc4m, medicalhist_immuno_influenz_vacc4m | |||
| rev_immunoinfluenzvacc4y | Integer | Recommended | Influenza Vaccine 4 Year | medicalhist_immuno_influenz_vacc4y, Charge_medicalhist_rev_immunoinfluenzvacc4y | |||
| rev_immunoinfluenzvacc5d | Integer | Recommended | Influenza Vaccine 5 Day | medicalhist_immuno_influenz_vacc5d, Charge_medicalhist_rev_immunoinfluenzvacc5d | |||
| rev_immunoinfluenzvacc5m | Integer | Recommended | Influenza Vaccine 5 Month | medicalhist_immuno_influenz_vacc5m, Charge_medicalhist_rev_immunoinfluenzvacc5m | |||
| rev_immunoinfluenzvacc5y | Integer | Recommended | Influenza Vaccine 5 Year | Charge_medicalhist_rev_immunoinfluenzvacc5y, medicalhist_immuno_influenz_vacc5y | |||
| rev_immunoinfluenzvacc1_h1n1 | String | 15 | Recommended | Indicate the whether the vaccine given was the H1N1 vaccine | Yes; No | Charge_medicalhist_rev_immunoinfluenzvacc1_h1n1 | |
| rev_immunoinfluenzvacc2_h1n1 | String | 15 | Recommended | indicate whether the vaccine given was the H1N1 vaccine | Yes; No | Charge_medicalhist_rev_immunoinfluenzvacc2_h1n1 | |
| rev_immunoinfluenzvacc3_h1n1 | String | 15 | Recommended | Indicate whether the vaccine given was the H1N1 vaccine | Yes; No | Charge_medicalhist_rev_immunoinfluenzvacc3_h1n1 | |
| rev_immunoinfluenzvacc4_h1n1 | String | 15 | Recommended | Indicate whether the vaccine given was the H1N1 vaccine | Yes; No | Charge_medicalhist_rev_immunoinfluenzvacc4_h1n1 | |
| rev_immunoinfluenzvacc5_h1n1 | String | 15 | Recommended | Indicate whether the vaccine given was the H1N1 vaccine | Yes; No | Charge_medicalhist_rev_immunoinfluenzvacc5_h1n1 | |
| gender | String | 50 | Required | Gender | M; F |
