| Short Name: | nyu_family_history |
|---|---|
| Version: |
NYU Family History Form
NYU Family History Form as defined by the Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Centre, New York University Langone Medical Centre
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| ElementName | DataType | Size | Required | ElementDescription | ValueRange | Notes |
|---|---|---|---|---|---|---|
| subjectkey | GUID | Required | The NDAR Global Unique Identifier (GUID) for subjects which identifies a subject in NDAR | NDAR* | ||
| src_subject_id | String | 20 | Required | The site or study's subject identification | ||
| interview_date | Date | Required | Date on which the interview/genetic test/sampling/imaging was completed | Required field | ||
| 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 | |
| depression_familymember | String | 200 | Recommended | Subject family member who has depression | ||
| depression_maternal_paternal | String | 8 | Recommended | maternal or paternal family member with disorder | maternal; paternal | |
| depression_age_onset | Integer | Recommended | Age of family member at onset of disorder | |||
| depression_notes | String | 200 | Recommended | Notes | ||
| bipolar_familymember | String | 200 | Recommended | Subject family member who has bipolar disorder | ||
| bipolar_maternal_paternal | String | 8 | Recommended | maternal or paternal family member with disorder | maternal; paternal | |
| bipolar_age_onset | Integer | Recommended | Age of family member at onset of disorder | |||
| bipolar_notes | String | 200 | Recommended | Notes | ||
| anxiety_familymember | String | 200 | Recommended | Subject family member who has anxiety | ||
| anxiety_maternal_paternal | String | 8 | Recommended | maternal or paternal family member with disorder | maternal; paternal | |
| anxiety_age_onset | Integer | Recommended | Age of family member at onset of disorder | |||
| anxiety_notes | String | 200 | Recommended | Notes | ||
| ocd_familymember | String | 200 | Recommended | Subject family member who has ocd | ||
| ocd_maternal_paternal | String | 8 | Recommended | maternal or paternal family member with disorder | maternal; paternal | |
| ocd_age_onset | Integer | Recommended | Age of family member at onset of disorder | |||
| ocd_notes | String | 200 | Recommended | Notes | ||
| adhd_familymember | String | 200 | Recommended | Subject family member who has adhd | ||
| adhd_maternal_paternal | String | 8 | Recommended | maternal or paternal family member with disorder | maternal; paternal | |
| adhd_age_onset | Integer | Recommended | Age of family member at onset of disorder | |||
| adhd_notes | String | 200 | Recommended | Notes | ||
| eatingdisorder_familymember | String | 200 | Recommended | Subject family member who has an eating disorder | ||
| eatdisorder_maternal_paternal | String | 8 | Recommended | maternal or paternal family member with disorder | maternal; paternal | |
| eatingdisorder_age_onset | Integer | Recommended | Age of family member at onset of disorder | |||
| eatingdisorder_notes | String | 200 | Recommended | Notes | ||
| eccentric_familymember | String | 200 | Recommended | Subject family member who is considered eccentric | ||
| eccentric_maternal_paternal | String | 8 | Recommended | maternal or paternal family member with disorder | maternal; paternal | |
| eccentric_age_onset | Integer | Recommended | Age of family member at onset of eccentricity | |||
| eccentric_notes | String | 200 | Recommended | Notes | ||
| other_familymember | String | 200 | Recommended | Subject family member who has other disorder | ||
| other_maternal_paternal | String | 8 | Recommended | maternal or paternal family member with disorder | maternal; paternal | |
| other_familymember_age_onset | Integer | Recommended | Age of family member at onset of disorder | |||
| other_notes | String | 200 | Recommended | notes on other | ||
| gender | String | 50 | Required | Gender | M; F |
