|
subjectkey |
GUID |
|
Required |
The NDAR Global Unique Identifier (GUID) for research subject |
NDAR*
|
|
|
|
src_subject_id |
String |
20
|
Required |
Subject ID how it's defined in lab/project |
|
|
|
|
sex |
String |
20
|
Required |
Sex of subject at birth |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
gender |
|
grade |
String |
50
|
Recommended |
Current Grade |
|
|
|
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
|
Query
|
hispanic |
Integer |
|
Recommended |
Is subject of Hispanic, Latino, or Spanish origin? |
0; 1; 999
|
0 = No; 1 = Yes; 999= missing
|
|
|
race |
String |
30
|
Recommended |
Race of study subject |
American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported; Other Non-White; Other
|
|
|
|
race_other |
String |
100
|
Recommended |
Race of Respondent Specify |
|
|
|
|
part_education |
String |
100
|
Recommended |
Participant's Current Education Level |
Day care;Nursery;Preschool;Kindergarten;Elementary School;Secondary School;Other
|
|
|
|
mv_household_income |
String |
100
|
Recommended |
Total Household Income Last Year |
Less than $9,999;Between $10,000 and $19,999;Between $20,000 and $29,999;Between $30,000 and $39,999;Between $40,000 and $49,999;Between $50,000 and $59,999;Between $60,000 and $69,999;Between $70,000 and $79,999;Between $80,000 and $89,999;Between $90,000 and $99,999;Over $100,000
|
|
|
|
cg1_gender |
String |
10
|
Recommended |
Caregiver/Parent 1's Gender |
Male;Female
|
|
|
|
cg1_relation_status |
String |
100
|
Recommended |
Caregiver/Parent 1's Relationship Status |
|
|
|
|
cg1_relation_status_specify |
String |
100
|
Recommended |
Caregiver/Parent 1's Relationship Status Other Specify |
|
|
|
|
cg1_relationship |
String |
100
|
Recommended |
Caregiver/Parent 1's Relationship to Participant |
|
Parent;Step-parent;Foster parent;Grandparent;Other family member;Other; Biological Mother; Biological Father; Biological Parent; Adoptive Parent; Adoptive/Foster Parent; I do not wish to disclose; Step-father; Step-mother
|
|
|
cg1_relationship_specify |
String |
100
|
Recommended |
Caregiver/Parent 1's Relationship to Participant Other Specify |
|
|
|
|
cg1_guardian |
String |
10
|
Recommended |
Caregiver/Parent 1. Is this the Participant's Custodian/Legal Guardian? |
|
|
|
|
cg1_cohabitate |
String |
10
|
Recommended |
Caregiver/Parent 1. Does the participant live with this custodian? |
|
|
|
|
cg1_race |
String |
100
|
Recommended |
Race of the Caregiver/Parent 1 |
American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported
|
|
|
|
cg1_race_specify |
String |
100
|
Recommended |
Race of the Caregiver/Parent 1 Other Specify |
|
|
|
|
cg1_education |
String |
100
|
Recommended |
Caregiver/Prent 1's Highest Level of Education |
|
Some primary school;Some high school;High school diploma;GED;Some college or technical school;Associate degree;Baccalaureate degree;Graduate or professional degree; did not graduate from high school; college graduate; Middle School
|
|
|
cg1_occupation |
String |
100
|
Recommended |
Caregiver/Parent 1's Occupation |
|
|
|
Query
|
num_in_house_adults |
Integer |
|
Recommended |
Number of Individuals in Household Adults |
|
|
|
Query
|
num_in_house_kids |
Integer |
|
Recommended |
Number of Individuals in Household Children |
|
|
|
|
nih_mom_hispanic |
String |
10
|
Recommended |
Biological Parents Not in Household - Is the Mother of Hispanic or Latino Origin? |
|
|
|
|
nih_mom_race |
String |
100
|
Recommended |
Biological Parents Not in Household - Mother's Race |
American Indian or Alaskan Native;Asian;Pacific Islander;Black or African American;White;Other
|
|
|
|
nih_mom_race_specify |
String |
100
|
Recommended |
Biological Parents Not in Household - Mother's Race Other Specify |
|
|
|
|
nih_dad_hispanic |
String |
10
|
Recommended |
Biological Parents Not in Household - Is the Father of Hispanic or Latino Origin? |
|
|
|
|
nih_dad_race |
String |
100
|
Recommended |
Biological Parents Not in Household - Father's Race |
American Indian or Alaskan Native;Asian;Pacific Islander;Black or African American;White;Other
|
|
|
|
nih_dad_race_specify |
String |
100
|
Recommended |
Biological Parents Not in Household - Father's Race Other Specify |
|
|
|
|
cg2_relationship |
String |
100
|
Recommended |
Caregiver/Parent 2's Relationship to Participant |
|
Parent;Step-parent;Foster parent;Grandparent;Other family member;Other; Biological Mother; Biological Father; Biological Parent; Adoptive Parent; Adoptive/Foster Parent; I do not wish to disclose; Step-father; Step-mother
|
|
|
cg2_relationship_specify |
String |
100
|
Recommended |
Caregiver/Parent 2's Relationship to Participant Other Specify |
|
|
|
|
cg2_guardian |
String |
10
|
Recommended |
Caregiver/Parent 2. Is this the Participant's Custodian/Legal Guardian? |
|
|
|
|
cg2_hispanic |
String |
10
|
Recommended |
Is Caregiver/Parent 2 of Hispanic or Latino Origin? |
|
|
|
|
cg2_race |
String |
100
|
Recommended |
Race of the Caregiver/Parent 2 |
American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported
|
|
|
|
cg1_cg2_relationship |
String |
100
|
Recommended |
Relationship of Caregiver/Parent 2 to Caregiver/Parent 1 |
Spouse;In a relationship, unmarried;Other
|
|
|
|
cg1_cg2_relationship_specify |
String |
100
|
Recommended |
Relationship of Caregiver/Parent 2 to Caregiver/Parent 1 Other Specify |
|
|
|
|
cg2_relation_status |
String |
100
|
Recommended |
Caregiver/Parent 2's Relationship Status |
Married;Never married;Widowed;Divorced and remarried;Separated;Divorced;Widowed and remarried;Other; Living with Partner
|
|
|
|
cg2_relation_status_specify |
String |
100
|
Recommended |
Caregiver/Parent 2's Relationship Status Other Specify |
|
|
|
|
cg2_education |
String |
100
|
Recommended |
Caregiver/Parent 2's Highest Level of Education |
|
Some primary school;Some high school;High school diploma;GED;Some college or technical school;Associate degree;Baccalaureate degree;Graduate or professional degree; did not graduate from high school; college graduate; Middle School
|
|
|
cg2_occupation |
String |
100
|
Recommended |
Caregiver/Parent 2's Occupation |
|
|
|
|
child1_age |
String |
100
|
Recommended |
Other Child in Household 1 Age |
|
0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
|
|
|
child1_gender |
String |
10
|
Recommended |
Other Child in Household 1 Gender |
Male;Female;Other
|
|
|
|
child1_education |
String |
100
|
Recommended |
Other Child in Household 1 School Level |
Pre-school;Elementary;Jr high/middle;High school;Post-HS
|
|
|
|
child1_handedness |
String |
100
|
Recommended |
Other Child in Household 1 Handedness |
Left-handed;Right-handed
|
|
|
|
child1_proband_relationship |
String |
100
|
Recommended |
Other Child in Household 1 Relationship to Participant |
Sibling;Half-sibling;Other relative;Not related
|
|
|
|
child2_age |
String |
100
|
Recommended |
Other Child in Household 2 Age |
|
0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
|
|
|
child2_gender |
String |
10
|
Recommended |
Other Child in Household 2 Gender |
Male;Female;Other
|
|
|
|
child2_education |
String |
100
|
Recommended |
Other Child in Household 2 School Level |
Pre-school;Elementary;Jr high/middle;High school;Post-HS
|
|
|
|
child2_handedness |
String |
100
|
Recommended |
Other Child in Household 2 Handedness |
Left-handed;Right-handed
|
|
|
|
child2_proband_relationship |
String |
100
|
Recommended |
Other Child in Household 2 Relationship to Participant |
Sibling;Half-sibling;Other relative;Not related
|
|
|
|
child3_age |
String |
100
|
Recommended |
Other Child in Household 3 Age |
|
0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
|
|
|
child3_gender |
String |
10
|
Recommended |
Other Child in Household 3 Gender |
Male;Female;Other
|
|
|
|
child3_education |
String |
100
|
Recommended |
Other Child in Household 3 School Level |
Pre-school;Elementary;Jr high/middle;High school;Post-HS
|
|
|
|
child3_handedness |
String |
100
|
Recommended |
Other Child in Household 3 Handedness |
Left-handed;Right-handed
|
|
|
|
child3_proband_relationship |
String |
100
|
Recommended |
Other Child in Household 3 Relationship to Participant |
Sibling;Half-sibling;Other relative;Not related
|
|
|
|
child4_age |
String |
100
|
Recommended |
Other Child in Household 4 Age |
|
0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
|
|
|
child4_gender |
String |
10
|
Recommended |
Other Child in Household 4 Gender |
Male;Female;Other
|
|
|
|
child4_education |
String |
100
|
Recommended |
Other Child in Household 4 School Level |
Pre-school;Elementary;Jr high/middle;High school;Post-HS
|
|
|
|
child4_handedness |
String |
100
|
Recommended |
Other Child in Household 4 Handedness |
Left-handed;Right-handed
|
|
|
|
child4_proband_relationship |
String |
100
|
Recommended |
Other Child in Household 4 Relationship to Participant |
Sibling;Half-sibling;Other relative;Not related
|
|
|
|
child5_age |
String |
100
|
Recommended |
Other Child in Household 5 Age |
|
0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
|
|
|
child5_gender |
String |
10
|
Recommended |
Other Child in Household 5 Gender |
Male;Female;Other
|
|
|
|
child5_education |
String |
100
|
Recommended |
Other Child in Household 5 School Level |
Pre-school;Elementary;Jr high/middle;High school;Post-HS
|
|
|
|
child5_handedness |
String |
100
|
Recommended |
Other Child in Household 5 Handedness |
Left-handed;Right-handed
|
|
|
|
child5_proband_relationship |
String |
100
|
Recommended |
Other Child in Household 5 Relationship to Participant |
Sibling;Half-sibling;Other relative;Not related
|
|
|
|
child6_age |
String |
100
|
Recommended |
Other Child in Household 6 Age |
|
0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
|
|
|
child6_gender |
String |
10
|
Recommended |
Other Child in Household 6 Gender |
Male;Female;Other
|
|
|
|
child6_education |
String |
100
|
Recommended |
Other Child in Household 6 School Level |
Pre-school;Elementary;Jr high/middle;High school;Post-HS
|
|
|
|
child6_handedness |
String |
100
|
Recommended |
Other Child in Household 6 Handedness |
Left-handed;Right-handed
|
|
|
|
child6_proband_relationship |
String |
100
|
Recommended |
Other Child in Household 6 Relationship to Participant |
Sibling;Half-sibling;Other relative;Not related
|
|
|
|
child7_age |
String |
100
|
Recommended |
Other Child in Household 7 Age |
|
0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
|
|
|
child7_gender |
String |
10
|
Recommended |
Other Child in Household 7 Gender |
Male;Female
|
|
|
|
child7_education |
String |
100
|
Recommended |
Other Child in Household 7 School Level |
Pre-school;Elementary;Jr high/middle;High school;Post-HS
|
|
|
|
child7_handedness |
String |
100
|
Recommended |
Other Child in Household 7 Handedness |
Left-handed;Right-handed
|
|
|
|
child7_proband_relationship |
String |
100
|
Recommended |
Other Child in Household 7 Relationship to Participant |
Sibling;Half-sibling;Other relative;Not related
|
|
|
|
function_use_head |
String |
100
|
Recommended |
Does participant have functional use of head |
Normal use;Some Use/Functional Use;No Functional Use
|
|
|
|
function_use_hands |
String |
100
|
Recommended |
Does participant have functional use of hands |
Normal use;Some Use/Functional Use;No Functional Use
|
|
|
|
function_use_arms |
String |
100
|
Recommended |
Does participant have functional use of arms |
Normal use;Some Use/Functional Use;No Functional Use
|
|
|
|
function_use_torso |
String |
100
|
Recommended |
Does participant have functional use of torso |
Normal use;Some Use/Functional Use;No Functional Use
|
|
|
|
function_use_legs |
String |
100
|
Recommended |
Does participant have functional use of legs |
Normal use;Some Use/Functional Use;No Functional Use
|
|
|
|
function_use_feet |
String |
100
|
Recommended |
Does participant have functional use of feet |
Normal use;Some Use/Functional Use;No Functional Use
|
|
|
|
function_use_vision |
String |
100
|
Recommended |
Does participant have functional use of vision |
Normal use;Some Use/Functional Use;No Functional Use
|
|
|
|
function_use_hearing |
String |
100
|
Recommended |
Does participant have functional use of hearing |
Normal use;Some Use/Functional Use;No Functional Use
|
|
|
Query
|
premature_weeks |
Integer |
|
Recommended |
Weeks premature |
|
0 = Full term
|
|
Query
|
birth_weight_lbs |
Float |
|
Recommended |
Birth weight pounds |
|
|
|
Query
|
birth_weight_oz |
Float |
|
Recommended |
Birth weight ounces |
|
|
|
|
birth_injury |
String |
10
|
Recommended |
Was there any evidence of injury at birth? |
|
|
|
|
birth_injury_specify |
String |
200
|
Recommended |
If evidence of injury at birth, describe |
|
|
|
Query
|
ear_infection_num |
Integer |
|
Recommended |
How many ear infections has the participant had? |
|
|
|
|
rev_earpetube |
String |
50
|
Recommended |
PE Tubes |
|
NK = Not known
|
|
Query
|
rev_earpetube_month |
Integer |
|
Recommended |
If participant has received ear tubes, what month? |
|
MM month as two digits
|
|
Query
|
rev_earpetube_year |
Integer |
|
Recommended |
If participant has received ear tubes, what year? |
|
YY year as two digits
|
|
|
injury1 |
String |
500
|
Recommended |
List any significant injuries the participant has had? First occurrence |
|
|
|
Query
|
injury1_age_years |
Integer |
|
Recommended |
If participant has had a significant injury, at what age in years? First occurrence |
|
Age in years using two digit format
|
|
Query
|
injury1_age_months |
Integer |
|
Recommended |
If participant has had a significant injury, at what age in months? First occurrence |
|
Age in months using two digit format
|
|
|
injury2 |
String |
500
|
Recommended |
List any significant injuries the participant has had? Second occurrence |
|
|
|
Query
|
injury2_age_years |
Integer |
|
Recommended |
If participant has had a significant injury, at what age in years? Second occurrence |
|
Age in years using two digit format
|
|
Query
|
injury2_age_months |
Integer |
|
Recommended |
If participant has had a significant injury, at what age in months? Second occurrence |
|
Age in months using two digit format
|
|
|
injury3 |
String |
500
|
Recommended |
List any significant injuries the participant has had? Third occurrence |
|
|
|
Query
|
injury3_age_years |
Integer |
|
Recommended |
If participant has had a significant injury, at what age in years? Third occurrence |
|
Age in years using two digit format
|
|
Query
|
injury3_age_months |
Integer |
|
Recommended |
If participant has had a significant injury, at what age in months? Third occurrence |
|
Age in months using two digit format
|
|
|
operation1 |
String |
500
|
Recommended |
List any operations the participant has had? First occurrence |
|
|
|
Query
|
operation1_age_years |
Integer |
|
Recommended |
If participant has had an operation, at what age in years? First occurrence |
|
Age in years using two digit format
|
|
Query
|
operation1_age_months |
Integer |
|
Recommended |
If participant has had an operation, at what age in months? First occurrence |
|
Age in months using two digit format
|
|
|
operation2 |
String |
500
|
Recommended |
List any operations the participant has had? Second occurrence |
|
|
|
Query
|
operation2_age_years |
Integer |
|
Recommended |
If participant has had an operation, at what age in years? Second occurrence |
|
Age in years using two digit format
|
|
Query
|
operation2_age_months |
Integer |
|
Recommended |
If participant has had an operation, at what age in months? Second occurrence |
|
Age in months using two digit format
|
|
|
operation3 |
String |
500
|
Recommended |
List any operations the participant has had? Third occurrence |
|
|
|
Query
|
operation3_age_years |
Integer |
|
Recommended |
If participant has had an operation, at what age in years? Third occurrence |
|
Age in years using two digit format
|
|
Query
|
operation3_age_months |
Integer |
|
Recommended |
If participant has had an operation, at what age in months? Third occurrence |
|
Age in months using two digit format
|
|
Query
|
measles_age_years |
Integer |
|
Recommended |
If the participant has had measles, provide the age in months when they had measles |
|
Age in years using two digit format
|
|
Query
|
measles_age_months |
Integer |
|
Recommended |
If the participant has had measles, provide the age in years when they had measles |
|
Age in months using two digit format
|
|
Query
|
germanmeasles_age_years |
Integer |
|
Recommended |
If the participant has had German measles, provide the age in months when they had German measles |
|
Age in years using two digit format
|
|
Query
|
germanmeasles_age_months |
Integer |
|
Recommended |
If the participant has had German measles, provide the age in years when they had German measles |
|
Age in months using two digit format
|
|
Query
|
mumps_age_years |
Integer |
|
Recommended |
If the participant has had mumps, provide the age in months when they had mumps |
|
Age in years using two digit format
|
|
Query
|
mumps_age_months |
Integer |
|
Recommended |
If the participant has had mumps, provide the age in years when they had mumps |
|
Age in months using two digit format
|
|
Query
|
brokenbone_age_years |
Integer |
|
Recommended |
If the participant has had broken bones, provide the age in months when they had broken bones |
|
Age in years using two digit format
|
|
Query
|
brokenbone_age_months |
Integer |
|
Recommended |
If the participant has had broken bones, provide the age in years when they had broken bones |
|
Age in months using two digit format
|
|
Query
|
headachemigraine_age_years |
Integer |
|
Recommended |
If the participant has had headaches/migraines, provide the age in months when they had headaches/migraines |
|
Age in years using two digit format
|
|
Query
|
headachemigraine_age_months |
Integer |
|
Recommended |
If the participant has had headaches/migraines, provide the age in years when they had headaches/migraines |
|
Age in months using two digit format
|
|
Query
|
hearingtest_age_years |
Integer |
|
Recommended |
If the participant has had hearing test, provide the age in months when they had hearing test |
|
Age in years using two digit format
|
|
Query
|
hearingtest_age_months |
Integer |
|
Recommended |
If the participant has had hearing test, provide the age in years when they had hearing test |
|
Age in months using two digit format
|
|
Query
|
whoopingcough_age_years |
Integer |
|
Recommended |
If the participant has had whooping cough, provide the age in months when they had whooping cough |
|
Age in years using two digit format
|
|
Query
|
whoopingcough_age_months |
Integer |
|
Recommended |
If the participant has had whooping cough, provide the age in years when they had whooping cough |
|
Age in months using two digit format
|
|
Query
|
chickenpox_age_years |
Integer |
|
Recommended |
If the participant has had chicken pox, provide the age in months when they had chicken pox |
|
Age in years using two digit format
|
|
Query
|
chickenpox_age_months |
Integer |
|
Recommended |
If the participant has had chicken pox, provide the age in years when they had chicken pox |
|
Age in months using two digit format
|
|
Query
|
eeg_age_months |
Integer |
|
Recommended |
If the participant has had EEG, provide the age in months when they had EEG |
|
Age in years using two digit format
|
|
Query
|
eeg_age_years |
Integer |
|
Recommended |
If the participant has had EEG, provide the age in years when they had EEG |
|
Age in months using two digit format
|
|
|
diagnosis_autism |
String |
10
|
Required |
Has the participant been diagnosed with Autism? |
|
999=NA/missing
|
|
|
diagnosis_autism_madeby |
String |
100
|
Recommended |
If the participant has been diagnosed with autism, who gave this diagnosis? |
|
|
|
|
diagnosis_seizures |
String |
10
|
Required |
Has the participant been diagnosed with seizures? |
|
CPEA STAART: -7 = Don't know; -8 = Refused to answer; -9 = Does not apply
|
|
|
diagnosis_other_specify |
String |
500
|
Recommended |
What other diagnoses has the participant had? |
|
|
|
|
atypical_dev_signs |
String |
500
|
Recommended |
Prior to a diagnosis, were there any signes that led you to believe that the participant was developing atypically? |
|
|
|
|
earlydev_fsymc |
String |
1,020
|
Recommended |
First symptoms to arouse parental concern (specify) |
|
|
|
|
feed_swallow_problem |
String |
10
|
Recommended |
Has the participant demonstrated any feeding or swallowing problems? |
|
|
|
|
feed_swallow_problem_specify |
String |
500
|
Recommended |
If they have demonstrated feeding or swallowing problems, describe them |
|
|
|
|
medication1_name |
String |
500
|
Recommended |
Name first medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
|
|
medication1_current |
String |
10
|
Required |
First medication currently taking? |
|
999=NA/missing
|
|
|
medication1_past |
String |
10
|
Recommended |
First medication took in the past? |
|
|
|
|
medication2_name |
String |
500
|
Recommended |
Name second medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
|
|
medication2_current |
String |
10
|
Recommended |
second medication currently taking? |
|
|
|
|
medication2_past |
String |
10
|
Recommended |
second medication took in the past? |
|
|
|
|
medication3_name |
String |
500
|
Recommended |
Name third medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
|
|
medication3_current |
String |
10
|
Recommended |
third medication currently taking? |
|
|
|
|
medication3_past |
String |
10
|
Recommended |
third medication took in the past? |
|
|
|
|
medication4_name |
String |
500
|
Recommended |
Name fourth medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
|
|
medication4_current |
String |
10
|
Recommended |
fourth medication currently taking? |
|
|
|
|
medication4_past |
String |
10
|
Recommended |
fourth medication took in the past? |
|
|
|
|
medication5_name |
String |
500
|
Recommended |
Name fifth medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
|
|
medication5_current |
String |
10
|
Recommended |
fifth medication currently taking? |
|
|
|
|
medication5_past |
String |
10
|
Recommended |
fifth medication took in the past? |
|
|
|
|
medication6_name |
String |
500
|
Recommended |
Name sixth medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
|
|
medication6_current |
String |
10
|
Recommended |
sixth medication currently taking? |
|
|
|
|
medication6_past |
String |
10
|
Recommended |
sixth medication took in the past? |
|
|
|
|
medication7_name |
String |
500
|
Recommended |
Name seventh medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
|
|
medication7_current |
String |
10
|
Recommended |
seventh medication currently taking? |
|
|
|
|
medication7_past |
String |
10
|
Recommended |
seventh medication took in the past? |
|
|
|
|
medication8_name |
String |
500
|
Recommended |
Name eighth medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
|
|
medication8_current |
String |
10
|
Recommended |
eighth medication currently taking? |
|
|
|
|
medication8_past |
String |
10
|
Recommended |
eighth medication took in the past? |
|
|
|
|
medication9_name |
String |
500
|
Recommended |
Name ninth medication that the participant has taken |
|
|
|
|
medication9_current |
String |
10
|
Recommended |
ninth medication currently taking? |
|
|
|
|
medication9_past |
String |
10
|
Recommended |
ninth medication took in the past? |
|
|
|
|
medication10_name |
String |
100
|
Recommended |
Name tenth medication that the participant has taken |
|
|
|
|
medication10_current |
String |
10
|
Recommended |
tenth medication currently taking? |
|
|
|
|
medication10_past |
String |
10
|
Recommended |
tenth medication took in the past? |
|
|
|
|
play_opps_other_kids |
String |
10
|
Recommended |
Does the participant have opportunities to play with other children? |
|
|
|
|
likes_play_other_kids |
String |
10
|
Recommended |
Does the participant like to play with other children? |
|
|
|
|
assist_dressing |
String |
10
|
Recommended |
Is the participant able to assist with dressing himself/herself? |
|
|
|
|
special_behavior_problems |
String |
10
|
Recommended |
Does the participant present any special behavior problems? |
|
|
|
|
special_behavior_probs_specify |
String |
200
|
Recommended |
If the participant does present special behavior problems, please describe |
|
|
|
Query
|
milestone_age_mo_smile |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in months: smiled |
|
|
|
Query
|
milestone_age_yr_smile |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: smiled |
|
|
|
Query
|
milestone_age_mo_satup |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in months: sat up without support |
|
|
|
Query
|
milestone_age_yr_satup |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: sat up without support |
|
|
|
Query
|
milestone_age_mo_crawl |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in months: crawled |
|
|
|
Query
|
milestone_age_yr_crawl |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: crawled |
|
|
|
Query
|
milestone_age_mo_solidfood |
Float |
|
Recommended |
Age in which the participant accomplished the following milestone in months: started solid foods |
|
|
|
Query
|
milestone_age_yr_solidfood |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: started solid foods |
|
|
|
Query
|
milestone_age_mo_words |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in months: used words |
|
|
|
Query
|
milestone_age_yr_words |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: used words |
|
|
|
Query
|
milestone_age_mo_stopbottle |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in months: gave up bottle |
|
|
|
Query
|
milestone_age_yr_stopbottle |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: gave up bottle |
|
|
|
Query
|
milestone_age_mo_toilettrain |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in months: was toilet trained |
|
|
|
Query
|
milestone_age_yr_toilettrain |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: was toilet trained |
|
|
|
Query
|
milestone_age_mo_walkalone |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in months: walked alone |
|
|
|
Query
|
milestone_age_yr_walkalone |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: walked alone |
|
|
|
Query
|
milestone_age_mo_fedselfspoon |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in months: fed self with a spoon |
|
|
|
Query
|
milestone_age_yr_fedselfspoon |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: fed self with a spoon |
|
|
|
Query
|
milestone_age_mo_drankcup |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in months: drank with a cup |
|
|
|
Query
|
milestone_age_yr_drankcup |
Integer |
|
Recommended |
Age in which the participant accomplished the following milestone in years: drank with a cup |
|
|
|
|
respond_to_sounds |
String |
10
|
Recommended |
Does the participant respond consistently to sounds in the home (doorbell, phone, etc)? |
|
|
|
|
understand_what_others_say |
String |
10
|
Recommended |
Does the participant understand what you say to him/her? |
|
|
|
|
suspect_hearing_loss |
String |
10
|
Required |
Do you suspect a hearing loss? |
|
999=NA/missing
|
|
|
babble |
String |
10
|
Recommended |
Does the participant babble (e.g., baba, didi, yada)? |
|
|
|
|
babble_short_phrases |
String |
10
|
Recommended |
Does the participant babble using short phrases (e.g., mama up, ball please, bye-bye dada)? |
|
|
|
|
cg_understand_speech |
String |
10
|
Recommended |
Do the caregivers understand the participant's speech? |
|
|
|
|
strangers_understand_speech |
String |
10
|
Recommended |
Do strangers understand the participant's speech? |
|
|
|
|
otherkids_understand_speech |
String |
10
|
Recommended |
Do other children understand the participant's speech? |
|
|
|
|
imitate_soundswords |
String |
10
|
Recommended |
Does the participant imitate sounds and/or words after you say them first? |
|
|
|
|
diagnosis_apraxia_motorsensdis |
String |
10
|
Recommended |
Has the participant been diagnosed with apraxia or a motor/sensory disorder? |
|
|
|
|
sounds_used_number |
String |
10
|
Recommended |
How many different sounds does the participant use? |
|
|
|
|
sounds_used_specify |
String |
50
|
Recommended |
Give examples of sounds he/she says (e.g., b, p, m, n, ) |
|
|
|
|
vocabulary_size |
String |
50
|
Recommended |
Estimate the participants current vocabulary size |
No words yet;1-2 words;3-5 words;6-10 words;11-20 words;21-30 words;31-50 words;50 or more
|
|
|
|
vocabulary_specify |
String |
200
|
Recommended |
Give examples of words or phrases |
|
|
|
|
augcomm_taught_pecs |
String |
10
|
Recommended |
Has the participant ever been taught to use any of these augmentative communication devices or systems: Picture Exchange Communication System |
|
|
|
|
augcomm_taught_pointpics |
String |
10
|
Recommended |
Has the participant ever been taught to use any of these augmentative communication devices or systems: Pointing to pictures |
|
|
|
|
augcomm_taught_speechdevice |
String |
10
|
Recommended |
Has the participant ever been taught to use any of these augmentative communication devices or systems: Speech generating device (e.g., DynaVox, SpeakEasy, etc) |
|
|
|
|
augcomm_taught_signlanguage |
String |
10
|
Recommended |
Has the participant ever been taught to use any of these augmentative communication devices or systems: Sign language |
|
|
|
|
earlyint1_start_date |
Date |
|
Recommended |
Early Intervention Program Occurrence 1: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
earlyint1_end_date |
Date |
|
Recommended |
Early Intervention Program Occurrence 1: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
earlyint1_week_hrs |
Float |
|
Recommended |
Early Intervention Program Occurrence 1:For the following intervention, how many hours per week were provided? |
|
|
|
|
earlyint1_group_ind |
String |
50
|
Recommended |
Early Intervention Program Occurrence 1: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
earlyint1_setting |
String |
75
|
Recommended |
Early Intervention Program Occurrence 1:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
earlyint1_funding |
String |
50
|
Recommended |
Early Intervention Program Occurrence 1:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
earlyint1_funding_specify |
String |
200
|
Recommended |
Early Intervention Program Occurrence 1: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
earlyint2_start_date |
Date |
|
Recommended |
Early Intervention Program Occurrence 2: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
earlyint2_end_date |
Date |
|
Recommended |
Early Intervention Program Occurrence 2: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
earlyint2_week_hrs |
Integer |
|
Recommended |
Early Intervention Program Occurrence 2:For the following intervention, how many hours per week were provided? |
|
|
|
|
earlyint2_group_ind |
String |
50
|
Recommended |
Early Intervention Program Occurrence 2: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
earlyint2_setting |
String |
75
|
Recommended |
Early Intervention Program Occurrence 2:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
earlyint2_funding |
String |
50
|
Recommended |
Early Intervention Program Occurrence 2:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
earlyint2_funding_specify |
String |
200
|
Recommended |
Early Intervention Program Occurrence 2: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
earlyint3_start_date |
Date |
|
Recommended |
Early Intervention Program Occurrence 3: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
earlyint3_end_date |
Date |
|
Recommended |
Early Intervention Program Occurrence 3: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
earlyint3_week_hrs |
Integer |
|
Recommended |
Early Intervention Program Occurrence 3:For the following intervention, how many hours per week were provided? |
|
|
|
|
earlyint3_group_ind |
String |
50
|
Recommended |
Early Intervention Program Occurrence 3: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
earlyint3_setting |
String |
75
|
Recommended |
Early Intervention Program Occurrence 3:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
earlyint3_funding |
String |
50
|
Recommended |
Early Intervention Program Occurrence 3:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
earlyint3_funding_specify |
String |
200
|
Recommended |
Early Intervention Program Occurrence 3: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
behavioral1_start_date |
Date |
|
Recommended |
Behavioral Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
behavioral1_end_date |
Date |
|
Recommended |
Behavioral Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
behavioral1_week_hrs |
Integer |
|
Recommended |
Behavioral Therapy Occurrence 1:For the following intervention, how many hours per week were provided? |
|
|
|
|
behavioral1_group_ind |
String |
50
|
Recommended |
Behavioral Therapy Occurrence 1: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
behavioral1_setting |
String |
75
|
Recommended |
Behavioral Therapy Occurrence 1:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
behavioral1_funding |
String |
50
|
Recommended |
Behavioral Therapy Occurrence 1:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
behavioral1_funding_specify |
String |
200
|
Recommended |
Behavioral Therapy Occurrence 1: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
behavioral2_start_date |
Date |
|
Recommended |
Behavioral Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
behavioral2_end_date |
Date |
|
Recommended |
Behavioral Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
behavioral2_week_hrs |
Integer |
|
Recommended |
Behavioral Therapy Occurrence 2:For the following intervention, how many hours per week were provided? |
|
|
|
|
behavioral2_group_ind |
String |
50
|
Recommended |
Behavioral Therapy Occurrence 2: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
behavioral2_setting |
String |
75
|
Recommended |
Behavioral Therapy Occurrence 2:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
behavioral2_funding |
String |
50
|
Recommended |
Behavioral Therapy Occurrence 2:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
behavioral2_funding_specify |
String |
200
|
Recommended |
Behavioral Therapy Occurrence 2: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
behavioral3_start_date |
Date |
|
Recommended |
Behavioral Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
behavioral3_end_date |
Date |
|
Recommended |
Behavioral Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
behavioral3_week_hrs |
Integer |
|
Recommended |
Behavioral Therapy Occurrence 3:For the following intervention, how many hours per week were provided? |
|
|
|
|
behavioral3_group_ind |
String |
50
|
Recommended |
Behavioral Therapy Occurrence 3: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
behavioral3_setting |
String |
75
|
Recommended |
Behavioral Therapy Occurrence 3:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
behavioral3_funding |
String |
50
|
Recommended |
Behavioral Therapy Occurrence 3:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
behavioral3_funding_specify |
String |
200
|
Recommended |
Behavioral Therapy Occurrence 3: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
ot1_start_date |
Date |
|
Recommended |
Occupational Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
ot1_end_date |
Date |
|
Recommended |
Occupational Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
ot1_week_hrs |
Float |
|
Recommended |
Occupational Therapy Occurrence 1:For the following intervention, how many hours per week were provided? |
|
|
|
|
ot1_group_ind |
String |
50
|
Recommended |
Occupational Therapy Occurrence 1: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
ot1_setting |
String |
75
|
Recommended |
Occupational Therapy Occurrence 1:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
ot1_funding |
String |
50
|
Recommended |
Occupational Therapy Occurrence 1:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
ot1_funding_specify |
String |
200
|
Recommended |
Occupational Therapy Occurrence 1: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
ot2_start_date |
Date |
|
Recommended |
Occupational Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
ot2_end_date |
Date |
|
Recommended |
Occupational Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
ot2_week_hrs |
Integer |
|
Recommended |
Occupational Therapy Occurrence 2:For the following intervention, how many hours per week were provided? |
|
|
|
|
ot2_group_ind |
String |
50
|
Recommended |
Occupational Therapy Occurrence 2: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
ot2_setting |
String |
75
|
Recommended |
Occupational Therapy Occurrence 2:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
ot2_funding |
String |
50
|
Recommended |
Occupational Therapy Occurrence 2:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
ot2_funding_specify |
String |
200
|
Recommended |
Occupational Therapy Occurrence 2: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
ot3_start_date |
Date |
|
Recommended |
Occupational Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
ot3_end_date |
Date |
|
Recommended |
Occupational Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
ot3_week_hrs |
Integer |
|
Recommended |
Occupational Therapy Occurrence 3:For the following intervention, how many hours per week were provided? |
|
|
|
|
ot3_group_ind |
String |
50
|
Recommended |
Occupational Therapy Occurrence 3: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
ot3_setting |
String |
75
|
Recommended |
Occupational Therapy Occurrence 3:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
ot3_funding |
String |
50
|
Recommended |
Occupational Therapy Occurrence 3:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
ot3_funding_specify |
String |
200
|
Recommended |
Occupational Therapy Occurrence 3: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
slp1_start_date |
Date |
|
Recommended |
Speech and Language Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
slp1_end_date |
Date |
|
Recommended |
Speech and Language Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
slp1_week_hrs |
Integer |
|
Recommended |
Speech and Language Therapy Occurrence 1:For the following intervention, how many hours per week were provided? |
|
|
|
|
slp1_group_ind |
String |
50
|
Recommended |
Speech and Language Therapy Occurrence 1: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
slp1_setting |
String |
75
|
Recommended |
Speech and Language Therapy Occurrence 1:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
slp1_funding |
String |
50
|
Recommended |
Speech and Language Therapy Occurrence 1:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
slp1_funding_specify |
String |
200
|
Recommended |
Speech and Language Therapy Occurrence 1: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
slp2_start_date |
Date |
|
Recommended |
Speech and Language Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
slp2_end_date |
Date |
|
Recommended |
Speech and Language Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
slp2_week_hrs |
Integer |
|
Recommended |
Speech and Language Therapy Occurrence 2:For the following intervention, how many hours per week were provided? |
|
|
|
|
slp2_group_ind |
String |
50
|
Recommended |
Speech and Language Therapy Occurrence 2: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
slp2_setting |
String |
75
|
Recommended |
Speech and Language Therapy Occurrence 2:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
slp2_funding |
String |
50
|
Recommended |
Speech and Language Therapy Occurrence 2:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
slp2_funding_specify |
String |
200
|
Recommended |
Speech and Language Therapy Occurrence 2: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
slp3_start_date |
Date |
|
Recommended |
Speech and Language Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
slp3_end_date |
Date |
|
Recommended |
Speech and Language Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
slp3_week_hrs |
Integer |
|
Recommended |
Speech and Language Therapy Occurrence 3:For the following intervention, how many hours per week were provided? |
|
|
|
|
slp3_group_ind |
String |
50
|
Recommended |
Speech and Language Therapy Occurrence 3: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
slp3_setting |
String |
75
|
Recommended |
Speech and Language Therapy Occurrence 3:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
slp3_funding |
String |
50
|
Recommended |
Speech and Language Therapy Occurrence 3:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
slp3_funding_specify |
String |
200
|
Recommended |
Speech and Language Therapy Occurrence 3: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
floortime1_start_date |
Date |
|
Recommended |
Floortime Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
floortime1_end_date |
Date |
|
Recommended |
Floortime Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
floortime1_week_hrs |
Float |
|
Recommended |
Floortime Therapy Occurrence 1:For the following intervention, how many hours per week were provided? |
|
|
|
|
floortime1_group_ind |
String |
50
|
Recommended |
Floortime Therapy Occurrence 1: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
floortime1_setting |
String |
75
|
Recommended |
Floortime Therapy Occurrence 1:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
floortime1_funding |
String |
50
|
Recommended |
Floortime Therapy Occurrence 1:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
floortime1_funding_specify |
String |
200
|
Recommended |
Floortime Therapy Occurrence 1: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
floortime2_start_date |
Date |
|
Recommended |
Floortime Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
floortime2_end_date |
Date |
|
Recommended |
Floortime Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
floortime2_week_hrs |
Integer |
|
Recommended |
Floortime Therapy Occurrence 2:For the following intervention, how many hours per week were provided? |
|
|
|
|
floortime2_group_ind |
String |
50
|
Recommended |
Floortime Therapy Occurrence 2: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
floortime2_setting |
String |
75
|
Recommended |
Floortime Therapy Occurrence 2:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
floortime2_funding |
String |
50
|
Recommended |
Floortime Therapy Occurrence 2:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
floortime2_funding_specify |
String |
200
|
Recommended |
Floortime Therapy Occurrence 2: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
floortime3_start_date |
Date |
|
Recommended |
Floortime Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
floortime3_end_date |
Date |
|
Recommended |
Floortime Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
floortime3_week_hrs |
Integer |
|
Recommended |
Floortime Therapy Occurrence 3:For the following intervention, how many hours per week were provided? |
|
|
|
|
floortime3_group_ind |
String |
50
|
Recommended |
Floortime Therapy Occurrence 3: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
floortime3_setting |
String |
75
|
Recommended |
Floortime Therapy Occurrence 3:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
floortime3_funding |
String |
50
|
Recommended |
Floortime Therapy Occurrence 3:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
floortime3_funding_specify |
String |
200
|
Recommended |
Floortime Therapy Occurrence 3: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
othertherapy1_name |
String |
200
|
Recommended |
Other Therapy1: If a therapy other than one listed was provided to participant, provide the name and description of the therapy |
|
|
|
|
othertherapy1_start_date |
Date |
|
Recommended |
Other Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
othertherapy1_end_date |
Date |
|
Recommended |
Other Therapy Occurrence 1: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
othertherapy1_week_hrs |
Float |
|
Recommended |
Other Therapy Occurrence 1:For the following intervention, how many hours per week were provided? |
|
|
|
|
othertherapy1_group_ind |
String |
50
|
Recommended |
Other Therapy Occurrence 1: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
othertherapy1_setting |
String |
75
|
Recommended |
Other Therapy Occurrence 1:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
othertherapy1_funding |
String |
50
|
Recommended |
Other Therapy Occurrence 1:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
othertherapy1_funding_specify |
String |
200
|
Recommended |
Other Therapy Occurrence 1: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
othertherapy2_name |
String |
200
|
Recommended |
Other Therapy2: If a therapy other than one listed was provided to participant, provide the name and description of the therapy |
|
|
|
|
othertherapy2_start_date |
Date |
|
Recommended |
Other Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
othertherapy2_end_date |
Date |
|
Recommended |
Other Therapy Occurrence 2: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
othertherapy2_week_hrs |
Integer |
|
Recommended |
Other Therapy Occurrence 2:For the following intervention, how many hours per week were provided? |
|
|
|
|
othertherapy2_group_ind |
String |
50
|
Recommended |
Other Therapy Occurrence 2: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
othertherapy2_setting |
String |
75
|
Recommended |
Other Therapy Occurrence 2:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
othertherapy2_funding |
String |
50
|
Recommended |
Other Therapy Occurrence 2:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
othertherapy2_funding_specify |
String |
200
|
Recommended |
Other Therapy Occurrence 2: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
othertherapy3_name |
String |
200
|
Recommended |
Other Therapy3: If a therapy other than one listed was provided to participant, provide the name and description of the therapy |
|
|
|
|
othertherapy3_start_date |
Date |
|
Recommended |
Other Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention begin? |
|
|
|
|
othertherapy3_end_date |
Date |
|
Recommended |
Other Therapy Occurrence 3: If participant participated in the following intervention, what date did the intervention end |
|
|
|
Query
|
othertherapy3_week_hrs |
Integer |
|
Recommended |
Other Therapy Occurrence 3:For the following intervention, how many hours per week were provided? |
|
|
|
|
othertherapy3_group_ind |
String |
50
|
Recommended |
Other Therapy Occurrence 3: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
|
|
othertherapy3_setting |
String |
75
|
Recommended |
Other Therapy Occurrence 3:For the following intervention, where was it delivered? |
Home;School;Clinic;Home and School;Home and Clinic;School and Clinic;All
|
|
|
|
othertherapy3_funding |
String |
50
|
Recommended |
Other Therapy Occurrence 3:Was the following intervention funded by the school district? |
SD;PP;SD and PP;SD and Other;PP and Other;SD and PP and Other;Other
|
SD = School district; PP = Private pay
|
|
|
othertherapy3_funding_specify |
String |
200
|
Recommended |
Other Therapy Occurrence 3: If the intervention was funded by a source other than the school district or private pay, provide details on source of funding? |
|
|
|
|
barriers_services |
String |
500
|
Recommended |
What were the barriers that you encountered in obtaining or receiving services? |
|
|
|
|
barriers_implement_strategies |
String |
500
|
Recommended |
What were the barriers you encountered in implementing the strategies from these service provders? |
|
|
|
|
strategy_implement_competency |
String |
500
|
Recommended |
How competent do you feel in your ability to use the strategies from these services? |
|
|
|
|
goals_important |
String |
500
|
Recommended |
What are you most important goals for the participant? |
|
|
|
|
goals_future |
String |
500
|
Recommended |
What do you foresee as important future goals for the participant? |
|
|
|
|
training_parent_behavior |
String |
500
|
Recommended |
Please list any parent training or behavior management training in which you've participated. |
|
|
|
|
training_prompted_changes |
String |
500
|
Recommended |
What are you doing differently as a result of these training programs and What did you gain from this service? |
|
|
|