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NIMH Data Archive
NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

Cumulative Illness Rating Scale

6,262 Shared Subjects

N/A
Clinical Assessments
Questionnaire
12/09/2014
crs01
04/05/2024
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR* guid, nimhid, z1
src_subject_id String 20 Required Subject ID how it's defined in lab/project catieid, id, participant_id, ptid, randid, record_id, subject_id, subjid, z2
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY bprs_doa, cirsg_date, cirsg_doa, intvdate, testdate, z3
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0::1440 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. age, intvage, z4
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender, z5
Query update Integer Recommended Updated form 0;1 1= yes; 0= no
crcid String 40 Recommended CRC ID/ROA ID
Query heart Integer Recommended Heart 0::4 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe cirsg_1, cirsg_1_heart, crs1
Query vsclr Integer Recommended Vascular 0::4 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe cirsg_2, cirsg_2_vascular, crs2, vascular
Query hema Integer Recommended Haematopoietic 0::4 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe cirsg_3, cirsg_3_hematopoietic, crs3, hematopoietic
Query eyes Integer Recommended Eyes, ears, nose, throat, and larynx 0::4; -9 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe; -9 = Missing cirsg_5, cirsg_5_eentl, crs5, ent, mh_eent2
Query ugi Integer Recommended Upper GI 0::4; -9 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe; -9 = Missing cirsg_6, cirsg_6_upper_gastro, cirsg_6_uppergastro, crs6, mh_ugi2, uppergi
Query lgi Integer Recommended Lower GI 0::4; -9 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe; -9 = Missing cirsg_7, cirsg_7_lower_gastro, cirsg_7_lowergastro, crs7, lowergi, mh_lgi2
Query renal Integer Recommended Renal 0::4; -9 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe; -9 = Missing cirsg_9, cirsg_9_renal, crs9, mh_renal2
Query genur Integer Recommended Genitourinary 0::4; -9 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe; -9 = Missing cirsg_10, cirsg_10_genitourinary, crs10, mh_genit2, urinary
Query mskl Integer Recommended Musculoskeletal/Integument 0::4; -9 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe; -9 = Missing cirsg_11, cirsg_11_musculoskel, crs11, mh_msklt2, musculoskeletal
Query neuro Integer Recommended Neurological 0::4; -9 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe; -9 = Missing cirsg_12, cirsg_12_neurological, crs12, mh_oneur2, neurological
Query psych Integer Recommended Psychiatric illness 0::4 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe cirsg_14, cirsg_14_psychiatric
Query respiratory Integer Recommended Respiratory 0::4 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe cirsg_4, cirsg_4_respiratory, crs4, resp
Query liverd Integer Recommended Liver 0::4; -9 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe; -9 = Missing cirsg_8, cirsg_8_liver, crs8, liver, mh_liver2
Query endod Integer Recommended Endocrine/metabolic, and breast 0::4 0=no problem; 1=current mild or no problem; 2= moderate disability/morbidity; 3-severe constant disability; 4= extremely severe cirsg_13, cirsg_13_endocrine, crs13, endo, endocrine
Query days_baseline Integer Recommended Days since baseline date
Query cirscnt Integer Recommended Count of scored CIRS-G items cirsg_cat_endorsed, cirsg_total_num_cat_endorsed
Query cirstot Integer Recommended CIRS-G Total Score cirsg_score, cirsg_total
Query site String 101 Recommended Site Study Site
Query week Float Recommended Week in level/study 99=week 10-week 14 intid
Query study_id Integer Recommended Study ID number 46=Acute Phase; 47=Stabilization Phase
Query cirsg_severity_index Float Recommended CIRS-G Severity Index 999 = Missing
Query cirsg_num_level3_severity Integer Recommended Number of categories at level-3 severity cirsg_level3_severity
Query cirsg_num_level4_severity Integer Recommended Number of categories at level-4 severity cirsg_level4_severity
Query iecsig Integer Recommended Investigator signature on form. 0;1 0=No; 1= Yes cirsg_signature_clin_staff
lab020 Date Recommended Date of PI/clinician signature cirsg_date_time_signature
comments String 4,000 Recommended Comments about assessment cirsg_notes
doa_futdt String 20 Recommended Future date entered (Assessment) cirsg_doa_futdt
dode String 10 Recommended Date of Data Entry cirsg_dode
dode_futdt String 20 Recommended Future date entered (Data Entry) cirsg_dode_futdt
Query form_completed Integer Recommended Was the form completed? 1::4 1=Yes; 2=No; 3=Unverified; 4 = N/A-Not in age range cirsg_form_complete
Query form_explain Integer Recommended Why was this form not completed? 86::99 99=Participant unable to complete due to cognitive impairment; 98=Participant unable to complete due to physical impairment; 97=Participant refused to begin/finish; 96=Participant completed but with less than best effort; 95=Participant unable to be contacted; 94=Participant deceased; 93=Participant withdrew consent; 92=Time constraints; 91=Rater forgot to administer; 90=Missed appointment; 89=Participant was terminated from study; 88=Other;87 = Not Done (reason unspecified); 86 = Not Applicable cirsg_explain
other_reason_nc String 100 Recommended Other reason form was not completed cirsg_other_reason_nc
Query assessment_complete Integer Recommended Complete? 0::2 0=Incomplete; 1=Unverified; 2=Complete cirsg_complete
cirsg_1_heart_condn String 200 Recommended Describe Heart condition
cirsg_2_vascular_condn String 200 Recommended Describe Vascular condition
Query cirsg_3_hematopoietic_condn String 200 Recommended Describe Hematopoietic condition
cirsg_4_respiratory_condn String 200 Recommended Describe Respiratory condition
cirsg_5_eentl_condn String 200 Recommended Describe Eyes, Ears, Nose, Throat and Larynx condition
cirsg_6_upper_gastro_condn String 200 Recommended Describe Upper Gastrointestinal Tract condition
cirsg_7_lower_gastro_condn String 200 Recommended Describe Lower Gastrointestinal Tract condition
Query cirsg_8_liver_condn String 200 Recommended Describe Liver condition
Query cirsg_9_renal_condn String 200 Recommended Describe Renal condition
Query cirsg_10_genitourinary_condn String 200 Recommended Describe Genito-urinary condition
cirsg_11_musculoskel_condn String 200 Recommended Describe Musculoskeletal/integument condition
cirsg_12_neurological_condn String 200 Recommended Describe Neurological condition
cirsg_13_endocrine_condn String 200 Recommended Describe Endocrine/metabolic and breast condition
cirsg_14_psychiatric_condn String 200 Recommended Describe Psychiatric illness condition
Query tleq_31 Integer Recommended Have you ever had a life-threatening illness? If yes, how often? 0::6 1 = Once; 2 = Twice; 3 = 3 times; 4 = 4 times; 5 = 5 times; 6 = more than 5 times; 0= None
Query cirs_sum4 Integer Recommended Number of severe illnesses
Query cirs_sum5 Integer Recommended Number of moderate illnesses
Query cirs_sum6 Integer Recommended Total CIRS score excluding psychiatric
Query visitid Integer Recommended MetaTrial Visit ID System variable: unique code for each type of visit -use to merge files
Query rbsr_overall_endorsed Integer Recommended Overall number of items endorsed
Query cir99f Integer Recommended Cardiovascular Score Heart + Score Vascular
Query visit String 60 Recommended Visit name visitnum, vtypbima, vtypbprs
Query visnum Float Recommended Numeric Visit Number -1.5 = Pre-Screening; -1 = Screening; 0 = Baseline; ## = Visit ## (from 1 to 10); Whole numbers = standard monthly visits; #.001 - #.009 = Unscheduled; #.1 = End of Phase 1; #.2 = End of Phase 2; #.3 = End of Phase 3; #.4 = End of Open Choice Phase; #.5 = End of Study; #.6 = Genetic Analysis; 1000=all visits
Query me2 Integer Recommended Status 0;1 0 = Past [Inactive]; 1 = Active
Query mhxa1e Integer Recommended Heart attack/ myocardial infarction 0;1;9;-9 0=No; 1=Yes; 9=not evaluated; -9=unknown mh_hrta
Query mhxa1d Integer Recommended Angina 0;1;-9 0=No; 1=Yes; -9 = Not applicable or Missing mh_ang
Query afib Integer Recommended atrial fibrillation 0;1;-7;-9 0=No; 1=Yes; -7=Refused; -9 = Not applicable or Missing mh_afib
Query cr6 Integer Recommended Left Ventricular Hypertrophy (by EKG criteria)? 0;1 0 = no;1 = yes mh_lvh
Query blood_ps Integer Recommended systolic blood pressure mh_sys
Query blood_pd Integer Recommended diastolic blood pressure mh_dia
Query cr2 Integer Recommended Diabetes Mellitus 0;1 0 = No current diabetes or random BS < 220;1 = Diagnosis of diabetes or random BS >220 mh_dbt
Query medhx_celiac Integer Recommended Celiac Disease 0::2 0 = No, 1 = Yes, 2 = Not sure mh_celac
Query cfmh_othr_ibs Integer Recommended Irritable bowel syndrome 1;0 0 = No; 1 = Yes mh_ibs
Query medhx_ulc Integer Recommended Ulcerative Colitis 0::2 0 = No, 1 = Yes, 2 = Not sure mh_ulcc
Query genit_dis Integer Recommended Genitourinary Disorder (Bladder, Reproductive System) 0;1;9 1 = Yes; 0 = No; 9 = Unknown mh_genit
Query headinjr Integer Recommended head injury 0;1 0= no; 1= yes mh_hdin
Query scrn10 Integer Recommended 10. Does the patient have tardive dyskinesia 0::4 0=No; 1=Yes;2=Current; 3=In partial remission; 4=Past mh_td
Query scq_15 Integer Recommended Rheumatoid arthritis 0;1 0=No; 1=Yes mh_arth3
Query exambat233 Integer Recommended Visual impairment 0;1 0=No;1=Yes mh_visn
dawba_m2_l4 String 255 Recommended Description - Other Concerns - Other things you are concerned about mh_oth3
Query charc19d Integer Recommended CCI question 19d: If 19=1, received chemotherapy or radiation therapy (for any tumor ever);0=No,1=Yes 0;1;9 0=No; 1=Yes; 9=Missing mh_chemo
Query smoke_current Integer Recommended Is the child a current smoker 0;1;9 1 = Yes; 0 = No; 9 = Unknown mh_smkc
Query smkamt Integer Recommended About how many cigarettes smoke per day mh_smkn
Query yearssmoking Float Recommended Years smoking 0.0::99.9 mh_smkny
Query cr3b Float Recommended Tobacco Use: If yes, smoked: Years since quitting smoking mh_smkyq
Query psqb18 Integer Recommended Drink caffeinated beverages on a typical day 0::2; 9 0 = No; 1 = Yes; 2 = Do not know; -9 = Missing value mh_caff
Query medhx12 Integer Recommended Do you drink alcohol? 0;1 0 = No; 1 = Yes mh_alchc
Query mentalhealth19 Integer Recommended have you been treated for an alcohol problem? 0;1 0=No; 1=Yes mh_alctx
Query subus30 Integer Recommended Does the client currently use any other recreational drugs? 1;0 1=Yes; 0=No mh_idrgc
Query ca834 Integer Recommended Lifetime history - Drug use: Have you ever sought treatment for drug use? 0;1 0=No; 1=Yes mh_drgtx
quesmoth_probhighbp String 50 Recommended Hypertension (High blood pressure)
Yes;No;Don't Know
mh_hypt
condition_neurological String 5 Recommended Other Neurological Disorder
Yes; No
Y = Checked mh_oneur
fs_v2_loss_of_consciousness String 2 Recommended Full Screener (Visit 2): Loss of consciousness? (Y=Yes; N=No; NA=Not Provided)
Y;N;NA
Y = Yes; N = No; NA = Not provided mh_loc
condition_health String 5 Recommended Other Health Conditions (e.g., cardiac disorder, asthma)
Yes; No;999
Y = Checked mh_oth
Query subus26 Integer Recommended If client currently uses alcohol, number of drinks/week mh_alchcn
Query alcab_treat Float Recommended Alcohol Abuse: treatment mh_alctx1
Query mh_chd2 Integer Recommended Coronary heart disease (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_hrta2 Integer Recommended Heart attack (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_ang2 Integer Recommended Angina (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_afib2 Integer Recommended Atrial Fibrillation (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_athr Integer Recommended Atherosclerosis 0; 1 0=No; 1=Yes
Query mh_athr2 Integer Recommended Atherosclerosis (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_ci Integer Recommended Coronary Insufficiency 0; 1 0=No; 1=Yes
Query mh_ci2 Integer Recommended Coronary Insufficiency (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mhxa1h Integer Recommended Congestive heart failure 0;1;8 1=Yes;0= No;8=Don't Know mh_chf
Query mh_chf2 Integer Recommended Congestive/congenital heart failure (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_crdmy Integer Recommended Cardiomyopathy 0; 1 0=No; 1=Yes
Query mh_crdmy2 Integer Recommended Cardiomyopathy (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_ic Integer Recommended Intermittent claudication 0; 1 0=No; 1=Yes
Query mh_ic2 Integer Recommended Intermittent claudication (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_lvh2 Integer Recommended Left ventricular hypertrophy or echocardiogram (EKG) (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_hypt2 Integer Recommended Hypertension (history of or high blood pressure meds) (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_dbt2 Integer Recommended Diabetes mellitus (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mdga10 Integer Recommended Diagnosed with: Hyperlipidemia 0;1; -9 0=No; 1=Yes; -9=unknown mh_hypl
Query mh_hypl2 Integer Recommended Hyperlipidemia (high blood cholesterol/triglyceride) (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query baseline_k_006 Integer Recommended Stroke 0;1; -888; -999 0=No; 1=Yes; -888=Not Applicable; -999=Missing; mh_strk
Query mh_strk2 Integer Recommended Stroke/TIA (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_owt Integer Recommended Overweight 0; 1 0=No; 1=Yes
Query mh_owt2 Integer Recommended Overweight (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_renal Integer Recommended Renal problems (chronic nephritis, kidney failure or dialysis) 0; 1 0=No; 1=Yes
Query hyperthy Integer Recommended hyperthyroidism overactive thy 0;1;-7; 9; -999 0=No; 1=Yes; -7=Refused; 9=Not evaluated; -999= Don't know/Missing Data mh_hyprt
Query mh_hyprt2 Integer Recommended Hyperthyroidism (Overactive thyroid/Graves' disease) (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query hypothy Integer Recommended hypothyroidism underactive thy 0;1;-7; 9; -999 0=No; 1=Yes; -7=Refused;9=Not evaluated; -999= Don't know/Missing Data mh_hypot
Query mh_hypot2 Integer Recommended Hypothyroidism (low thyroid hormone) (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query medhx_respprob Integer Recommended Respiratory Problems 0::2 0 = No, 1 = Yes, 2 = Not sure mh_resp
Query mh_resp2 Integer Recommended Respiratory (Asthma, COPD et al (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_eent Integer Recommended Eyes, Ears, Nose, Throat & Larynx 0; 1 0=No; 1=Yes
Query mh_peri Integer Recommended Periodontal (gum) disease 0; 1 0=No; 1=Yes
Query mh_peri2 Integer Recommended Periodontal (gum) disease (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_cysta Integer Recommended Cystic Acne 0; 1 0=No; 1=Yes
Query mh_cysta2 Integer Recommended Cystic Acne (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query wk_seizure Integer Recommended 40. Seizure 0;1 No = 0; Yes = 1; mh_szr
Query mh_szr2 Integer Recommended Seizure disorders (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_park Integer Recommended Parkinson's disease 0; 1 0=No; 1=Yes
Query mh_park2 Integer Recommended Parkinson's disease (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query elig_18 Integer Recommended Liver disease 0;1 0=No; 1=Yes mh_liver
Query mh_ugi Integer Recommended Upper GI problems 0; 1 0=No; 1=Yes
Query mh_celac2 Integer Recommended Celiac disease (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_lgi Integer Recommended Lower GI problems 0; 1 0=No; 1=Yes
Query mh_ibs2 Integer Recommended Irritable bowel syndrome (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_ulcc2 Integer Recommended Ulcerative colitis (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query medhx_crohn Integer Recommended Crohn's Disease 0::2 0 = No, 1 = Yes, 2 = Not sure mh_crohn
Query mh_crohn2 Integer Recommended Crohn's disease (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_hdin2 Integer Recommended Head injury (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_loc2 Integer Recommended Loss of consciousness (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_mem Integer Recommended Memory problems 0; 1 0=No; 1=Yes
Query mh_mem2 Integer Recommended Memory problems (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_td2 Integer Recommended Tardive dyskinesia (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_anem Integer Recommended Anemia or coagulation problems 0; 1 0=No; 1=Yes
Query mh_anem2 Integer Recommended Anemia or coagulation problems (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query cfmh_othr_cancer Integer Recommended Cancer 1;0 0 = No; 1 = Yes mh_cncr
Query mh_cncr2 Integer Recommended Cancers (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
mh_cncr3 String 150 Recommended Cancers (description)
Query mh_msklt Integer Recommended Musculoskeletal/Integument 0; 1 0=No; 1=Yes
Query mh_fbrmy Integer Recommended Fibromyalgia 0; 1 0=No; 1=Yes
Query mh_fbrmy2 Integer Recommended Fibromyalgia (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query wk_arthritis Integer Recommended 3. Arthritis 0;1 No = 0; Yes = 1; mh_arth
Query mh_arth2 Integer Recommended Arthritis (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_oinf Integer Recommended Other inflammatory disorder 0; 1 0=No; 1=Yes
Query mh_oinf2 Integer Recommended Other inflammatory disorder (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_visn2 Integer Recommended Severe visual impairment (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_hrng Integer Recommended Severe auditory impairment 0; 1 0=No; 1=Yes
Query mh_hrng2 Integer Recommended Severe auditory impairment (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_oth2 Integer Recommended Other conditions (current impact) 0::4; -9 0=No current problem; 1=Current mild problem or past significant problem; 2=Moderate disability or morbidity/requires "first line" therapy; 3=Severe/constant significant disability/uncontrollable chronic problems; 4=Extremely severe/immediate treatment required/end organ failure/severe impairment in function; -9=Missing
Query mh_hosp Integer Recommended Major hospitalizations 0; 1 0=No; 1=Yes
wk_hospitalization_spec String 50 Recommended Hospitalization. Specifics mh_hosp2
Query mh_fam Integer Recommended Do any medical conditions run in your family 0; 1 0=No; 1=Yes
Query exbreast Integer Recommended Pregnant or breastfeeding 0;1;-99 0=No; 1=Yes; -99 = Missing mh_preg
Query mh_surg Integer Recommended Have you recently (within last month) had surgery 0; 1 0=No; 1=Yes
Query mh_vacc Integer Recommended Have you recently (within last month) had any vaccinations 0; 1 0=No; 1=Yes
mh_smkqn String 150 Recommended Rate of smoking before quitting (cigarettes/day)
Query cdcaf Float Recommended caffeine cups per day 999=DK; 77=Refused mh_caffn
Query mh_alchp Integer Recommended History of drinking 0; 1 0=No; 1=Yes
Query mh_alchpn Float Recommended Number of years since quitting drinking
mh_idrgc1 String 150 Recommended Last use of recreational drugs
mh_drgtx1 String 150 Recommended When in drug treatment
strconheartdis String 5 Recommended Does the child/patient have heart disease?
Yes; No;999;Ref
Ref=refused; 999=NA/NK/missing mh_chd
time_unit String 25 Recommended Time Unit
cirsg_2_s Integer Recommended Vascular: Have you ever had any health problems with your heart? This includes hypertension, stenosis of blood vessels 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_3_s Integer Recommended Hematopoietic: Have you ever had any health problems related to your blood or blood cells? This includes anemia, iron deficiencies, B12 deficiencies, leukemia, lymphoma. 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_4_s Integer Recommended Respiratory: Have you ever had any health problems with your breathing or lungs? This includes bronchitis, asthma, COPD, lung cancer, pneumonia. Do you currently smoke? If not, have you ever smoked? If yes, For how many years? How many cigarettes or packs per day? 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_5_s Integer Recommended Eyes, ears, nose, throat, and larynx: Have you ever had any health problems related to your eyes, ears, nose, or throat? This includes hearing loss/hearing aids, vertigo, blindness, deafness, macular degeneration, glaucoma, and seasonal allergies. If wears glasses: Do you ever have difficulty reading the newspaper or driving even when wearing glasses/contacts? 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_6_s Integer Recommended Upper GI: Have you ever had any health problems related to your stomach? This includes heartburn, stomach ulcer, gastric bypass, stomach cancer. 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_7_s Integer Recommended Lower GI: Have you ever had any health problems related to your intestines? This includes hemorrhoids, hernias, constipation, diarrhea, irritable bowel disease or bowel obstructions. 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_8_s Integer Recommended Liver: Have you ever had any health problems related to your liver? This includes hepatitis, heavy alcohol use, gall stones, pancreatitis, elevated bilirubin. Note: if there are no liver tests, score heavy alcohol use as indicated in the manual. 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_9_s Integer Recommended Renal: Have you ever had any health problems with your kidneys? This includes kidney stones, dialysis. 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_10_s Integer Recommended Genitourinary: Have you ever had any problems with your urinary or reproductive health? This includes incontinence, hysterectomy, UTI's, prostate problems. 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_11_s Integer Recommended Musculoskeletal/Integument: Have you ever had any health problems with your skin or bones? This includes arthritis, skin cancer, osteoporosis. 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_12_s Integer Recommended Neurological: Have you ever had any neurological health problems? This includes mini-strokes, chronic headaches/migraines, neurodegenerative diseases such as Parkinson's, MS, etc. 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_13_s Integer Recommended Endocrine/Metabolic and breast: Have you ever had any metabolic or endocrine health problems? This includes diabetes, hormone replacement, electrolyte imbalances, breast cysts, lumps or cancer, thyroid problems. Height? Weight? 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
cirsg_miss Integer Recommended cirsg_cumulative_illness_rating_scale_geriatric MISSCODE 0::26;99;925 0 = DATA COLLECTED PRIOR TO IMPLEMENTING MISSING CODES ; 1 = DONE - COMPLETE ; 2 = CLINICAL STATUS OF PATIENT ; 3 = PHYSICAL STATUS OF PATIENT ; 4 = TIME CONSTRAINTS ; 5 = THERAPIST NEGLECTED TO COMPLETE OR GIVE FORM TO PATIENT ; 6 = PATIENT REFUSAL ; 7 = THIS WAS NOT A REGULARLY SCHEDULED PROTOCOL APPOINTMENT ; 8 = FORMS WERE NOT IN CHART; UNABLE TO LOCATE HARD COPY OF FORM ; 9 = IN PROCESS; ASSESSMENT NOT RETURNED AND IS PENDING NEXT VISIT ; 10 = ASSESSMENT RETURNED INCOMPLETE; SENT BACK TO RATER OR PATIENT ; 11 = ITEMS ARE MISSING AND CAN NOT BE RETRIEVED ; 12 = INVALID SAMPLE COLLECTION ; 13 = PARTIAL SAMPLE COLLECTION ; 14 = LAB ERROR ; 15 = NOT APPLICABLE ; 16 = CONTACT DONE VIA PHONE ; 17 = UNABLE TO BE COMPLETED DUE TO COGNITIVE STATUS OF PATIENT ; 18 = MEDICAL DATA COLLECTION DEFERRED PENDING AVAILABILITY OF DOCTOR/NURSE ; 19 = NO MEMORY OF INFORMATION ; 20 = PATIENT TERMINATED FROM STUDY DURING VISIT ; 21 = EQUIPMENT NOT AVAILABLE ; 22 = EQUIPMENT NOT WORKING PROPERLY ; 23 = NOT PART OF PROTOCOL AT TIME SUBJECT WAS STUDIED ; 24 = NOT ABLE TO CONTACT SUBJECT TO SCHEDULE ; 25 = PARTIC UNABLE TO UNDERSTAND DUE TO LANGUAGE BARRIER ; 26 = DONE ON WDX, PESTERING ON ; 99 = DATA FLAGGED BY THE PI AND MAY NEED TO BE EXCLUDED FROM ANALYSIS ; 925 = SKIP VISIT
cirsg_1_s Integer Recommended Heart: Have you ever had any health problems with your heart? This includes heart attacks, chest pain, arrthymias, heart murmurs, coronary bypass or valve replacement. 0::4 0 = No Impairment ; 1 = Current Mild Problem or Past Significant Problem ; 2 = Moderate Disability or Morbidity - Requires 'First Line' Therapy ; 3 = Severe/Constant Significant Disability - 'Uncontrollable' Chronic Problems ; 4 = Extremely Severe - Immediate Treatment Required - End Organ Failure - Severe Impairment in Function
version_form String 121 Recommended Form used/assessment name
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

  • Element Name: This is the standard element name
  • Data Type: Which type of data this element is, e.g. String, Float, File location.
  • Size: If applicable, the character limit of this element
  • Required: This column displays whether the element is Required for valid submissions, Recommended for valid submissions, Conditional on other elements, or Optional
  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
  • For valid elements with shared data, on the far left is a Filter button you can use to view a summary of shared data for that element and apply a query filter to your Cart based on selected value ranges

At the top of this page you can also:

  • Use the search bar to filter the elements displayed. This will not filter on the Size of Required columns
  • Download a copy of this definition in CSV format
  • Download a blank CSV submission template prepopulated with the correct structure header rows ready to fill with subject records and upload

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