|
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) |
|
|
mh_hypt |
|
condition_neurological |
String |
5
|
Recommended |
Other Neurological Disorder |
|
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 = Yes; N = No; NA = Not provided
|
mh_loc |
|
condition_health |
String |
5
|
Recommended |
Other Health Conditions (e.g., cardiac disorder, asthma) |
|
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? |
|
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 |
|
|
|