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Medical History

medhistory

01

Medical History

Download Definition as
Download Submission Template as
Element NameData TypeSizeRequiredDescriptionValue RangeNotesAliases
subjectkeyGUIDRequiredThe NDAR Global Unique Identifier (GUID) for research subjectNDAR*guid
src_subject_idString20RequiredSubject ID how it's defined in lab/projectaid, bid, id, patid, pid, randid, record_id, subject_id, subjectid
interview_dateDateRequiredDate on which the interview/genetic test/sampling/imaging was completed. MM/DD/YYYYRequired fieldco_doa, intvdate, med_history_date, visit_date
interview_ageIntegerRequiredAge in months at the time of the interview/test/sampling/imaging.0 :: 1260Age 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.intvage
genderString20RequiredSex of the subjectM;FM = Male; F = Female
relationshipString255RecommendedRelationship of respondent to individual
1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31;32;33;34;35;36;37;38;39;40;41;42;43;44;45;46;47;48;49;50;51;52;53;54;55;56;57;58;59;60;61;62;63;64;65;66;67;68;69;70;71;72;73;74;75;76;77;78;79;80;81;82;83;84; -999
1 = Biological mom; 2 = Biological dad; 3 = Grandparent; 4 = Special education (sped) teacher; 5 = General education teacher; 6 = Occupational therapist; 7 = Speech and language therapist; 8 = Behavioral therapist; 9 = Paraprofessional; 10 = Aide; 11 = Principal; 12 = Administrator; 13 = Other; 14 = Content teacher; 15 = Parent center director; 16 = Self; 17=Adoptive mother; 18=Adoptive father; 19=Foster mother; 20 = Foster father; 21=Grandmother; 22=Grandfather; 23=Step-mother; 24 = Step-father; 25=Aunt; 26=Uncle; 27=Missing Data; 28=Both parents;31= Grandmother from mother side; 32= Grandfather from mother side; 33= Grandmother from father side; 34= Grandfather from father side; 36= Brother; 37= Sister; 38= Cousin; 39= female caregiver; 40=male caregiver; 41=Female child; 42=Male child; 43=Spouse/Mate; 44=Friend; 45=Parent; 46=Significant other; 47=Sibling; 48=Son/Daughter; 49=Son-in-law/Daughter-in law; 50=Other Relative; 51=Paid caregiver; 52=Friends; 90= Other, specify; -999= Missing; 53=Roommate; 54=Supervisor; 55=mother's boyfriend; 56=other parental figure; 57=Summary; 58=counselor ; 59 = other female relative; 60 = other male relative; 61 = non-relative ;62=Maternal Aunt; 63=Maternal Uncle; 64=Maternal Cousin; 65 = Paternal Aunt; 66=Paternal Uncle; 67=Paternal Cousin ;68=Biological/Adoptive Mother and Grandmother; 69=Biological/Adoptive Mother and Stepmother and Grandmother; 70=Biological/Adoptive Mother and Grandmother and Foster Father; 71=Biological/Adoptive Mother and Stepmother and Foster Mother; 72=Biological/Adoptive Mother and Foster Mother; 73=Biological/Adoptive Mother and Biological/Adoptive Father; 74=Biological/Adoptive Mother and Stepmother and Biological/Adoptive Father; 75=Biological/Adoptive Mother and Other; 76=Biological/Adoptive Mother and Stepmother and Stepfather; 77=Biological/Adoptive Mother and Stepfather; 78=Biological/Adoptive Mother and Grandfather; 79=Biological/Adoptive Mother and Stepmother and Foster Father; 80=Biological/Adoptive Mother and Stepmother; 81=Guardian, female; 82=Other female; 83=Guardian, male; 84=Other maleRESPREL
respondent_other_specifyString50RecommendedRespondent: Other (specify)RESPREL_SP
age_concernIntegerRecommendedAge of first developmental concern (months)0 :: 1200DIAG_AOFC, agedevelopconcernsmon
devel_concern_cogIntegerRecommended2. Developmental concerns (check all that apply): (choice=Cognitive/learning)0;10=Unchecked; 1=Checkeddevelopconcernscheck_cognitivele
devel_concern_behIntegerRecommended2. Developmental concerns (check all that apply): (choice=Behavior)0;10=Unchecked; 1=Checkeddevelopconcernscheck_behavior
devel_concern_hearIntegerRecommended2. Developmental concerns (check all that apply): (choice=Hearing)0;10=Unchecked; 1=Checkeddevelopconcernscheck_hearing
devel_concern_motIntegerRecommended2. Developmental concerns (check all that apply): (choice=Motor)0;10=Unchecked; 1=Checkeddevelopconcernscheck_motor
devel_concern_langIntegerRecommended2. Developmental concerns (check all that apply): (choice=Language)0;10=Unchecked; 1=Checkeddevelopconcernscheck_language
aut_diagIntegerRequiredAutism-related diagnosis1::4;9991 = Autism; 2 = Autism Spectrum Disorder; 3 = Asperger syndrome; 4 = PDD-NOSautismrelateddiagche, diagnosis
diag_diagnosismadebyString50RecommendedDiagnosis made byPhysician;Psychologist;Other; NKNK = Not knowndiagmadeby, diagnosismadeby
diagnosis_otherString20RecommendedDid the subject recieve another diagnosis?Yes; No; Don't Know (DK); Not Applicable (N/A)OTHDIAGYN, developconcernscheck_other
diagnosis_other_specifyString500RecommendedWhat other diagnoses has the participant had?OTHDIAGSP, autismrelateddiagotherspec, developconcernsother
othdiagyIntegerRecommendedother diagnosis Years
othdiagmIntegerRecommendedother diagnosis Months
othdiag_ageIntegerRecommendedAge at other diagnosis months
preg_complicString10RequiredComplications during pregnancy?Yes; No; NKNK = Not knowncmedhx8
preg_comp_noteString255RecommendedNote regarding complications during pregnancyPGCOMPLSP
preg_dxdrugString10RequiredUsed prescription medications during pregnancy?
Yes; No; NK
NK = Not known
any_medication_pregString200Recommendedwas the mother given any medication during pregnancyPGMEDSSP
pgartIntegerRecommended9. Used Assisted Reproductive Technology (ART)?0::2
pgartspString200RecommendedART Used: Please Describe
preg_age_momIntegerRecommendedAge of mother at the time of birthIn years; 999=UnknownMAGEATBRTH, cmedhx1
preg_age_dadIntegerRecommendedAge of father at the time of birthIn years; 999=UnknownFAGEATBRTH
birth_weight_lbsFloatRecommendedBirth weight poundsBIRTH_WEIGHT_LBS, cmedhx7a
birth_weight_ozFloatRecommendedBirth weight ouncesBWOZ, cmedhx7b
bwnk_2IntegerRecommendedBirth weight not Known or Not Available (choice=NK)0;10=Unchecked; 1=Checked
ldnb_lgthinFloatRecommendedWhat was the babys length at birth(inches)-1 = Not known
blnk_2IntegerRecommendedBirth length not Known or Not Available (choice=NK)0;10=Unchecked; 1=Checked
full_termString10RequiredFull-term delivery? 37-42 weeks
Yes; No; NK
NK = Not known
info_gestString50RecommendedNo. Weeks Gestation (G.A.)
ldnb_hosptotalmomFloatRecommendedHow many days did the mom stay in the hospital after birth
walk10_ageIntegerRecommendedWalking 10 steps - age0 :: 1200p7902devhistagewalkingmonth
ad016IntegerRecommendedAge of first single words (months)994 = Milestone not reached; 996 = N/K, but apparently normal; 997 = N/K, but apparently delayed; 998 = N/A; 999 = N/K or not askedp7902devhistagefirstwordsmonth
age_3wordIntegerRecommendedAge at 3-word sentences (in months)p7902devhistagefirst3wordsente2
current_langString10RecommendedCurrent speech/language. Verbal?Yes; No; NKNK = Not known
verb_wordsIntegerRecommendedIf yes, how many words?1::41 = <10 Single words; 2 = Speaks in 10 or more single words; 3 = Speaks in 2 word combinations; 4 = Speaks in 3 or more word combinations
intelligIntegerRecommended20. Is your childs speech intelligible to you?0::20=No; 1= Yes; 2=Sometimes
intelligothIntegerRecommended21. Is your childs speech intelligible to other people?0::20=No; 1= Yes; 2=Sometimes
aacIntegerRecommended22. Does your child use an augmentative communication device?0::20=No; 1=Yes; 2=NK
aac_pecsIntegerRecommendedWhat type of AAC does your child use? (choice=PECS)0;10=Unchecked; 1=Checked
aac_ipadIntegerRecommendedWhat type of AAC does your child use? (choice=iPad single words)0;10=Unchecked; 1=Checked
aac_spgenIntegerRecommendedWhat type of AAC does your child use? (choice=Speech generating device)0;10=Unchecked; 1=Checked
aacothIntegerRecommendedWhat type of AAC does your child use? (choice=Other type)0;10=Unchecked; 1=Checked
speechdevspString200RecommendedPlease describe speech generating device:
speechdevothString200RecommendedPlease describe other AAC type:
aacfreqIntegerRecommendedHow often does your child use the AAC?1::51=Frequently; 2=Sometimes in different contexts; 3=Only at home; 4=Only at school; 5=Rarely
child_devdelayString50RecommendedDoes (did) the Child have a Developmental Delay?
Yes;No; NK
DELAY
rx_behavString10RequiredPrescription medications for behavioral concernsYes; No; NKNK = Not known
rx_physString10RequiredPrescription medications for physical health concernsYes; No; NKNK = Not known
otc_medString10RequiredOver-the-counter medicationsYes; No; NKNK = Not known
ds_medString10RequiredDietary supplementsYes; No; NKNK = Not known
ds_medspString200RecommendedDietary Supplements: Please Describe
gastro_spec_dietString50RequiredDoes subject have a special diet?Yes; No; NKNK = Not known
specialdiet_current_descString100RecommendedSpecial diet - DescribeGASTRO_SPEC_SP
specialdiet_pastString6Recommendedtaking special diets in the past?TRUE;FALSE; NKSPDIETP
spdietphowlongString50RecommendedSpecial Diet in the Past: How Long
spdietpspString100RecommendedSpecial Diet in the Past: Please Describe
weight_stdFloatRecommendedWeight - Standard Unit-1 = Not knownCHWGT, dx20_in, weight
fs_v2_height_feetIntegerRecommendedHow tall is the subject now (feet)?CHHGTF
fs_v2_height_inchesIntegerRecommendedHow tall is the subject now (inches)?CHHGTI
hosp_medIntegerRecommended32. Has your child ever been hospitalized for: (choice=Medical)0;10=Unchecked; 1=Checked
hosp_behIntegerRecommended32. Has your child ever been hospitalized for: (choice=Behavioral)0;10=Unchecked; 1=Checked
hosp_mhIntegerRecommended32. Has your child ever been hospitalized for: (choice=Mental Health)0;10=Unchecked; 1=Checked
hospagemIntegerRecommendedAt what ages has your child been hospitalized for medical concerns?
hosplngthmString50RecommendedFor how long:
hospagebIntegerRecommendedAt what ages has your child been hospitalized for behavioral concerns?
hosplngthbString50RecommendedFor how long:
hospagemhIntegerRecommendedAt what ages has your child been hospitalized for mental health concerns?
hosplngthmhString50RecommendedFor how long:
child_rettsString50RequiredDoes the Child have Rett's Syndrome?
Yes;No;999
GEN_DIS_RETT
child_downssyndString50RequiredDoes (did) the Child have Down's Syndrome?
Yes;No;999
GEN_DIS_DOWN
child_tubersclString50RequiredDoes (did) the Child have Tuberous Sclerosis?Yes; No; NK; NSNK= Not known; NS = Not sureGEN_DIS_TUB, q26
child_fragilexString50RequiredDoes (did) the Child have Fragile X?
Yes;No;999
GEN_DIS_FRAGX
fhi_df_nfib_chdIntegerRequiredFamily History: Neurofibromatosis Child0;1;9990=Unchecked; 1=CheckedGEN_DIS_NEUROF
child_geneticdisString50RecommendedDoes (did) the Child have a Genetic Disorder?
Yes; No; NK; NS
NK= Not known; NS = Not sureGEN_DIS_OTHGEN
gen_dis_conf_rettIntegerRecommendedIs the Rett Syndrome confirmed by a physician-ordered genetic analysis?0::20=No; 1=Yes; 2=NK
gen_dis_conf_downIntegerRecommendedIs the Down Syndrome confirmed by a physician-ordered genetic analysis?0::20=No; 1=Yes; 2=NK
gen_dis_conf_tubIntegerRecommendedIs the Tuberous Sclerosis Complex confirmed by a physician-ordered genetic analysis?0::20=No; 1=Yes; 2=NK
gen_dis_conf_fragxIntegerRecommendedIs the Fragile X Syndrome confirmed by a physician-ordered genetic analysis?0::20=No; 1=Yes; 2=NK
gen_dis_conf_neurofIntegerRecommendedIs the Neurofibromatosis I confirmed by a physician-ordered genetic analysis?0::20=No; 1=Yes; 2=NK
child_geneticdis_cmtString255RecommendedSpecify Child's Genetic DisorderGEN_DISOTH
rev_headmeningitisString50RecommendedMeningitisYes; No; NK; NSNK= Not known; NS = Not sure
meningitisyIntegerRecommendedMeningitis Years
meningitismIntegerRecommendedMeningitis Months
rev_headmeningitisageIntegerRecommendedMeningitis: Age(in months)0 :: 1200
rev_headmeningitisorgString255RecommendedMeningitis: Organism
rev_headencephalitisString50RecommendedEncephalitis
Yes; No; NK; NS
NK= Not known; NS = Not sure
encephalitisyIntegerRecommendedEncephalitis Years
encephalitismIntegerRecommendedEncephalitis Months
rev_headencephalitisageIntegerRecommendedEncephalitis: Age(in months)0 :: 1200
rev_headencephalitisorgString255RecommendedEncephalitis: Organism
rev_headfebseizString50RecommendedFebrile Seizures
Yes; No; NK; NS
NK= Not known; NS = Not sure
rev_headfebseizagesString255RecommendedFebrile Seizures: Age(S)
rev_headseizureString50RequiredSeizuresYes; No; NK; NSNK= Not known; NS = Not sureseizure
rev_headseizureonsetString255RecommendedSeizures: Onset
rev_headseizurecontrolString50RequiredSeizures: Controlled
Yes;No;NK
NK = Not known
nfebseizhowString100RecommendedHow are the seizures controlled?
fhxcpString5RequiredCerebral Palsy
Yes;No; NK
NK = Not known
hist_traumaString10RecommendedHistory of head trauma
Yes; No; NK; NS
NK= Not known; NS = Not sure
rev_headimagestudyString50RecommendedImaging Studies
Yes;No;NK
NK = Not known
headimage_usIntegerRecommendedHead imaging type (choice=Ultrasound)0;10=Unchecked; 1=Checked
ctscanofbrainString10RecommendedDid the subject take a CT scan of brain?
TRUE;FALSE;UNKNOWN;NK
NK = Not knownHEADIMAGE_CT
mribrainscanString10RecommendedDid the subject take an MRI scan of brain?
TRUE;FALSE;UNKNOWN;NK
NK = Not knownHEADIMAGE_MR, mri001
diag_petString50RecommendedPET scan
Yes; No; NK; NS
NK= Not known; NS = Not sureHEADIMAGE_PET, pet001
diag_eegString50RecommendedEEG
Yes;No
HEADIMAGE_EEG
usresIntegerRecommendedResults: Ultrasound1;21=Normal; 2=Abnormal
ctscanresultIntegerRecommendedDetails of MRI/CT scan result(s)1;2;31 = Normal; 2 = Abnormal; 3 = UnknownCTRES
mriscanresultsIntegerRecommendedDetails of the brain MRI result(s)1;2;31 = Normal; 2 = Abnormal; 3 = UnknownMRRES
petresIntegerRecommendedResults: PET scan1::31=Normal; 2=Abnormal; 3= Not Sure
eegresultsIntegerRecommendedDetails of the EEG result(s)1;2;31 = Normal; 2 = Abnormal; 3 = UnknownEEGRES
braincommString250RecommendedBrain imaging commentsmri003
vis_blindString10RecommendedSignificant visual loss or congenital blindnessYes; No; NKNK = Not knownVISCORR
weareyeglassesIntegerRecommendedDoes (did) the Child wear Glasses/lenses?0;1;20 = No; 1 = Yes; 2 = UnknownEYESCOMM
rev_eyeoterString255RecommendedEyes Other/Comments:
rev_eartestString50RecommendedHearing Testing:
Yes;No;NK
NK = Not known
rev_eartestagesString255RecommendedHearing Testing: Age(S)
rev_eartestresultString50RecommendedHearing Testing: ResultNormal;Abnormal;Unknown
hear_lossString10RequiredDeafness or significant hearing loss
Yes;No;NK
NK = Not known
othmem_hearingcorString50RecommendedHearing corrected?
Yes;No
hearcorryIntegerRecommendedHearing corrected Years
hearcorrmIntegerRecommendedHearing corrected Months
hearcorrageIntegerRecommendedAge of hearing correction (months)
rev_earrecuotitisString50RequiredRecurrent Otitis Media
Yes; No; NK; NS
NK= Not known; NS = Not sure
rev_earrecuotitisyearIntegerRecommendedRecurrent Otitis Media: #Year
recuotitisyIntegerRecommendedRecurrent otitis Years
recuotitismIntegerRecommendedRecurrent otitis Months
rev_earrecuotitisageIntegerRecommendedRecurrent Otitis Media: Age of Onset(in months)0 :: 1200
rev_earpetubeString50RecommendedPE Tubes
Yes;No;NK
NK = Not knownEAR_PETUBE
rev_earotherString255RecommendedEars Other/CommentsEARCOMM
rev_mouthcleptlipIntegerRecommended48. Cleft lip
rev_mouthcleptpalateIntegerRecommended49. Cleft Palate0;10=No; 1=Yes
feed_swallow_problemString10RecommendedHas the participant demonstrated any feeding or swallowing problems?
Yes;No; NK
SWALLOW
rev_mouthspeechdiffString50RecommendedSpeech Difficulties
Yes;No;NK
NK = Not knownSPEECH
mouthcommString100RecommendedOther/Comments
rev_teethdentalabString50RecommendedDental abnormalities
Yes;No;NK
NK = Not known
rev_teethdentalabdescString255RecommendedDental abnormalities: DescribeDENTCOMM
rev_neckspinalabString50RecommendedSpinal abnormalities
Yes;No;NK
NK = Not known
rev_neckotherString255RecommendedOther/CommentsNECKCOMM
rev_skinbirthmarkString50RecommendedBirthmarks (e.g., cafe-au-lait spots, white spots)
Yes;No;NK
NK = Not known
rev_skineczemaString50RecommendedEczema
Yes;No;NK
NK = Not known
rev_skinabcessesString50RequiredSkin Infections/Abcesses
Yes;No;NK
NK = Not known
rev_skinotherString255RecommendedSkin Other/CommentsSKINCOMM
rev_pulbreathabString50RecommendedAbnormal Breathing
Yes;No;NK
NK = Not known
rev_pulasthmaString50RequiredAsthma
Yes;No;NK
NK = Not known
rev_lungString10RecommendedLung diseaseYes;No;NKNK = Not known
rev_pulotherString255RecommendedPulmonary Other/CommentsPULMCOMM
rev_cardiomalfuncString50RequiredCardiac Malformation
Yes;No;NK
NK = Not known
rev_cardiocyanosisString50RecommendedCyanosis
Yes;No;NK
NK = Not known
rev_rythmString10RecommendedAbnormal rhythm or heart rateYes;No;NKNK = Not known
rev_cardiootherString255RecommendedCardiac Other/CommentsCARDIOCOMM
rev_gastrodysphagiaString50RecommendedDysphagia
Yes;No;NK
NK = Not known
rev_gastrorefluxString50RequiredReflux
Yes; No; NK; NS
NK= Not known; NS = Not sure
rev_gastrorefluxmedString50RequiredReflux: Medication Required
Yes;No;NK
NK = Not known
rev_gastrootherString50RecommendedOther feeding difficulties
Yes;No;NK
NK = Not known
rev_gastroothercomString255RecommendedGastro Other/commentsGASTROCOMM
rev_endoprecociousString50RecommendedPrecocious Puberty
Yes;No;NK
NK = Not known
endoprecociousyIntegerRecommendedEarly puberty Years
endoprecociousmIntegerRecommendedEarly puberty Months
rev_endoprecociousageIntegerRecommendedPrecocious Puberty: Age(in months)0 :: 1200
rev_endohypothyroidismString50RequiredHypothyroidism
Yes;No;NK
NK = Not knownmhxa24_1
rev_endohyperthyroidismString50RequiredHyperthyroidism
Yes;No;NK
NK = Not known
rev_endodiabetesString50RequiredDiabetes
Yes;No;NK
NK = Not knownmhxa2
rev_endodiabetestypeString50RequiredDiabetes: TypeI;II;999
rev_endohypoglycemiaString50RecommendedHypoglycemia
Yes;No;NK
NK = Not known
rev_endootherString255RecommendedEndo Other/commentsENDOCOMM
rev_hemanemiaString50RecommendedAnemia
Yes;No;NK
NK = Not known
rev_hembleeddisorderString50RecommendedBleeding disorder
Yes;No;NK
NK = Not known
hemacommString100RecommendedHematology Other/Comments
rev_immunorecurinfectioIntegerRecommended73. Recurrent infections (>2 pneumonia or sinus infections/yr, >8 OM /yr, abscesses)0;1;-90=No;1=Yes;-9=Unknown
rev_immunoigdeficiencyString50RecommendedIg Deficiency
Yes;No;NK
NK = Not known
rev_immunocellimmunedefString50RecommendedCell Mediated Immune Def.
Yes;No;NK
NK = Not known
rev_immunoenvallergyString50RequiredEnvironmental Allergies
Yes;No;NK
NK = Not known
rev_immunomedallergyString50RequiredMedication Allergies
Yes;No;NK;NA
NK = Not known; NA=Not Applicablecmedhx13
rev_immunoimmunizationString50RecommendedImmunizations
Up to date;Behind;None;NK
NK = Not knowncmedhx14
othmem_bipolarString50RecommendedBipolar disorder (Manic/depression)
Yes;No; NK
NK = Not known
othmem_depressionString50RecommendedDepression
Yes;No; NK
NK = Not known
othmem_anxietyString50RecommendedAnxiety disorder
Yes;No; NK
NK = Not known
cfmh_othr_ocdIntegerRecommendedObsessive compulsive disorder1;0; -90 = No; 1 = Yes; -9 = Not known
othmem_schizophreniaString50RecommendedSchizophrenia
Yes;No; NK
NK = Not known
othmem_selfinjString50RecommendedSelf-injuring behavior
Yes;No; NK
NK = Not known
othmem_adhdString50RecommendedAttention deficit hyperactivity disorder (ADHD)
Yes;No; NK
NK = Not known
othmem_eatingdisString50RecommendedEating disorder. Bulimia, Anorexia, other
Yes;No; NK
NK = Not known
othmem_eatingdis_typeString100RecommendedIf yes, specify type
sleep_patString10RecommendedDisrupted sleep patternsYes;No;NKNK = Not known
touretString10RequiredTourette Syndrome
Yes; No; NK; NS
NK= Not known; NS = Not sure
mhcommString100RecommendedMental Health Other/Comments
data_derivedIntegerRecommendedData Derived From1::41 = Physical examination; 2 = Medical record; 3 = Both; 4=Parental report
mhx001aaIntegerRecommendedHistory of: Allergies - Drugs1;2; 91=No; 2=Yes; 9=not evaluatedallergy, mhx01a
mhx001abString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Allergies - Drugsmhx01b
mhx001baIntegerRecommendedHistory of: Allergies - Other1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedmhxs_q09a, q09c
mhx001bString250RecommendedAllergies. Other (Specify:)
mhx001bbString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Allergies - Other
mhx002aIntegerRecommendedHistory of:Sensitivity to study medication(s)1;2;91=No; 2=Yes;9=not evaluated
mhx002bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Sensitivity to study medication(s)
q19_a5IntegerRecommendedHEENT (includes thryroid)0; 1; -7; -8; -9; 999Field should not be left blank. If missing, please use -7,8, -9.mhx003a, mhx02a, mhxa24, mhxa27_1
mhx003bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: HEENT disordermhx02b
mhx004aIntegerRecommendedHistory of: Cardiovascular disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedcardio, mhx03a, mhxa25, mhxa28_1, mhxs_q03a, q03c
mhx004bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Cardiovascular disordermhx03b
mhx005aIntegerRecommendedHistory of: Renal disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedmhx04a, mhxa11, mhxs_q12a, q12a, renalgen
mhx005bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Renal disordermhx04b
mhx006aIntegerRecommendedHistory of: Hepatic disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedhepatic, mhx05a, mhxa9, mhxs_q13a, q13a
mhx006bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Hepatic disordermhx05b
mhx007aaIntegerRecommendedHistory of: Pulmonary disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedmhx06a, mhxs_q02a
mhx007abString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Pulmonary disordermhx06b
w1_m_cu_asthmaIntegerRecommendedhealth at interview - has a history of asthma0;1; -888; -9990 = No; 1 = Yes; -999 = missing; -888 = not applicablemhx007ba
mhx007bbString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: History of Asthma
mhx008aIntegerRecommendedHistory of: Gastrointestinal disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedgastrint, mhx07a, mhxa8, mhxs_q05a, q05c
mhx008bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Gastrointestinal disordermhx07b
mhx009aIntegerRecommendedHistory of: Musculoskeletal disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedmhx08a, mhxs_q07a, muscular, q07c
mhx009bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Musculoskeletal disordermhx08b
mhx010aIntegerRecommendedHistory of: Neurologic disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedmhx09a, mhxa4, mhxs_q10a, q10c
mhx010bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Neurologic disordermhx09b
mhx011aIntegerRecommendedHistory of: Ophthalmologic disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedmhxs_q11a, q11a
mhx011bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Ophthalmologic disorder
mhx012aIntegerRecommendedHistory of: Psychiatric disorder1;21=No; 2=Yes
mhx012bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Psychiatric disorder
mhx013aIntegerRecommendedHistory of: Dermatologic disorder1::3;91=No; 2=Yes;9=not evaluateddermat, mhx10a, mhxa13a
mhx013bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Dermatologic disordermhx10b
medhx_metsyndIntegerRecommendedMetabolic Syndrome0::20 = No, 1 = Yes, 2 = Not suremhx014a, mhx11a
mhx014bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Metabolic disordermhx11b
mhx015aIntegerRecommendedHistory of: Hematologic disorder1;2;91=No; 2=Yes;9=not evaluatedmhx12a, mhxa15
mhx015bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Hematologic disordermhx12b
mhx016aIntegerRecommendedHistory of: Endocrine disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedendocrin, mhx13a, mhxa23_1, mhxs_q04a
mhx016bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Endocrine disordermhx13b
mhx017aIntegerRecommendedHistory of: Genitourinary disorder1::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedmhx14a, mhxs_q06a, q06c
mhx017bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Genitourinary disordermhx14b
mhx018aIntegerRecommendedHistory of: Reproductive System disorder1;2;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluated
mhx018bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Reproductive disorder
mhx019aIntegerRecommendedHistory of: Infectious Disease1;2;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedmhx15a, mhxa18
mhx019bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Infectious Diseasemhx15b
mhx020aIntegerRecommendedHistory of: Other 11::3;91=No; 2=Yes; 3=Yes, Inactive;9=not evaluatedmhxa25_1, mhxs_q15a, othergen
mhx020String250RecommendedSpecify Other History 1mhx016, mhxs_q15b
mhx020bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Other
mhx021aIntegerRecommendedHistory of: Other 21::31=No; 2=Yes; 3=Yes, Inactivemhx16a, mhxs_q16a
mhx021String250RecommendedSpecify Other History 2mhx16, mhxs_q16b
mhx021bString250RecommendedIf YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Othermhx16b
siteString100RecommendedSiteStudy Siteasite, mhxs_site_x, site_uid, siteid
visitString50RecommendedVisit nameCharacter description of each type of visitint1, interval, mhxs_interval, visit_name, wave
daysrzIntegerRecommendeddays since randomizationmdga0b, mhxa0b, visitdt
fseqnoIntegerRecommendedSequence Number0::999The FSEQNO variable in the ADJ form has a special interpretation compared to other forms. For example, ADJ FSEQNO of '1' can be thought of as being '001', FSEQNO of '2' can be thought of as being '002', and FSEQNO of '3' can be thought of as being '003'. The first digit of FSEQNO relates to the corresponding ENF sequence number at that visit and the third digit relates to the specific adjudicator who completed the adjudication form.
version_formString100RecommendedForm usedform_name, vers
baseline_k_006IntegerRecommendedStroke0;1; -888; -9990=No; 1=Yes; -888=Not Applicable; -999=Missing;mdga1, mhxa1a
mhxa1bIntegerRecommendedDate crisis resolved (physician determination):mdga2_a
mhxa1cIntegerRecommendedCoronary artery disease0;1; -90=No; 1=Yes; -9 =NKmdga3
mhxa1dIntegerRecommendedAngina0;10=No; 1=Yesmdga4
mhxa1eIntegerRecommendedHeart attack/ myocardial infarction0;1; -9; 90=No; 1=Yes; 9=not evaluated; -9=unknownmdga5
mhxa1fIntegerRecommendedPeripheral vascular disease0;10=No; 1=Yesmdga6
mhxa1gIntegerRecommendedAbdominal aortic aneurysm0;10=No; 1=Yesmdga7
mhxa1hIntegerRecommendedCongestive heart failure0;10=No; 1=Yesmdga8
quesmoth_probhighbpString50RecommendedHypertension (High blood pressure)
Yes;No;Don't Know
dx3, mdga9, mhxa1i
mhxa2aIntegerRecommendedIf yes, Is the patient now prescribed insulin?0;1;9990=No; 1=Yes;999= legitimiately skipped
mhxa2bIntegerRecommendedIf yes, Is the patient now prescribed an oral hypoglycemic agent?0;1;9990=No; 1=Yes;999= legitimiately skipped
baseline_k_004IntegerRecommendedHIV0;1; -888; -9990=No; 1=Yes; -888=Not Applicable; -999=Missing;mdga17, mhxa3
mhxa5IntegerRecommendedEyes0;10=No; 1=Yes
mdga2IntegerRecommendedEye, Ears, Nose or Throat0;11=Yes; 0=Noeyesnose, mhxa6
mhxa7aIntegerRecommendedChronic Obstructive Pulmonary Disease0;10=No; 1=Yesmdga14a
mhxa7bIntegerRecommendedOther pulmonary disease0;10=No; 1=Yesmdga15
hepatIntegerRecommendedHepatitis1;0;-7; -9 0=No; 1=Yes;-7=Refused; -9 =unknownmdga19, mhxa10
medhx_genitalIntegerRecommendedGenital Problems0::20 = No, 1 = Yes, 2 = Not suremhxa12
mhxa14aIntegerRecommendedMusculoskeletal: Osteoarthritis0;10=No; 1=Yes
mhxa14bIntegerRecommendedMusculoskeletal: Osteoporosis0;10=No; 1=Yesmdga16
mhxa16IntegerRecommendedImmune System (include allergies)0;10=No; 1=Yes
mhxa17IntegerRecommendedOther Sexually Transmitted Diseases0;10=No; 1=Yesmdga18
baseline_k_003IntegerRecommendedCancer0;1; -888; -9990=No; 1=Yes; -888=Not Applicable; -999=Missing;mhxa19
medhx_surgIntegerRecommendedMajor Surgeries?0::20 = No, 1 = Yes, 2 = Not suremhxa20, surgery
q21_5fIntegerRecommendedOther major illness or injury0; 1; -7; -8; -9; 999Field should not be left blank. If missing, please use -7, 8, -9.mdga20, mhxa21
hysterecIntegerRecommendedhysterectomy0;1;-7; 888; 9990=No; 1=Yes; -7=Refused; 888=N/A; 999=missing datamhxa22
mhxa22aIntegerRecommendedIf Yes, with oophorectomy? (Y/N/U)0;1;2;9990=No; 1=Yes; 2= Unknown;999= legitimiately skipped
mxha17String20RecommendedGeneral Appearance/SkinA;NA=Abnormal; N=Normalmhxa23, mhxa26_1
mxha20String20RecommendedChestA;NA=Abnormal; N=Normalmhxa26, mhxa29_1
mhxa27IntegerRecommendedAbdominal0;10=Abnormal; 1=Normalmhxa30
mxha22String20RecommendedExtremities/JointsA;NA=Abnormal; N=Normalmhxa28, mhxa31
mhxa29IntegerRecommendedNeurological0;10=Abnormal; 1=Normalmhxa32
mdga10IntegerRecommendedDiagnosed with: Hyperlipidemia0;1; -90=No; 1=Yes; -9=unknown
mdga11aIntegerRecommendedDiagnosed with: Other heart disease0;10=No; 1=Yes
mdga12IntegerRecommendedDiagnosed with: Diabetes Type I (insulin dependent)0;10=No; 1=Yes
mdga13IntegerRecommendedDiagnosed with: Diabetes Type II0;10=No; 1=Yes
mdga20aString150RecommendedMedical Illness 1
mdga20bString150RecommendedMedical Illness 2
mdga20cString150RecommendedMedical Illness 3
mdga20dString150RecommendedMedical Illness 4
mdga20eString150RecommendedMedical Illness 5
mdga20fString150RecommendedMedical Illness 6
ch20probFloatRecommended10 Year Probability Of CHD
studyString100RecommendedStudymhxs_studyid, studyid
completedIntegerRecommendedChecks if form is completed0::20=No; 1=Yes; 2=Yes, lostformcomp, frmcomp
subtrial_nameIntegerRecommendedName of subtrial1::31=Crossover; 2=Guanfacine; 3= Open Label MPH
mhalldreIntegerRecommendedAllergies Drugs1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhalloteIntegerRecommendedAllergies Other1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq09a
mhsensmeIntegerRecommendedSensitivity to study medication(s)1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhheenteIntegerRecommendedHEENT Disorder1::4;-9;91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown;4=Yes; 9=not evaluated
mhcardieIntegerRecommendedCardiovascular Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq03a
mhrenaleIntegerRecommendedRenal Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq12c
mhhepateIntegerRecommendedHepatic Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq13c
mhpulmneIntegerRecommendedPulmonary Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhasthmeIntegerRecommendedHistory of Asthma1::4;-9;91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown;4=Yes; 9=not evaluated
mhgastreIntegerRecommendedGastrointestinal Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq05a
mhmusskeIntegerRecommendedMusculoskeletal Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq07a
mhneuroeIntegerRecommendedNeurologic Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq10a
mhophtheIntegerRecommendedOphthalmologic Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq11c
mhpsycheIntegerRecommendedPsychiatric Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhdermaeIntegerRecommendedDermatologic Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhmetabeIntegerRecommendedMetabolic Disorder1::4;-9;91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown;4=Yes; 9=not evaluatedq01c, q25
mhhemateIntegerRecommendedHematologic Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhendoceIntegerRecommendedEndocrine Disorder
1::3; -9; 9
1=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq04a
mhgenureIntegerRecommendedGenitourinary Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluatedq06a
mhreproeIntegerRecommendedReproductive System Disorder1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhinfeceIntegerRecommendedInfectious Disease1::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhothr1IntegerRecommendedOther 11::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhothr2IntegerRecommendedOther 21::3; -9; 91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown; 9=not evaluated
mhsurIntegerRecommendedAny surgeries0;10=No; 1=Yes
mhsur1eIntegerRecommendedMajor Surgery 11::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown
mhsur2eIntegerRecommendedMajor Surgery 21::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown
mhsur3eIntegerRecommendedMajor Surgery 31::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown
mhsur4eIntegerRecommendedMajor Surgery 41::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown
mhsur5eIntegerRecommendedMajor Surgery 51::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknown
mhpbirthIntegerRecommendedOther condition premature birth1;21=Yes 2=Nocmedhx6
mhcoordIntegerRecommendedOther condition coordination problem1;21=Yes 2=No
mhspeechIntegerRecommendedOther condition speech delay1;21=Yes 2=No
mhlangIntegerRecommendedOther condition language difficulty1;21=Yes 2=No
mhlearnIntegerRecommendedOther condition learning disability1;2; -91=Yes 2=No; -9=NK
mhsur1dtIntegerRecommendedMajor Surgery 1 Date in days from the randomization date (MHSUR1DT = Date of surgery - randomization date)Date of the surgery was assumed to be 15th of the month
mhsur2dtIntegerRecommendedMajor Surgery 2 Date in days from the randomization date (MHSUR2DT = Date of surgery - randomization date)Date of the surgery was assumed to be 15th of the month
mhsur3dtIntegerRecommendedMajor Surgery 3 Date in days from the randomization date (MHSUR3DT = Date of surgery - randomization date)Date of the surgery was assumed to be 15th of the month
mhsur4dtIntegerRecommendedMajor Surgery 4 Date in days from the randomization date (MHSUR4DT = Date of surgery - randomization date)Date of the surgery was assumed to be 15th of the month
mhsur5dtIntegerRecommendedMajor Surgery 5 Date in days from the randomization date (MHSUR5DT = Date of surgery - randomization date)Date of the surgery was assumed to be 15th of the month
session_idString20Recommendedsession ID/screening IDscreeningid
medhxevtString250RecommendedMedical history Event
medhxdscString250RecommendedMedical history event Description
medhxmthString30RecommendedMedical History event Month
medhxyrIntegerRecommendedMedical History event Year
medhxprsIntegerRecommendedMedical history event Currently Present?1;21=Yes; 2=No
nervsysIntegerRecommendedNervous system disorders (other than MD)0;10=No;1=Yes
medhx_respprobIntegerRecommendedRespiratory Problems0::20 = No, 1 = Yes, 2 = Not surerespir
lymphIntegerRecommendedHematopoietic-Lymphatic disorders0;10=No;1=Yes
maligIntegerRecommendedMalignancy0;10=No;1=Yes
scrn09bIntegerRecommendedAlcohol abuse0;10=No; 1=Yesalcabuse
curalcIntegerRecommendedCurrent alcohol use0;10=No;1=Yes
curalcfrIntegerRecommendedCurrent alcohol use frequency1::51=Occasional (<1 drink/week); 2=Occasional (1-2 drinks/week); 3=Occasional (?3 drinks/week); 4=Most days of the week (1-2 drinks/day); 5= Most days of the week (?3 drinks/day)
ysuaIntegerRecommendedAbuse. Other drug abuse/dependence. Diagnosis for other substance abuse0 :: 10 = Absent; 1 = Presentsubsbuse
maleIntegerRecommendedIs the subject male?0;10=No;1=Yes
menopausIntegerRecommendedDepression from menopause0;10=No;1=Yes
rlhqlqlIntegerRecommendedPatient's status is childbearing potential
1;2;9
1=No; 2=Yes; 9=unknownchildbr
contrcepIntegerRecommendedAny contraception use0;10=No;1=Yes
age1stmpIntegerRecommendedfirst menstrual period999= NAmensage
numpregIntegerRecommendednumber of pregnanciespregnum
lbirthIntegerRecommendedLive birthslivebrth
miscarIntegerRecommendedMiscarriagesmscarnum
abortIntegerRecommendedAbortionsabortnum
oralcntrIntegerRecommendedHas the patient ever taken oral contraceptives0;10=No;1=Yes
postpartIntegerRecommendedPostpartum1;0;-70=No; 1=Yes;-7=Refusedpostprtm
useoralIntegerRecommendedDepression from oral contraceptives0;10=No;1=Yes
pmsIntegerRecommendedDepression from PMS0;10=No;1=Yes
menostasIntegerRecommendedMenopause status1::31=Post-menopausal (natural or surgical); 2=Peri-menopausal; 3=Pre-menopausal
mnpsageIntegerRecommendedAge of menopause (Years)menoage
estrogenIntegerRecommendedhormone replacement therapy0;1;-70=No; 1=Yes; -7=Refusedtakehorm
menscausIntegerRecommendedMenopause due to:1::31=Natural; 2=Surgery (ovaries removed); 3=Chemotherapy or radiation
agelastIntegerRecommendedAge of last normal menstrual period
me3IntegerRecommendedDid the patient have a hysterectomy?0;10=No; 1=Yesposthyst
regmenseIntegerRecommendedRegular menstrual periods0;1; 9990=No;1=Yes; 999=NAregular_periods
mensdaysIntegerRecommendedAverage menstrual cycle length
condomIntegerRecommendedBC: Condom0;10=No;1=Yes
spermcdIntegerRecommendedBC: Spermicide0;10=No;1=Yes
bcpIntegerRecommendedOral Birth Control Pill0;10=No; 1=Yesbrthcntrl
iudIntegerRecommendedUse of IUD0;10=No;1=Yes
implantIntegerRecommendedBC: Implant0;10=No;1=Yes
tuballigIntegerRecommendedBC: Tubal ligation0;10=No;1=Yes
controthIntegerRecommendedUse of other birth control0;10=No;1=Yes
lasatmenseIntegerRecommendedPremenopause last menstrual date
mpdatmIntegerRecommendedDate of last menstrual periodmensesdt
phaseIntegerRecommendedPhase9 =follow up
days_baselineIntegerRecommendedDays since baselinedate, lof
weekFloatRecommendedWeek in level/study99=week 10-week 14
midihist_002aString250RecommendedAllergies- Other Specifiedmhxs_q09b
midihist_003aString250RecommendedHEENT Disorder explain or describe
midihist_013aString250RecommendedHepatic Disorder describemhxs_q13b
midihist_012aString250RecommendedRenal Disorder describemhxs_q12b
midihist_014aString250RecommendedPulmonary Disorder describemhxs_q02b
midihist_015aString250RecommendedGastrointestinal Disorder describemhxs_q05b
midihist_016aString250RecommendedMusculoskeletal Disorder describemhxs_q07b, mhxs_q08b
midihist_017aString250RecommendedNeurologic Disorder describemhxs_q10b
midihist_018aString250RecommendedDermatologic Disorder describe
midihist_020aString250RecommendedHemotologic Disorder describe
endocmtString250RecommendedEndocrine/Diabetes commentsmhxs_q04b
midihist_025aString250RecommendedGenitourinary Disorder describemhxs_q06b
midihist_026aString250RecommendedInfectious Disease describe
midihist_040aString250RecommendedOther medical history 1 describe
mhx003b_1String250RecommendedExplain Cardiovascular disorder historymhxs_q03b
mhx011b_1String250RecommendedExplain Metabolic disorder historymhxs_q01b
lab020DateRecommendedDate of PI/clinician signaturemhx017
fmri001IntegerRecommendedWas a Bold fMRI performed on this subject?0;1;-90=No; 1=Yes; -9=Unknown
fmri002DateRecommendedWhen was the Bold fMRI performed?
fmri003String200RecommendedfMRI comments
mrs001IntegerRecommendedWas a Glx MRS performed on this subject?0;1;-90=No; 1=Yes; -9=Unknown
mrs002DateRecommendedWhen was the Glx MRS performed?
mrs003String200RecommendedGlx MRS: Comments
visdayIntegerRecommendedNumber of days from study baseline to date of visitdaymedhxc
respondentString20RecommendedRespondent
Mother;Father;Both; Child; Other; Parent
nfmedhxc
respond_detail_oth_specString255RecommendedRespondent detailsinfrmoth
fh07IntegerRecommended7. Subject adopted0;1;9adopted
cmedhx3IntegerRecommendedTake any medications other than vitamins and iron?0;10 = No;1 = Yes
cmedhx9IntegerRecommendedDid the baby have any other trouble? (Jaundice, infections, other?)0;10 = No;1 = Yes
cmedhx10IntegerRecommendedHow many days did the baby stay in the hospital after birth?
daycmedh11aIntegerRecommendedStudy Day of last medical exam
cmedhx14aIntegerRecommendedAny bad reactions to immunizations?0;10 = No;1 = Yes
cmedhx18IntegerRecommendedAre any current medications taken regularly?0;10 = No;1 = Yes
cmedhx19IntegerRecommendedAre there any past medications which were taken regularly?0;10 = No;1 = Yes
cmedhx20IntegerRecommendedAny operations?0;10 = No;1 = Yes
cmedhx21IntegerRecommendedHas your child had frequent ear infections?0;10 = No;1 = Yes
cmedhx25IntegerRecommendedIs there asthma, recurrent cough or any lung problems?0;10 = No;1 = Yes
cmedhx27IntegerRecommendedAny problems with urination?0;10 = No;1 = Yes
cmedhx28IntegerRecommendedAny problems with diarrhea or constipation?0;10 = No;1 = Yes
cmedhx29IntegerRecommendedHave there been any convulsions or other problems with the nervous system?0;10 = No;1 = Yes
cmedhx30IntegerRecommendedAny eczema, hives, or other skin conditions?0;10 = No;1 = Yes
cmedhx31IntegerRecommendedHas your child ever been anemic?0;10 = No;1 = Yes
cmedhx34IntegerRecommendedAny hormonal problems?0;10 = No;1 = Yes
cmedhx37IntegerRecommendedAny history of physical and/or sexual abuse?0;10 = No;1 = Yes
cmedhx38IntegerRecommendedAny other medical problems?0;10 = No;1 = Yes
illness_pregnancyString200Recommendeddid the mother experience any illnesses during pregnancyYes; Nocmedhx2
presmed_alcoholString50RecommendedIn this pregnancy, did the birth mother do any of the following activities - Drink alcohol
Yes;No
cmedhx4
presmed_smokeString50RecommendedIn this pregnancy, did the birth mother do any of the following activities - Smoke cigarettes or other tobacco products
Yes;No;999
cmedhx5
height_stdFloatRecommendedHeight - Standard Unit-1 = Not knownheight
othmem_foodallergyString50RecommendedFood Allergy
Yes;No
cmedhx13a
hi_81eIntegerRecommendedPast two years. Bee or Insect Sting Allergies0;10=No; 1=Yescmedhx13b
hospitalizationsString200Recommendedhas the subject had any hospitalisationscmedhx15, p7902devhisthospitalizations
tc9IntegerRecommendedLife threatening illness and/or serious injury1;2;-99;77;881= Yes; 2= No; -99= NA; 77= Refused ; 88= Missingcmedhx16
ediheaIntegerRecommendedHead injury
0;1;2;9; -999
0 = No; 1 = Possible; 2 = Definite; 9 = Not answered/Not evaluated; -999= Don't know/Missing Datacmedhx17
visionproblemsIntegerRecommendedVision: Does (did) the subject have Vision/eye problems?
0;1;2
0 = No/False; 1 = Yes/True; 2 = Unknowncmedhx22
q17_b11IntegerRecommendedAny problem with mouth lips or teeth-7;-8;-9;0;1Field should not be left blank. If missing please use -78 -9.cmedhx23
wk_sore_throatIntegerRecommended42. Sore throat0;1No = 0; Yes = 1;cmedhx24
q17_b14IntegerRecommendedAny problems with heart0::20 = No, 1 = Yes, 2 = Not surecmedhx26
medhx_kidurIntegerRecommendedKidney/Urinary Problems0::20 = No, 1 = Yes, 2 = Not surecmedhx32
elig_18IntegerRecommendedLiver disease0;10=No; 1=Yescmedhx33
cfmh_othr_migraineIntegerRecommendedMigraine headaches0;1; -90 = No; 1 = Yes; -9=unknowncmedhx35, dx14
medhx_sleep_probString50RecommendedDoes subject have sleep problems?
Yes; No
cmedhx36
chronic2IntegerRecommendedType of chronic illness - Asthma1;21=no; 2=yesdx1
diabetesIntegerRecommendedDiabetes, or problems with blood sugar levels, if so are you insulin dependant1::4;9991 = No; 2 = Yes, in the past; 3 = Yes, currently; 4 = Under doctor's care nowdx2
medcon_dx4IntegerRecommendedArthritis or rheumatism0;10=No; 1=Yesdx4
medcon_dx5IntegerRecommendedCancer diagnosed within the last 3 years0;10=No; 1=Yesdx5
medcon_dx6IntegerRecommendedA neurological condition, such as epilepsy, convulsions, fainting spells, or Parkinsons disease0;10=No; 1=Yesdx6
medcon_dx7IntegerRecommendedStroke or major paralysis (inability to use arms or walk)0;10=No; 1=Yesdx7
baseline_k_002IntegerRecommendedHeart disease or heart attack0;1; -888; -9990=No; 1=Yes; -888=Not Applicable; -999=Missing;dx8
medcon_dx9IntegerRecommendedBack problems including disk or spine0;10=No; 1=Yesdx9
scq_05IntegerRecommendedUlcer or Stomach Disease0;10=No; 1=Yesdx10
medcon_dx11IntegerRecommendedChronic inflamed bowel, enteritis, or colitis0;10=No; 1=Yesdx11
cfmh_othr_thyroiddisIntegerRecommendedThyroid Disease1;0; -90 = No; 1 = Yes; -9=Unknowndx12
medcon_dx13IntegerRecommendedKidney failure0;10=No; 1=Yesdx13
medcon_dx15IntegerRecommendedDo you have trouble seeing even with glasses or contact lenses0;10=No; 1=Yesdx15
medcon_dx16IntegerRecommendedNot including asthma, has a doctor told you that you have chronic lung disease such as chronic bronchitis or emphysema?0;10=No; 1=Yesdx16
medcon_dx17IntegerRecommendedDo you have a physical disability such as a loss of an arm or leg, or loss of your eyesight or hearing or a birth defect that limits your ability to do daily activities?0;10=No; 1=Yesdx17
dusa1aIntegerRecommendedIf yes, on average, how many cigarettes per day have you smoked in the past 7 days?0::100; 999999= Legitimately skippeddx18
cig_smoking1_100IntegerRecommendedHave you smoked at least 100 cigarettes in your entire life? PX030601_Cigarette_Smoking_1001;2;971=Yes; 2=No; 97=Don't Know/Refuseddx18a
weight_metFloatRecommendedWeight - Metric Unitdx19
medcon_dx21IntegerRecommendedHow often do you get physical exercise, either on your job or in a recreational activity?1::41=regularly; 2= occasionally; 3= seldom; 4= neverdx21
clinicidIntegerRecommendedClinic IDaclinic
intervIntegerRecommendedIntervention Status0;11=ITV, intervention; 0=TAU, treatment as usual
tchrondsIntegerRecommendedNumber of major chronic medical conditions
rchrondsFloatRecommendedsquare root of total chronic diseases
chronds3IntegerRecommendedmajor chronic medical conditions1=none;2=one;3=two or more
chron0IntegerRecommendedno major chronic medical conditions0;10=No;1=Yes
chron1IntegerRecommended1 major chronic medical condition0;10=No;1=Yes
chron2IntegerRecommended2 or more major chronic medical conditions0;10=No;1=Yes
date_updatedDateRecommendedDate record updatededit_date
mhxa1b_1IntegerRecommendedCardiovascular Disorders: Transient Ischemic Attacks, TIAs0;10=No;1=Yes
mhxa33String2RecommendedOther illness/diseaseA;NA=Abnormal; N=Normal
mhxs_q01aIntegerRecommendedMetabolic History1::31=No; 2=Yes; 3=Yes, Inactiveq01a
mhxs_q08aIntegerRecommendedSkin/Appendages History1::31=No; 2=Yes; 3=Yes, Inactiveq08c
mhxs_q01cIntegerRecommendedMetabolic Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q02cIntegerRecommendedRespiratory/Pulmonary Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q03cIntegerRecommendedCardiovascular Disease Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q04cIntegerRecommendedEndocrinological System Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q05cIntegerRecommendedGastrointestinal System Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q06cIntegerRecommendedGenitourinary/Reproductive Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q07cIntegerRecommendedMusculoskeletal System Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q08cIntegerRecommendedSkin/Appendages Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q09cIntegerRecommendedAllergies Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q10cIntegerRecommendedNeurological System Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q11cIntegerRecommendedOphthalmologic Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q12cIntegerRecommendedRenal Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q13cIntegerRecommendedHepatic Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q14cIntegerRecommendedHematopoietic System Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q11bString250RecommendedOphthalmologic Description
mhxs_q14aIntegerRecommendedHematopoietic System History1::31=No; 2=Yes; 3=Yes, Inactiveq14a
mhxs_q14bString250RecommendedHematopoietic System Description
mhxs_q15String45RecommendedOther 1 Name
mhxs_q15cIntegerRecommendedOther 1 Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q16String45RecommendedOther 2 Name
mhxs_q16cIntegerRecommendedOther 2 Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q17String30RecommendedOther 3 Name
mhxs_q17aIntegerRecommendedOther 3 History1::31=No; 2=Yes; 3=Yes, Inactive
mhxs_q17bString250RecommendedOther 3 Description
mhxs_q17cIntegerRecommendedOther 3 Significance1;21= Yes, significant; 2= Not signifiant
mhxs_q18String30RecommendedOther 4 Name
mhxs_q18aIntegerRecommendedOther 4 History1::31=No; 2=Yes; 3=Yes, Inactive
mhxs_q18bString250RecommendedOther 4 Description
mhxs_q18cIntegerRecommendedOther 4 Significance1;21= Yes, significant; 2= Not signifiant
visitdayIntegerRecommendedday of visitmhxs_visitdat_x, studyday
medhisx_q02aIntegerRecommendedRespiratory/Pulmonary System1::31=No; 2=Yes; 3=Yes, Inactiveq02a
medhisx_q02cIntegerRecommendedRespiratory/Pulmonary Clin. Relevant1::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknownq02c
medhisx_q04cIntegerRecommendedEndocrinological System Clin. Relevant1::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknownq04c
medhisx_q08aIntegerRecommendedSkin/Appendages1::31=No; 2=Yes; 3=Yes, Inactiveq08a
medhisx_q14cIntegerRecommendedHematopoietic System Clinically Relevant1::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknownq14c
medhisx_q15aIntegerRecommendedOther 11::31=No; 2=Yes; 3=Yes, Inactiveq15a
medhisx_q15cIntegerRecommendedOther 1 Clinically Relevant1::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknownq15c
medhisx_q16aIntegerRecommendedOther 21::31=No; 2=Yes; 3=Yes, Inactiveq16a
medhisx_q16cIntegerRecommendedOther 2 Clinically Relevant1::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknownq16c
medhisx_q17aIntegerRecommendedOther 31::31=No; 2=Yes; 3=Yes, Inactiveq17a
medhisx_q17cIntegerRecommendedOther 3 Clinically Relevant1::3; -91=No history 2=Yes, excludes;3=Yes, does not exclude; -9 =unknownq17c
medhisx_q18IntegerRecommendedAdverse Psycho-social1;2;91=Yes; 2=No; 9=Not applicableq18
medhisx_q19IntegerRecommendedFragile X Syndrome1;2;91=Yes; 2=No; 9=Not applicableq19
medhisx_q20IntegerRecommendedCornelia De Lange Syndrome1;2;91=Yes; 2=No; 9=Not applicableq20
medhisx_q21IntegerRecommendedLandau-Kleffner Syndrome1;2;91=Yes; 2=No; 9=Not applicableq21
medhisx_q22IntegerRecommendedSturge Weber Syndrome1;2;91=Yes; 2=No; 9=Not applicableq22
medhisx_q23IntegerRecommendedOther Genetic Syndrome1;2;91=Yes; 2=No; 9=Not applicableq23
medhisx_q24IntegerRecommendedNeurofibromatosis1;2;91=Yes; 2=No; 9=Not applicableq24
medhisx_q27IntegerRecommendedConigenital Rubella Exposure1;2;91=Yes; 2=No; 9=Not applicableq27
ci_enrolledIntegerRecommendedParticipant enrolled0;10=No; 1=Yesenrolled
sitedatasource_1IntegerRecommendedSource of Data: Site0;1; -888; -9990=False; 1=True; -888=Not Applicable; -999=Missing;infosrcr
sitedatasource_phoneIntegerRecommendedSource of Data: Telephone0;1; -888; -9990=False; 1=True; -888=Not Applicable; -999=Missing;infosrct
sitedatasource_physicianIntegerRecommendedSource of Data: Physician0;1; -888; -9990=False; 1=True; -888=Not Applicable; -999=Missing;infosrcp
anymedhistIntegerRecommendedNo Medication History1;21= Yes; 2= Nonomeds
ad_exc11IntegerRecommendedCurrent use of antidepressants or anticonvulsants0;10=No; 1=Yesantimed
medication_nameString255RecommendedName of medicationmedname
cmindString75RecommendedIndicationpurpind
cmrouteIntegerRecommendedRoute
1::16;99;999
1 = oral; 2 = intravenous; 3 = subcutaneous; 4 = topical; 5 = inhalation; 6 = transdermal; 7 = rectal; 8 = intramuscular; 9 = sublingual; 10 = PEG; 99 = Other (specify); 999 =unknown; 11=oral/intramuscular; 12 = Nasal; 13 = Vaginal; 14 = Auricular; 15 = Intra-articular; 16 = Intraocularroute
cmroutoString30RecommendedRoute other specify
ddoseString50Recommendeddaily dose-9=unknowndose
cmunitIntegerRecommendedUnits
1::29; 99
1 = micrograms (mkg); 2 = milligrams (mg); 3 = grams (g); 4 = tablet(s); 5 = capsule(s); 6 = gtt; 7 = meq; 8 = international units (IU); 9 = units (U); 10=Percent (%); 11=Compount/more than one medicine combind; 12=Grains (gr); 13=mg/kg; 99 = Other (specify); 14 = ml; 15 = mg/mL; 16 = mcg/mL; 17 = tbls; 18 = 3tts; 19 = cc; 20 = ss; 21 = puff; 22 = spray/squirt; 23 = suppository; 24 = teaspoon; 25 = uL; 26 = unknown; 27 = oz;28=millicurie; 29=microcurieunits
cmunitoString50RecommendedUnit other specify
cmfreqIntegerRecommendedFrequency
1::31;99
1 = QD; 2 = BID; 3 = TID; 4 = QID; 5 = QHS; 6 = CONT IV; 7 = PRN; 8=Q4H; 9=Q6H; 10=Q8H; 11=Q12H; 12=BIS; 13=QS; 14=QM; 15=U; 99 = Other (specify); 16=QOD; 17=qam; 18=qw; 19=q30m; 20=q1h; 21=q5h; 22=biw; 23=qpm; 24=q15m; 25=q3h; 26 = q6pm; 27=tiw; 28 = ac; 29 = q2h;30=once; 31=Unknownfreq
cmfreqoString40RecommendedFrequency other specify
startdyIntegerRecommendedStart Dayadddate
enddayIntegerRecommendedStop Daystopdate
cmcontIntegerRecommendedContinuing at end of study?1;21=Yes; 2=Nocontinue
commentsString4,000RecommendedComments about assessmentco_notes, medical_history
labsample29String10RecommendedDate of last menstrual periodNA=if male or pre-pubertylmp_date
reason_irregular_periodIntegerRecommendedReason for irregular period0::30= Surgical Menopause;1= Natural Menopause;2= Non-Menopausal;3= Birth Control
smokerIntegerRecommendedSmoker?0;1; 90=No; 1=Yes; 9=NK/missingco_current_smoke_yn, smoking_status
quantity_currentuseFloatRecommendedNumber of cigarettes smoked per day0 :: 500cigs_per_day
cr3cFloatRecommendedTobacco Use: If yes, smoked: Number of pack-yearsco_pack_years, pack_years
current_medicationString200Recommendedsubject's current medicationsmeds
drug_classIntegerRecommendedDrug Class1::61= Antidepressants;2= Mood Stabilizers;3= Sedatives;4= Antipsychotics;5= Stimulants;6= Other
antidepressantsIntegerRecommendedAntidepressants1= Anafranil (clomipramine hydrchloride);2= Asendin (amoxapine);3= Celexa (citalopram hydrobromide);4= Desyrel (trazodone);5= Effexor (venlafaxine);6= Lexapro (escitalopram oxalate);7= Ludiomil (maprotiline);8= Luvox (fluvoxamine);9= Marplan (isocarboxazid);10= Nardil (phenelzine sulfate);11= Norpramin (desipramine);12= Pamelor/Aventyl (nortriptyline);13= Parnate (tranylcypromine);14= Paxil (paroxetine);15= Prozac (fluoxetine);16= Remeron (mirtazapine);17= Serzone (nefazodone);18= Sinequan (doxepine);19= Surmontil (trimipramine);20= Tofranil (imipramine);21= Vivactil (protriptyline);22= Wellbutrin (bupropion);23= Zoloft (sertraline);24= Cymbalta (duloxetine)
mood_stabilizers1IntegerRecommendedMood Stabilizers1= Lamictal (lamotrigine);2= Lithium;3= Tegretol (carbamazepine);4= Valproic Acid (depakene= depakote)mood_stabilizers
sedatives1IntegerRecommendedSedatives / Hypnotics / Minor Tranquilizers1= Ambien (zolpidem= midzolam);2= Atarax (hydroxyzine);3= Ativan (lorazepam);4= Benadryl (diphenhydramine);5= Buspar (buspirone);6= Dalmane (flurazepam hydrochloride);7= Halcion (triazolam);8= Klonopin (clonazepam);9= Librium (chlordiazepoxide);10= Miltown/Equanil (meprobamate);11= Noctec (chloral hydrate);12= Placidyl (ethchlorvynol);13= Restoril (temazepam);14= Seconal (secobarbital);15= Serax (oxazepam);16= Tranzene (chlorazepate);17= Valium (diazepam);18= Xanax (alprazolam)sedatives
antipsychotics1IntegerRecommendedAntipsychotics1= Abilify (ariprapizole);2= Clozaril (clozapine);3= Geodon (ziprasidone);4= Haldol (haloperidol);5= Loxitane (loxapine);6= Mellaril (thioridazine);7= Moban (molindone);8= Navane (thiothixene);9= Prolixin (fluphenazine);10= Risperdal (risperidone);11= Serentil (mesoridazine);12= Seroquel (sertindole);13= Stelazine (trifluoperazine);14= Thorazine (chlorpromazine);15= Trilafon (perphenazine);16= Zyprexa (olanzapine)antipsychotics
stimulants1IntegerRecommendedStimulants1= Adderall (amphetamine/dextroamphetamine);2= Concerta (methylphenidate hydrochloride);3= Cylert (pemoline);4= Dexedrine (amphetamine);5= Metadate (methylphenidate hydrochloride);6= Provigil (modafinil);7= Ritalin (methylphenidate)stimulants
other_drugs1IntegerRecommendedOther Drugs1= Neurontin (gabapentin);2= Trileptal (oxycarbazepine [anti-epileptic]);3= Topamax (topiramate [anti-epileptic]);4= Strattera (atomoxetine [norepinephrine reuptake blocker]);5= Symbyax (olanzapine and fluoxetine hydrochloride)other_drugs
macnumepIntegerRecommendedTotal number of episodes of manic syndrome, including current99 = too numerous or indistinct to count; -9=Unknownlifetime_episodes_mania
manic_ageIntegerRecommendedManic and Hypomania Age of Onset-9=Unknownage_of_onset_mania
depr_onsetIntegerRecommendedDepression age of onsetage_of_onset_depression
lifetime_episodes_depressionIntegerRecommendedNumber of lifetime depressed episodes
recent_episodeIntegerRecommendedMost recent episode1::51= Depression;2= Hypomania;3= Mania;4= Mixed;5= Unknown
recent_episode_notesString255RecommendedApproximate dates/notes about recent episode
age_concern_yrIntegerRecommendedAge of first developmental concern (years)0::100agedevelopconcernsyr
aut_relatedString10RecommendedIs there an Autism related diagnosisYes; No; Not knownautismrelateddiagnosis
additional_it_q1String20RecommendedDo you have any concerns about your child's development?
Yes; No
developmentalconcerns
diag_ageatdiagIntegerRecommendedAge at diagnosis(in months)
0 :: 1200
diagnosisagemon
diag_ageatdiag_yrIntegerRecommendedAge at diagnosis(in years)0::100ageatdiagnosisyear, diagnosisageyr
diag_diagnosismadeby_otrString500RecommendedDiagnosis made by Other specifieddiagmadebyother, diagnosismadebyother
age_3word_yearIntegerRecommendedAge at 3-word sentences (in years)p7902devhistagefirst3wordsente
ad016_yearIntegerRecommendedAge of first single words (years)p7902devhistagefirstwordsyear
walk10_age_yrIntegerRecommendedWalking 10 steps - age (years)p7902devhistagewalkingyear
devel_changesIntegerRecommendedAny changes in developmental history since last visit?1; 2; 91 = Yes; 2 = No; 9 = Not applicablep7902devhistchangesindevhist
devel_changes_specString50RecommendedAny changes in developmental history since last visit? - Specifiedp7902devhistchangesindevhistsp
adja5bIntegerRecommendedAdmission to an emergency department0;11=Yes; 0=No Indicate all criteria defining the study endpoint (select all that apply):p7902devhistemergencyvisits
srfa6gIntegerRecommendedEmergency Room (Medical) number of visits0::200p7902devhistnumofemergencyvisi
numhospIntegerRecommendedIf yes, number of times hospitalizedp7902devhistnumofhospitalizati
diag_changesIntegerRecommendedChanges in diagnostic history since last visit?0; 10 = No; 1 = Yeschangessincelastvisit
physicianspecialtyString50RecommendedPhysicians's specialty
co_levels_ppmFloatRecommendedExpired CO levels (PPM)
co_levels_cohbFloatRecommendedExpired CO levels ( COHb)
cr3IntegerRecommendedTobacco Use: Did person ever smoke?0;1; 90 = no;1 = yes; 9=NK/missingco_ever_smoke_yn
co_age_startIntegerRecommendedIf you have ever smoked or currently smoke, what age did you start:
cig_smokeString50RecommendedThe amount of cigarettes you smokeco_how_many_cigs
freq_unit_perIntegerRecommendedFrequency unit1::31=Per day; 2=Per week; 3=Per monthco_smoke_freq
prescan_003IntegerRecommendedHow many cigarettes did you smoke during the last 8 hours?co_smoke_today_how_many
labsample27String10RecommendedTime since subject last smoked tobaccoNA=Non-userco_smoke_last
cigarette_number_packsFloatRecommendedindicate the average number of packs of cigarettes smoked dailyco_packs_day
cigaretteuse_time_yrsFloatRecommendedindicate the number of years that the participant has smoked cigarettesco_years_smokes
co_age_quitIntegerRecommendedWhat age did you quit?
co_nic_replace_ynIntegerRecommendedAre you on nicotine replacement?1;2;91=Yes; 2=No; 9=Unknown/Missing
doa_futdtString20RecommendedFuture date entered (Assessment)co_doa_futdt
dodeString10RecommendedDate of Data Entryco_dode
dode_futdtString20RecommendedFuture date entered (Data Entry)co_dode_futdt
form_completedIntegerRecommendedWas the form completed?1;21=Yes; 2=Noco_form_complete
form_explainIntegerRecommendedWhy was this form not completed?86::9999=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 Applicableco_explain
other_reason_ncString100RecommendedOther reason form was not completedco_other_reason_nc
assessment_completeIntegerRecommendedComplete?0::20=Incomplete; 1=Unverified; 2=Completenicotine_expired_co_complete
migraine_currentIntegerRecommendedHas the subject had a migraine within the last month0;10=No; 1=Yes
pol_therapyIntegerRecommendedPhysical, occupational, or language therapy0;10=No; 1=Yes
neurologistIntegerRecommendedHas the subject ever seen a neurologist?0;10=No; 1=Yes
surg_surgtype1String255RecommendedTYPE OF SURGERY 1
medreason1String250RecommendedReason for taking medication 1
pcpkps_76String100RecommendedReferral Speicified
surg_reasonhosp1String255RecommendedWHY HOSPITALIZED 1
head_circumFloatRecommendedHead Circumference (in cm)-1 = Not known
chrt_que_1aIntegerRecommended1. Suicide Ideation - Passive (i.e. wanting to be dead) and/or active (i.e. method, intent, plan) suicidal ideation present.0;10=No; 1=Yes
ca639IntegerRecommendedPast psychosis - Suicidal behavior: Suicidal gestures or attempts0;10=No; 1=Yes
ss10IntegerRecommendedInterview reliability1::51=Very good; 2=Good; 3=Fair; 4=Poor; 5=Very poor
ari_c_2IntegerRecommended2. Often Lose temper.0::2; -90=not true, 1=somewhat true, 2=certainly true; -9=incomplete
wk_mri_dateDateRecommendedMRI. Datemri002
petddDateRecommendedPET datepet002
pet003String150RecommendedCPKPET comments
visnumFloatRecommendedNumeric 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
aescodeIntegerRecommendedStaff code number of person completing this form
raceString30RecommendedRace of study subjectAmerican Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported
ethnicityString30RecommendedEthnicity of participantHispanic or Latino; Not Hispanic or Latino; Unknown
panss_115String3RecommendedG1.Do you have any medical illness or disease?yes;no
rev_immunomedallergymedString255RecommendedMedication Allergies: Medications
v1_mh_cap1_ongoingIntegerRecommendedCondition 1 Ongoing (yes/no)0;10= no; 1= yes
mhf_22IntegerRecommendedChecks if condition is ongoing - other III0;10=No; 1=Yes
saea26a3aIntegerRecommendedmed illness 1 ongoing0;10 = No; 1 = Yes
saea26b3aIntegerRecommendedmed illness 2 ongoing0;10 = No; 1 = Yes
saea26c3aIntegerRecommendedmed illness 3 ongoing0;10 = No; 1 = Yes
saea26d3aIntegerRecommendedmed illness 4 ongoing0;10 = No; 1 = Yes
thc14dIntegerRecommendedEvent 1: Is it on going0;10=No; 1=Yes
thc19dIntegerRecommendedEvent 2: Is it on going0;10=No; 1=Yes
fammedhx_other_specifyString255RecommendedIf any other disorder/illness: specify
fammedhx_other_specify2String255RecommendedIf any other disorder/illness: specify 2
fammedhx_other_specify3String255RecommendedIf any other disorder/illness: specify 3
surg_surgtype2String255RecommendedTYPE OF SURGERY 2
surg_surgtype3String255RecommendedTYPE OF SURGERY 3
wk_surgery_otherString50RecommendedSurgery. If other, please specify
wk_surgery_comString250RecommendedSurgery. Comments (Medications taken?)
dx_ongoingIntegerRecommendedIs diagnosis ongoing?0;10 = no; 1 = yes
mhx2_bIntegerRecommendedIf diabetes history, what is the non-insulin control?1;21=Diet controlled; 2=Oral hypoglycemics
pcosIntegerRecommendeddiagnosed pcos0;1;-7; -9; -80=No; 1=Yes; -7=Refused; -9=unknown; -8=NA
otherraceString50Recommendedspecify other race
fls1IntegerRecommendedHave you fallen since your last appointment?0;1;-7;-9 0 =no; 1 = yes; -9 = don't know; -7 = refused
mse1IntegerRecommendedFeeling dizzy or faint0;1;-7;-9 0 =no; 1 = yes; -9 = don't know; -7 = refused
fls1dIntegerRecommendedDid you sustain any injuries? Any bruises?0;1;-7;-9 0 =no; 1 = yes; -9 = don't know; -7 = refused
fls1eIntegerRecommendedDid you see a physician or seek medical attention?0;1;-7;-9 0 =no; 1 = yes; -9 = don't know; -7 = refused
me2IntegerRecommendedStatus0;10 = Past [Inactive]; 1 = Active
surgerydatedd1_1DateRecommendedDate surgery 1
surgerydatedd2_1DateRecommendedSurgery Date 2
surgerydatedd3_1DateRecommendedSurgery Date 3
typeofsurgerycode4_1String100RecommendedType of surgery Code 4
typeofsurgerycode5_1String100RecommendedType of surgery Code 5
sigp1IntegerRecommendedPhysician signature present0;10 = No; 1 = Yes
sigd1IntegerRecommendedPhysician/PI signature date (days since randomization)
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)
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Distribution for DataStructure: medhistory01 and Element:
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