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NIMH Data Archive
NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

Demographics and Med History Form

404 Shared Subjects

N/A
Clinical Assessments
Med History
12/05/2016
demomhf01
02/26/2019
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR* guid
src_subject_id String 20 Required Subject ID how it's defined in lab/project case_id, patid, subject
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY histdate
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. bslage
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender, sex
Query birthstate String 2 Recommended State of Birth, Abbreviation
Query ethnicity String 30 Recommended Ethnicity of participant
Hispanic or Latino; Not Hispanic or Latino; Unknown
ethnic_group
Query race String 30 Recommended Race of study subject
American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported; Other Non-White; Other
race1
Query otherrace String 100 Recommended specify other race The following questions are about you or the child's family. otherspecify, racespc
Query family_lives String 255 Recommended Members of family living in home
Query cg1_relationship String 100 Recommended Caregiver/Parent 1's Relationship to Participant Parent;Step-parent;Foster parent;Grandparent;Other family member;Other; Biological Mother; Biological Father; Biological Parent; Adoptive Parent; Adoptive/Foster Parent; I do not wish to disclose; Step-father; Step-mother infrmnt1, relationship_parent1
cg1_relationship_specify String 100 Recommended Caregiver/Parent 1's Relationship to Participant Other Specify relat_parent1_other
Query parent_1_lives Integer Recommended Parent 1 lives with child or deceased 1::3 1=Yes; 2=No; 3=Deceased
Query cg2_relationship String 100 Recommended Caregiver/Parent 2's Relationship to Participant Parent;Step-parent;Foster parent;Grandparent;Other family member;Other; Biological Mother; Biological Father; Biological Parent; Adoptive Parent; Adoptive/Foster Parent; I do not wish to disclose; Step-father; Step-mother infrmnt2, relationship_parent2
Query cg2_relationship_specify String 100 Recommended Caregiver/Parent 2's Relationship to Participant Other Specify relat_parent2_other
Query parent_2_lives Integer Recommended Parent 2 lives with child or deceased 1::3 1=Yes; 2=No; 3=Deceased
Query demo_maritial_status Integer Recommended Marital Status: 1 :: 7 1=Single/Never married; 2=Married or living with someone as if married; 3= Divorced or annulled; 4= Separated; 5=Widowed; 6=Other; 7= Remarried parent_marital
Query demo_caregiver_edu Integer Recommended Caregiver's highest education 1::8;97 1= Less than 7th grade ; 2= Junior High ; 3= Some High School ; 4= High School graduate ; 5= Special training after high school ; 6= Some college ; 7= College graduate ; 8= Graduate/professional training or above ; 97= Don't Know parent_1_education
Query cg1_occupation String 100 Recommended Caregiver/Parent 1's Occupation parent_1_occupation
Query parent_1_employment Integer Recommended Current employment status for parent 1 1::10 1=Employed - full time; 2=Retired;3=Employed - part time; 4=Unable to work/Disabled;5=Unemployed; 6=A full time student; 7=Other; 8 = Looking for work; 9 = Keeping house/raising children full-time; 10 = I do not wish to disclose
Query p_p2educ Integer Recommended What is the last level of formal education your child's other biological parent completed? 0::8;-99;88;77 0= No formal schooling ; 1= 7th grade or less ; 2= Junior high/middle school completed ; 3= Partial high school (at least one year) ; 4= High school graduate/GED ; 5= Partial college (at least one year) or specialized training ; 6= Junior college/associates degree (2 years) ; 7= Standard college or university graduation (4 years) ; 8= Graduate professional training, graduate degree ; -99= N/A ; 88= Missing ; 77= Refused parent_2_education
Query cg2_occupation String 100 Recommended Caregiver/Parent 2's Occupation parent_2_occupation
Query parent_2_employment Integer Recommended Current employment status for parent 2 1::10 1=Employed - full time; 2=Retired;3=Employed - part time; 4=Unable to work/Disabled;5=Unemployed; 6=A full time student; 7=Other; 8 = Looking for work; 9 = Keeping house/raising children full-time; 10 = I do not wish to disclose
Query family_income String 10 Recommended Ways family receives income 1=Employment; 2=Social Security or SSI; 3=Unemployment compensation; 4=Aid to Families with Dependent Children (AFDC); 5=WIC or Women Infants and Children; 6=Disability (workman-s comp); 7=Child support or alimony; 8=MI Bridges (or other equivalent food assistance program); 9=Investments or Rent; 10=Regular income from estate or trust
Query headtraumalostconsciousness String 5 Recommended Head trauma loss of consciousness
Yes; No; NK
head_trauma, medhist_headinjury
midihist_035a String 250 Recommended Head Injury describe head_trauma_describe
Query cfmh_chd_seizure Integer Recommended Does (did) the Child have Seizure Disorder/Epilepsy? 1;0;999; -7 0 = No; 1 = Yes; ; -7=Refused; 999=NA/NK seizure_disorder
rev_headseizuredetail String 500 Recommended Details of the seizure history and/or type(s) seizure_describe
Query neuro_dis Integer Recommended Neurologic Disorder (Brain, Spinal Cord, Peripheral Nerves) 0;1;9 1 = Yes; 0 = No; 9 = Unknown medhist_neurodis, neurologic_disorder
midihist_017a String 250 Recommended Neurologic Disorder describe neuro_disorder_desc
Query cfmh_chd_sleepdis Integer Recommended Does (did) the Child have a Sleep Disorder? 1;0 0 = No; 1 = Yes sleep_disorder
cfmh_chd_sleepdis_cmt String 255 Recommended Specify type of sleep disorder child has sleep_disorder_desc
Query endoc Integer Recommended Endocrine Disorder (Thyroid gland, Adrenal glands, etc.) 0;1;9 1 = Yes; 0 = No; 9 = Unknown endocrine_disorder
mhx016b String 250 Recommended If YES, Enter onset/resolved date indicate ongoing with treatment or not. If NOT EVALUATED, explain or describe below: Endocrine disorder endocrine_describe
Query cardio_disorder Integer Recommended Cardiovascular Disorder (Heart, Vessels) 0;1;9 1 = Yes; 0 = No; 9 = Unknown cardio_disease, diseaseh
mhx003b_1 String 250 Recommended Explain Cardiovascular disorder history cardio_describe
Query cgi02gasdiag Integer Recommended Has any gastrointestinal diagnosis been given? 0;1; 9 1 = Yes; 0 = No; 9 = Unknown gastro_disorder
cgi02gasdiagspec String 250 Recommended Specify gastrointestinal diagnosis gastro_describe
Query muscul Integer Recommended Musculoskeletal Disorder (Muscles, Joints, Spine) 0;1;9 1 = Yes; 0 = No; 9 = Unknown musculo_disorder
midihist_016a String 250 Recommended Musculoskeletal Disorder describe musculo_describe
Query mhf_10 Integer Recommended Checks if condition is ongoing - skin 0;1;9 1 = Yes; 0 = No; 9 = Unknown skin_disorder
Query mhf_09 String 250 Recommended Checks condition for Skin skin_describe
Query past_illness Integer Recommended History of past medical illness 0;1;9 1 = Yes; 0 = No; 9 = Unknown
Query past_illness_desc String 500 Recommended If history past medical illness, description
Query sigilln Integer Recommended significant medical illness 0;1;-7;9 0=No; 1=Yes; -7=Refused; 9=NK current_illness
Query mdga20a String 150 Recommended Medical Illness 1 current_describe
Query elig_27 Integer Recommended Clinically abnormal lab results 0;1;9 1 = Yes; 0 = No; 9 = Unknown abnormal_lab
abnormal_describe String 500 Recommended If any abnromal lab findings, description
Query current_psych_med Integer Recommended Current psychiatric medications 1;2 1=Yes; 2=No;
Query past_psych_med Integer Recommended Past psychiatric medications 1;2 1=Yes; 2=No;
medication1_name String 500 Recommended Name first medication that the participant has taken 0 = No medication; 999= Legitimately skipped psychmed1
medication1_dosage String 150 Recommended First medication dosage 0 = No medication; 999 = Missing psychmed1_dose
Query psychmed1_currpast Integer Recommended Medication 1 current or past 1;2 1=Current; 2=Past
psychmed1_date Date Recommended Medication 1; if past, date last used
medication2_name String 500 Recommended Name second medication that the participant has taken 0 = No medication; 999= Legitimately skipped psychmed2
medication2_dosage String 100 Recommended Second medication dosage 0 = No medication; 999 = Missing psychmed2_dose
Query psychmed2_currpast Integer Recommended Medication 2 current or past 1;2 1=Current; 2=Past
psychmed2_date Date Recommended Medication 2; if past, date last used
medication3_name String 500 Recommended Name third medication that the participant has taken 0 = No medication; 999= Legitimately skipped psychmed3
medication3_dosage String 100 Recommended Third medication dosage 0 = No medication; 999 = Missing psychmed3_dose
Query psychmed3_currpast Integer Recommended Medication 3 current or past 1;2 1=Current; 2=Past
psychmed3_date Date Recommended Medication 3; if past, date last used
medication4_name String 500 Recommended Name fourth medication that the participant has taken 0 = No medication; 999= Legitimately skipped psychmed4
medication4_dosage String 100 Recommended Fourth medication dosage 0 = No medication; 999 = Missing psychmed4_dose
Query psychmed4_currpast Integer Recommended Medication 4 current or past 1;2 1=Current; 2=Past
psychmed4_date Date Recommended Medication 4; if past, date last used
medication5_name String 500 Recommended Name fifth medication that the participant has taken 0 = No medication; 999= Legitimately skipped psychmed5
medication5_dosage String 100 Recommended Fifth medication dosage 0 = No medication; 999 = Missing psychmed5_dose
Query psychmed5_currpast Integer Recommended Medication 5 current or past 1;2 1=Current; 2=Past
psychmed5_date Date Recommended Medication 5; if past, date last used
Query nonpsychmeds Integer Recommended Current non-psychotropic medications 1;2 1=Yes; 2=No;
Query nonpsychmed1 String 100 Recommended Name of non-psychotropic medicaion 1
Query nonpsychmed1_dose String 30 Recommended Dose of non-psychotropic medication 1
Query nonpsychmed1_indication String 200 Recommended Indication of non-psychotropic medication 1
Query nonpsychmed2 String 50 Recommended Name of non-psychotropic medicaion 2
Query nonpsychmed2_dose String 30 Recommended Dose of non-psychotropic medication 2
Query nonpsychmed2_indication String 200 Recommended Indication of non-psychotropic medication 2
nonpsychmed3 String 50 Recommended Name of non-psychotropic medicaion 3
nonpsychmed3_dose String 30 Recommended Dose of non-psychotropic medication 3
nonpsychmed3_indication String 200 Recommended Indication of non-psychotropic medication 3
nonpsychmed4 String 50 Recommended Name of non-psychotropic medicaion 4
nonpsychmed4_dose String 30 Recommended Dose of non-psychotropic medication 4
nonpsychmed4_indication String 200 Recommended Indication of non-psychotropic medication 4
nonpsychmed5 String 50 Recommended Name of non-psychotropic medicaion 5
nonpsychmed5_dose String 30 Recommended Dose of non-psychotropic medication 5
nonpsychmed5_indication String 200 Recommended Indication of non-psychotropic medication 5
nonpsychmed6 String 50 Recommended Name of non-psychotropic medicaion 6
nonpsychmed6_dose String 30 Recommended Dose of non-psychotropic medication 6
nonpsychmed6_indication String 200 Recommended Indication of non-psychotropic medication 6
Query surg_surgtype1 String 255 Recommended TYPE OF SURGERY 1 surgery1
surgerydatedd1_1 Date Recommended Date surgery 1 surgery1_date
surg_surgtype2 String 255 Recommended TYPE OF SURGERY 2 surgery2
surgerydatedd2_1 Date Recommended Surgery Date 2 surgery2_date
surg_surgtype3 String 255 Recommended TYPE OF SURGERY 3 surgery3
surgerydatedd3_1 Date Recommended Surgery Date 3 surgery3_date
surgerydatedd4_1 Date Recommended Surgery Date 4 surgery4_date
Query smoke_current Integer Recommended Is the child a current smoker 0;1;9 1 = Yes; 0 = No; 9 = Unknown smoke
Query smoke_current_packs Float Recommended how many packs per day if yes? 0::10
surq_2d String 20 Recommended When did you have your last cigarette TIME 24 hour clock smoke_current_time
Query smoke_past Integer Recommended Child ever smoked? 0;1;9 1 = Yes; 0 = No; 9 = Unknown snoke_past
Query smoke_past_startage Integer Recommended if yes, age when regular smoking began 5::17
Query smoke_past_endage Integer Recommended If yes, age when child last smoked 5::17
Query smoke_past_packs Integer Recommended Estimated number of packs per day 0::10
Query nicotine Integer Recommended Does the child use nicotine 0;1;9 1 = Yes; 0 = No; 9 = Unknown medhist_smoker
nicotine_describe String 100 Recommended If uses nicotine, description
Query caffeine Integer Recommended Does the child consume caffeinated beverages regularly 0;1;9 1 = Yes; 0 = No; 9 = Unknown
Query caffeine_type String 100 Recommended caffeinated beverages. how much (type and amount)
Query surq_11d String 20 Recommended When was the last time you consumed a caffeinated drink TIME 24 hour clock caffeine_time
Query incpeople3 Integer Recommended How many people lived on this income over 65 years of age?
Query severe_react Integer Recommended Have you ever had any severe allergic reaction? 0;1 0 = No; 1 = Yes medhist_allergy, react
Query livkidney Integer Recommended Liver or kidney disease? 0;1 0 = No; 1 = Yes
Query deepvein Integer Recommended Deep vein thrombosis/clot? 0;1 0 = No; 1 = Yes
Query abuterinegrow Integer Recommended Abnormal uterine growth? 0;1 0 = No; 1 = Yes
Query embolclot Integer Recommended Pulmonary embolism or blood clot? 0;1 0 = No; 1 = Yes
Query gallbladpanc Integer Recommended Inflamed gall bladder or pancreatitis? 0;1 0 = No; 1 = Yes
Query pelviclesion Integer Recommended Pelvic lesion or ovarian enlargement? 0;1 0 = No; 1 = Yes
Query climpro Integer Recommended Sensitive to Climara(estradiol/estrogen) or Prometrium(progesterone)? 0;1 0 = No; 1 = Yes
Query psychotrop Integer Recommended Use psychotropic medication? 0;1 0 = No; 1 = Yes
Query hormonalprep Integer Recommended Use hormonal preparations? 0;1 0 = No; 1 = Yes
Query antiinflam Integer Recommended Use anti-inflammatory agents? 0;1 0 = No; 1 = Yes
surg_surgtype4 String 255 Recommended Type of surgery 4
respondent String 20 Recommended Respondent Mother;Father;Parent;Guardian;Teacher;Child;Self;Caregiver;Partner;Other
Query cfmh_othr_cancer Integer Recommended Cancer 1;0 0 = No; 1 = Yes medhist_cancer
Query thyroid Integer Recommended Thyroid disease 1;0;-7 0=No; 1=Yes;-7=Refused medhist_thyroid
Query daily_diary_8 Integer Recommended Do you have asthma? 0;1 0=No; 1=Yes medhist_asthma
Query medhx_2g Integer Recommended Has she/he ever been to a doctor for any of these things… Diabetes Diabetes 1 ; 0 1 = Yes; 0 = No medhist_diabetes
medhx21a String 100 Recommended If yes, please describe problems with diabetes: medhist_diabetes_text
medhistory_26b_txt String 250 Recommended Description of glasses or contacts medhist_glasses_contacts_text
Query clrblind Integer Recommended Is the participant colorblind 0;1 0=No; 1=Yes medhist_colorblind
medhistory_25_txt String 250 Recommended Description of colorblindness medhist_colorblind_text
Query cfmh_chd_hearingimp Integer Recommended Does the patient have a hearing impairment? 1;0 0 = No; 1 = Yes medhist_auditoryprob
w1_m_cu_hrng_det String 200 Recommended health at interview - problem hearing details medhist_auditoryprob_text
Query cmedhx38 Integer Recommended Any other medical problems? 0;1;-9 0=No; 1=Yes; -9 = missing/not reported medhist_othermed
Query cmedhx18 Integer Recommended Are any current medications taken regularly? 0;1 0 = No;1 = Yes meds_current
Query cmedhx19 Integer Recommended Are there any past medications which were taken regularly? 0;1 0 = No;1 = Yes meds_past
strconheartdis String 5 Recommended Does the child/patient have heart disease?
Yes; No;999;Ref
Ref=refused; 999=NA/NK/missing medhist_heartcond
phne_sc_18 String 5 Recommended 11. Do you wear glasses or contact lenses?
Yes;No
medhist_glasses_contacts
visionproblemdetail String 300 Recommended Details of the vision problem medhist_visualprob_text
scq_37_sp String 300 Recommended Specify any other medical condition medhist_othermed_text
current_medication String 300 Recommended subject's current medications meds_current_text
past_medication String 300 Recommended what are subjects past medications meds_past_text
Query medhist_liverkidgi Integer Recommended (A: Do you) (P: Does your child) have liver, kidney or GI problems? 0;1 0=no; 1=yes
Query medhist_bloodpressure Integer Recommended (A: Do you) (P: Does your child) have a history of blood pressure? 0;1 0=no; 1=yes
Query medhist_limbprob Integer Recommended (A: Do you) (P: Does your child) have problems with the use of any limbs? 0;1 0=no; 1=yes
Query seq1b_1 Integer Recommended Has a health or education professoinal told you that your child has any of the following conditions? : Blindness or another visual impairment not corrected with glasses
1;2;-99;77;88
2= No;1= Yes ; -99= N/A ; 77= Refused ; 88= Missing medhist_visualprob
allergies String 300 Recommended allergies medhist_allergy_text
Data Structure

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

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

At the top of this page you can also:

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