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Warning Notice This is a U.S. Government computer system, which may be accessed and used only for authorized Government business by authorized personnel. Unauthorized access or use of this computer system may subject violators to criminal, civil, and/or administrative action. All information on this computer system may be intercepted, recorded, read, copied, and disclosed by and to authorized personnel for official purposes, including criminal investigations. Such information includes sensitive data encrypted to comply with confidentiality and privacy requirements. Access or use of this computer system by any person, whether authorized or unauthorized, constitutes consent to these terms. There is no right of privacy in this system.
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This is a U.S. Government computer system, which may be accessed and used only for authorized Government business by authorized personnel. Unauthorized access or use of this computer system may subject violators to criminal, civil, and/or administrative action. All information on this computer system may be intercepted, recorded, read, copied, and disclosed by and to authorized personnel for official purposes, including criminal investigations. Such information includes sensitive data encrypted to comply with confidentiality and privacy requirements. Access or use of this computer system by any person, whether authorized or unauthorized, constitutes consent to these terms. There is no right of privacy in this system.

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NIMH Data Archive
NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

Yale Telephone Screening Form

132 Shared Subjects

Yale Telephone Screening Form. The Social Brain in Schizophrenia and Autism Spectrum Disorders
Clinical Assessments
Questionnaire
03/27/2014
phonescreen01
03/27/2014
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*
src_subject_id String 20 Required Subject ID how it's defined in lab/project
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.
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender
Query phne_sc_1 String 200 Recommended 1. What is your native language?
phne_sc_2 String 40 Recommended What is your highest grade completed in school?
Query phne_sc_3 String 5 Recommended 3. Have you ever had an MRI done before? Yes;No
Query phne_sc_4 String 120 Recommended When (have you had an MRI done before)?
Query phne_sc_5 String 5 Recommended Did you experience problems? Yes;No
Query phne_sc_6 String 5 Recommended 4. Have you ever had surgery or any other invasive procedures? Or any implants of any kind? Yes;No
Query phne_sc_7 String 160 Recommended What kind of surgery have you had and when did you have it? Heart:(i.e. cardiac pacemaker, cardiac defibrillator, heart valve replacement); Brain/Head:(aneurysm clip, ear implant); Spine/Body:(metal rods in bones; joint replacement, metal or wire mesh implants, transdermal deliver system (Nitro), nerve stimulation device or electronic pumps, impanted drug infusion device, vascular filter, IUD or diaphragm)
Query phne_sc_8 String 5 Recommended May we have the name and phone number of your physician to verify this information if needed? Yes;No
Query phne_sc_9 String 5 Recommended 5. Are you currently nursing, pregnant, or planning on becoming pregnant? Yes;No
Query phne_sc_10 String 5 Recommended Are you currently using birth control pills or any contraception? Yes;No
Query phne_sc_11 String 5 Recommended 6. Do you currently wear any dental devices (braces, orthodontia)? Yes;No
Query phne_sc_12 String 5 Recommended 7. Do you have any tattoos or body piercings that cannot be removed? Yes;No
Query phne_sc_13 String 5 Recommended Do the tattoos have any metal in the ink? Yes;No
Query phne_sc_14 String 5 Recommended 8. Have you ever worked as a machinist, metal worker, or in any profession or hobby involving Yes;No
Query phne_sc_15 String 5 Recommended 9. Have you ever been injured (shot, cut) with a metallic object? Yes;No
Query phne_sc_16 String 100 Recommended If so please describe (have you ever been injured with a metallic object)
Query phne_sc_17 String 5 Recommended 10. Have you ever had an injury to your eyes or been in a car accident which involved metal objects entering the eyes? Yes;No
Query phne_sc_18 String 5 Recommended 11. Do you wear glasses or contact lenses? Yes;No
Query phne_sc_19 String 5 Recommended 12. Do you have any problems with hearing (partial, full hearing loss)? Yes;No
Query phne_sc_20 String 5 Recommended Do you wear any ear pieces such as a hearing aid? Yes;No
Query phne_sc_21 String 5 Recommended 13. Do you have any fears of small spaces? (Claustrophobia) Yes;No
Query phne_sc_22 String 5 Recommended 14. Do you feel anxious in crowded rooms? Yes;No
Query phne_sc_23 String 5 Recommended 15. Do you feel anxious in elevators? Yes;No
Query phne_sc_24 String 5 Recommended 16. Can you lie flat on your back for 1 hour where your head is enclosed in a small tube? Yes;No
Query phne_sc_25 String 5 Recommended 17. (A drug test is required) is this an issue for you ? Yes;No
Query phne_sc_26 String 5 Recommended 18. Do you have a financial conservator or other? Yes;No
Query phne_sc_28 String 5 Recommended Health/ Medical.1. Are you currently seeing a doctor to be treated? Yes;No
phne_sc_29 String 100 Recommended Health/Medical. If yes (are you currently seeing a doctor to be treated) Please describe?
Query phne_sc_30 String 5 Recommended Health/ Medical.2. Have you ever been hospitalized for a psychiatric illness? Yes;No
Query phne_sc_31 String 200 Recommended Health/Medical. If yes (have you ever been hospitalized for a psychiatric illness), please describe
Query phne_sc_32 String 5 Recommended Health/ Medical. Have you been hospitalized at all in the last 6 months? Yes;No
Query phne_sc_33 String 100 Recommended Health/Medical. If yes (have you been hospitalized at all in the last 6 months) please describe.
Query phne_sc_34 String 5 Recommended Health/ Medical.3. Have you ever been diagnosed or are you currently diagnosed with a psychological disorder? Yes;No
Query phne_sc_35 String 5 Recommended Health/ Medical.4. Have you ever had a seizure? Yes;No
Query phne_sc_36 String 100 Recommended Health/Medical. If yes (have you ever had a seizure) please describe
Query phne_sc_37 String 5 Recommended Health/ Medical.5. Have you ever had a brain injury (TBI=traumatic brain injury, brain lesion, loss of consciousness for more than 30 minute)? Yes;No
Query phne_sc_38 String 100 Recommended Health/Medical. Explain (have you ever had a brian injury)
Query phne_sc_39 String 5 Recommended Health/ Medical.6. Are you currently taking any medications? Yes;No
Query phne_sc_40 String 100 Recommended Health/Medical. If yes (are you currently taking any medications), which ones and dosage
Query phne_sc_41 String 5 Recommended Health/Medical. Are any of these new medications? Yes;No
Query phne_sc_42 String 120 Recommended Health/Medical. If so, when did you start taking them?
Query phne_sc_43 String 5 Recommended Health/ Medical.7. Do you have any learning disabilities? Yes;No
phne_sc_44 String 100 Recommended Health/Medical. If yes (do you have any learning disabilites), please describe
Query phne_sc_45 String 5 Recommended Study Specific.1. Have you ever received any social skills training, currently or in the past? Yes;No
Query phne_sc_46 String 5 Recommended Study Specific.2. Any immediate relatives diagnosed with ASD, schizophrenia, psychosis or bipolar disorder? Yes;No
Data Structure

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

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

At the top of this page you can also:

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

Please email the The NDA Help Desk with any questions.

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