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Clinical History Form

0 Shared Subjects

N/A
Clinical Assessments
Med History
02/11/2015
chf01

View Change History
01
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 subject_id
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0 :: 1260 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.
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender
Query chf_01 Integer Recommended 1. Did the participant receive vagus nerve stimulation during the index episode? 0;1 0=No; 1=Yes
Query chf_02 Integer Recommended 2. Did the participant receive an ECT during the index episode? 0;1 0=No; 1=Yes
Query chf_03 Integer Recommended 3. Did the participant receive rTMS during the index episode? 0;1 0=No; 1=Yes
Query chf_04 Integer Recommended 4. Has the participant experienced any other somatic treatments during the index episode? 0;1 0=No; 1=Yes
chf_05 String 250 Recommended Type of other treatment
Query chf_06 Integer Recommended 5. Is the participant receiving psychotherapy that is depression-specific (CBT or IPT)? 0;1 0=No; 1=Yes
chf_07 String 250 Recommended Type of psychotherapy
Query chf_08 Integer Recommended 6. Is the participant currently enrolled in another research study that contraindicates participation in the EMBARC study? 0;1 0=No; 1=Yes
chf_09 String 250 Recommended Title of study
Query chf_10 Integer Recommended 7. Does the participant have any history of adequate treatment (dose and duration) with poor response to either Sertraline (SERT) or Bupropion (BUP)? 0;1 0=No; 1=Yes
Query chf_11 Integer Recommended 8. Does the participant have any history of poor tolerance to Sertraline (SERT) or Bupropion (BUP) treatment? 0;1 0=No; 1=Yes
Query chf_12 Integer Recommended 9. Has the participant taken fluoxetine in the past 6 weeks? 0;1 0=No; 1=Yes
chf_12a Date Recommended Last date taken - fluoxetine
Query chf_13 Integer Recommended 10. Has the participant taken benzodiazepine in the past 4 days? 0;1 0=No; 1=Yes
chf_13a Date Recommended Last date taken - benzo
Query chf_14 Integer Recommended 11. Has the participant taken any other antidepressants other than those listed above in the last 3 weeks? 0;1 0=No; 1=Yes
chf_14a Date Recommended Last date taken - other antidepressants
chf_date1 Date Recommended Date field of first suicide attempt
chf_date2 Date Recommended Date field of 2nd suicide attempt
chf_date3 Date Recommended Date field of 3rd suicide attempt
chf_date4 Date Recommended Date field of 4th suicide attempt
chf_date5 Date Recommended Date field of 5th suicide attempt
Query chf_hospital1 Integer Recommended Checks if hospitalized on 1st attempt 0;1 0=No; 1=Yes
Query chf_hospital2 Integer Recommended Checks if hospitalized on 2nd attempt 0;1 0=No; 1=Yes
Query chf_hospital3 Integer Recommended Checks if hospitalized on 3rd attempt 0;1 0=No; 1=Yes
Query chf_hospital4 Integer Recommended Checks if hospitalized on 4th attempt 0;1 0=No; 1=Yes
Query chf_hospital5 Integer Recommended Checks if hospitalized on 5th attempt 0;1 0=No; 1=Yes
chf_method1 String 250 Recommended 1st suicide attempt method
chf_method2 String 250 Recommended 2nd suicide attempt method
chf_method3 String 250 Recommended 3rd suicide attempt method
chf_method4 String 250 Recommended 4th suicide attempt method
chf_method5 String 250 Recommended 5th suicide attempt method
Query chf_num_suicide_attempts Integer Recommended Checks number of suicide attempts
chf_outcome1 String 250 Recommended Checks for outcome after 1st attempt
chf_outcome2 String 250 Recommended Checks for outcome after 2nd attempt
chf_outcome3 String 250 Recommended Checks for outcome after 3rd attempt
chf_outcome4 String 250 Recommended Checks for outcome after 4th attempt
chf_outcome5 String 250 Recommended Checks for outcome after 5th attempt
Query chf_rate_suicide_lifetime Integer Recommended Rates suicide over lifetime 1::7 1=Absent; 2=Thoughts of dying but no thoughts of suicide; 3=Occasional thoughts of suicide but no plans; 4=Often thought about suicide or has thought of a specific method; 5=Had a plan or made a gesture; 6=Made preparation for a potentially serious suicide attempt; 7=Suicide attempt with definite intent to die or be potentially medically harmful
chf_wash_benzo Date Recommended Actual washout date (Benzo)
chf_wash_fluox Date Recommended Actual washout date fluoxetine
chf_wash_other Date Recommended Actual washout date (Other)
subject_description String 4,000 Recommended Subject related information (e.g the affection, phenotype, disease information, etc.).
site String 101 Recommended Site Study Site
study String 100 Recommended Study; The code for each individual study
Query week Float Recommended Week in level/study 99=week 10-week 14
Data Structure

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

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

At the top of this page you can also:

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

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