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Demographic Intake Form

99 Shared Subjects

Clinical Assessments
View Change History
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 subjectid
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY date_of_rating
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. demo_01_age
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported demo_04_gender, gender
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 demo_06_race
Query ethnicity String 30 Recommended Ethnicity of participant Hispanic or Latino; Not Hispanic or Latino; Unknown demo_05_ethn
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 demo_07_ms
Query elig_22 Integer Recommended English fluency
0=No; 1=Yes demo_08a_lng
behavioralobservations_lang String 255 Recommended Language (e.g., first/native/other language, English fluency, articulation) demo_08_lng
Query subjedu Integer Recommended Subject's Education 1::16;18;20 1; 2; 3; 4; 5; 6; 7; 8; 9; 10=Elementary/ Middle; 11= High School no diploma; 12=H.S. diploma or GED; 13=Vocational; 14=Assoc. or Tech; 15= Some college courses; 16=Bach.; 18=Master; 20=Doc. demo_09_edu
Query empcur Integer Recommended Currently employed
0;1; -99; 77; 88
0 = No; 1 = Yes; -99= N/A ; 88= Missing ; 77= Refused demo__10a_emp
psdem1 String 50 Recommended What kind of job demo_10a_i_emp
psdem2 String 15 Recommended How long you are employed demo_10a_ii_emp
Query psdem3 Integer Recommended unemployment reason 1::3 1=Disabled; 2=Retired; 3=Other demo_10b_emp_i
Query psdem4 String 15 Recommended date of last employment demo_10b_ii_emp
Query psdem5 String 50 Recommended Type of job demo_10b_iii_emp
Query vetstatus Integer Recommended Veteran/Non-Veteran
1=No; 2=Yes demo_11_vet
Query psdem6 Integer Recommended Concervator
0=No; 1=Yes demo_12_con
Query psdem7 Integer Recommended Concervator type 1;2 1=County; 2= Private
Query psqc011 String 1,000 Recommended Significant long-term medical problem 1 demo_13_med
Query psycond1_diag String 100 Recommended Psychiatric Condition 1: diagnosis demo_14_psycdx
Query psdem8 Integer Recommended Do you have any problems with your eyesight
0=No; 1=Yes demo_15_eye
Query psdem9 Integer Recommended If yes, are the problems completely corrected by glasses or contact lenses
0=No; 1=Yes demo_15a_eye
Query psdem10 Integer Recommended Do you have glasses or lenses with you
0=No; 1=Yes demo_15b_eye
Query psdem11 String 25 Recommended Type of glasses/contacts (e.g. bifocals, reading, hard or soft contacts) demo_15b_eye_desc
Query psdem12 Integer Recommended Do you have any eye diseases (e.g. cataracts, glaucoma) and/or have you ever had any eye surgeries or injuries (gone to the eye doctor for anything besides getting glasses)
0=No; 1=Yes demo_16_eye
Query psdem13 String 50 Recommended Eye disease, specify demo_16_eye-ex
Query psdem14 Integer Recommended do you take medication/eye drops
0=No; 1=Yes demo_16a_eye
psdem15 String 25 Recommended Name of medication/eye drop demo_16b_eye
Query psdem16 Integer Recommended Have you ever had any neurological problems (e.g. epileptic seizures or coma)
0=No; 1=Yes demo_17_neuro
Query psdem17 String 50 Recommended Neurological problems, specify demo_17a_neuro
Query headinjr Integer Recommended head injury
0= no; 1= yes demo_18_inj
Query midihist_035a String 250 Recommended Head Injury describe demo_18a_inj
Query psdem18 Integer Recommended Were you unconscious (knocked out)
0=No; 1=Yes demo_18b_inj-y
Query psdem19 String 15 Recommended Uncounscious/knocked out how long demo_18b_inj
Query psdem20 Integer Recommended Were you hospitalized for head injury
0=No; 1=Yes demo_18c_inj
Query psdem21 Integer Recommended Did you have a concussion
0=No; 1=Yes demo_18d_inj
Query baseline_k_005 Integer Recommended Has she/he ever been to a doctor for any of these things…Diabetes /Diabetes
0;1; -888; -999;-7
0=No; 1=Yes; -888=Not Applicable; -999=Missing/NK; -7=Refused //Now I'd like to ask you about your child's use of health services during the past year and throughout his/her whole life. demo_19_diab
Query mdga12 Integer Recommended Diagnosed with: Diabetes Type I (insulin dependent)
0=No; 1=Yes demo_19a_diab
Query biofatheredu Integer Recommended Bio Father's Education 1::16;18;20 1; 2; 3; 4; 5; 6; 7; 8; 9; 10=Elementary/ Middle; 11= High School no diploma; 12=H.S. diploma or GED; 13=Vocational; 14=Assoc. or Tech; 15= Some college courses; 16=Bach.; 18=Master; 20=Doc. demo_20_fedu
Query employ_f4 String 100 Recommended Description of Father's job demo_20a_focc
Query psdem22 String 25 Recommended What was your father's income level demo_20b_finc
Query biomotheredu Integer Recommended Bio Mother's Education 1::16;18;20 1; 2; 3; 4; 5; 6; 7; 8; 9; 10=Elementary/ Middle; 11= High School no diploma; 12=H.S. diploma or GED; 13=Vocational; 14=Assoc. or Tech; 15= Some college courses; 16=Bach.; 18=Master; 20=Doc. demo_21_medu
Query momoccuc String 100 Recommended mother's current occupation demo_21_mocc
Query psdem23 String 25 Recommended What was your mother's income level demo_21_minc
Query psdem24 Integer Recommended Are you seeing psychiatrist currently 0;1 0=No; 1=Yes demo_22_psych
Query psdem25 String 15 Recommended Last visit to psychiatrist demo_22a_psych
Query psdem26 Integer Recommended Who is responsible for dispensing your daily medications 1;2 1=Me; 2=Someone else demo_23_med
Query psdem27 String 15 Recommended Person responsible for my daily medications demo_23a_med
Query psdem28 Integer Recommended Have you been or are you currently involved in any outpatient day treatment program? Counseling or group therapy 0;1 0=No; 1=Yes demo_24_tx
Query psdem29 String 50 Recommended where did you receive this therapy, how long have you been enrolled, how often do you attend, and what kind of therapy did you receive demo_24a_tx
Query psdem30 Integer Recommended Have you ever been in Cognitive-Behavioral Therapy or Social Skills Training 0;1 0=No; 1=Yes demo_25_cbt
Query psdem31 String 50 Recommended CBT specify
Query psdem32 String 50 Recommended Social Skills Training, specify
Query age_1st_sx Integer Recommended Age of onset of psychiatric symptoms (years) demo_26_pxsym
Query hpl_03 String 10 Recommended How old were you (or what year was) the first time you were hospitalized for psychiatric symptoms in years demo_26a_pxsym
Query dode String 10 Recommended Date of Data Entry date_of_entry
comments_misc String 4,000 Recommended Miscellaneous comments on study, interview, methodology relevant to this form data notes
Query aescode Integer Recommended Staff code number of person completing this form 999= Missing Data rater
Query t1wk Integer Recommended Weeks since Treatment Session 1 week
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.