|
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 |
|
|
child_id, hcpa_id, record_id, subject |
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
date_of_interview_contact |
|
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.
|
age, mcd1 |
|
sex |
String |
20
|
Required |
Sex of subject at birth |
|
M = Male; F = Female; O=Other; NR = Not reported
|
gender, mcd3, sex |
Query
|
visit |
String |
60
|
Recommended |
Visit name |
|
|
|
Query
|
medh1 |
Integer |
|
Recommended |
Medical history/physical exam completed in the past 30 days |
0;1
|
0=No; 1=Yes
|
|
Query
|
medh2 |
Integer |
|
Recommended |
Allergies |
1::3
|
1=no significant history; 2=past; 3= present
|
medical_10 |
|
medh3 |
String |
200
|
Recommended |
Allergies. Details/amount |
|
|
|
Query
|
medh4 |
Integer |
|
Recommended |
Cardiovascular |
1::3
|
1=no significant history; 2=past; 3= present
|
medical_3 |
|
medh5 |
String |
200
|
Recommended |
Cardiovascular Details/amount |
|
|
|
Query
|
medh6 |
Integer |
|
Recommended |
Dermatological |
1::3
|
1=no significant history; 2=past; 3= present
|
|
|
medh7 |
String |
200
|
Recommended |
Dermatological. Details/amount |
|
|
|
|
medh8 |
String |
200
|
Recommended |
Endocrine. Details/amount |
|
|
|
Query
|
medh9 |
Integer |
|
Recommended |
Endocrine/ |
1::3
|
1=no significant history; 2=past; 3= present
|
medical_4 |
Query
|
medh10 |
Integer |
|
Recommended |
Gastrointestinal |
1::3
|
1=no significant history; 2=past; 3= present
|
medical_5 |
|
medh11 |
String |
200
|
Recommended |
Gastrointestinal. Details/amount |
|
|
|
Query
|
medh12 |
Integer |
|
Recommended |
Genitourinary |
1::3
|
1=no significant history; 2=past; 3= present
|
medical_6 |
|
medh13 |
String |
200
|
Recommended |
Genitourinary. Details/amount |
|
|
|
Query
|
medh14 |
Integer |
|
Recommended |
Is the participant pregnant or planning to become pregnant during the study period |
0::2
|
0=No; 1=Yes; 2=NA
|
|
Query
|
medh15 |
Integer |
|
Recommended |
Hematological |
1::3
|
1=no significant history; 2=past; 3= present
|
|
|
medh16 |
String |
200
|
Recommended |
Hematological. Details/amount |
|
|
|
Query
|
medh17 |
Integer |
|
Recommended |
Hepatic |
1::3
|
1=no significant history; 2=past; 3= present
|
|
|
medh18 |
String |
200
|
Recommended |
Hepatic. Details/amount |
|
|
|
Query
|
medh19 |
Integer |
|
Recommended |
Immunological |
1::3
|
1=no significant history; 2=past; 3= present
|
|
|
medh20 |
String |
200
|
Recommended |
Immunological. Details/amount |
|
|
|
Query
|
medh21 |
Integer |
|
Recommended |
Metabolic |
1::3
|
1=no significant history; 2=past; 3= present
|
|
|
medh22 |
String |
200
|
Recommended |
Metabolic. Details/amount |
|
|
|
Query
|
medh23 |
Integer |
|
Recommended |
Musculoskeletal |
1::3
|
1=no significant history; 2=past; 3= present
|
medical_7 |
|
medh24 |
String |
200
|
Recommended |
Musculoskeletal. Details/amount |
|
|
|
Query
|
medh25 |
Integer |
|
Recommended |
Neoplastic |
1::3
|
1=no significant history; 2=past; 3= present
|
|
|
medh26 |
String |
200
|
Recommended |
Neoplastic. Details/amount |
|
|
|
Query
|
medh27 |
Integer |
|
Recommended |
Neurological |
1::3
|
1=no significant history; 2=past; 3= present
|
medical_1 |
|
medh28 |
String |
200
|
Recommended |
Neurological. Details/amount |
|
|
|
|
medh29 |
String |
200
|
Recommended |
Other med history (Specify) |
|
|
|
Query
|
medh30 |
Integer |
|
Recommended |
Other med history |
1::3
|
1=no significant history; 2=past; 3= present
|
medical_9 |
|
medh31 |
String |
200
|
Recommended |
Other med history. Details/amount |
|
|
|
Query
|
medh32 |
Integer |
|
Recommended |
Respiratory |
1::3
|
1=no significant history; 2=past; 3= present
|
medical_2 |
|
medh33 |
String |
200
|
Recommended |
Respiratory. Details/amount |
|
|
|
|
comments_misc |
String |
4,000
|
Recommended |
Miscellaneous comments on study, interview, methodology relevant to this form data |
|
|
comments, mh_notes |
Query
|
medhx_celiac |
Integer |
|
Recommended |
Celiac Disease |
0::2
|
0 = No, 1 = Yes, 2 = Not sure
|
|
|
version_form |
String |
121
|
Recommended |
Form used/assessment name |
|
|
|
|
ghq_8 |
Integer |
|
Recommended |
Current smoker. How many cigarettes have you smoked in the past 24 hours? |
1 :: 200
|
|
esq1 |
|
avnumcig |
Integer |
|
Recommended |
Average Number of Cigarettes |
|
|
esq2 |
|
pehxmen |
Integer |
|
Recommended |
History of menstruation |
0;1
|
0 = No; 1 = Yes
|
esq8_fem_1 |
|
urine_last_menstrual_pd_days |
String |
25
|
Recommended |
Urine Measures: Number of days since last menstrual period (Date sample taken - Date of last menstruation) |
|
|
esq8_fem_2 |
|
menstrualcycle3_y |
Integer |
|
Recommended |
Is your menstrual cycle regular? |
0::3
|
1 = Yes; 0 = No; 2 = Don't know; 3 = Refuse to answer; The following questions are about the history of your menstrual cycle. If you do not remember specific details, just try to answer as best you can.
|
esq8_fem_3, q4 |
|
mchq_18 |
String |
500
|
Recommended |
Do you have regular menstrual cycles. If no, explain |
|
|
esq8_fem_4 |
|
contr |
Integer |
|
Recommended |
Currently taking any type of hormonal contraceptive? |
0;1
|
0=No; 1=Yes
|
esq9_fem, q5 |
|
esq1_wk |
String |
90
|
Recommended |
Past week drug/alcohol use: Substance 1 |
|
|
|
|
esq2_wk |
String |
90
|
Recommended |
Past week drug/alcohol use: Substance 2 |
|
|
|
|
esq3_wk |
String |
90
|
Recommended |
Past week drug/alcohol use: Substance 3 |
|
|
|
|
esq4_wk |
String |
90
|
Recommended |
Past week drug/alcohol use: Substance 4 |
|
|
|
|
esq5_wk |
String |
90
|
Recommended |
Past week drug/alcohol use: Substance 5 |
|
|
|
|
esq6_wk |
String |
90
|
Recommended |
Past week drug/alcohol use: Substance 6 |
|
|
|
|
esq7_wk |
String |
90
|
Recommended |
Past week drug/alcohol use: Substance 7 |
|
|
|
|
esq8_wk |
String |
90
|
Recommended |
Past week drug/alcohol use: Substance 8 |
|
|
|
|
esq1_24hr |
String |
90
|
Recommended |
Past 24 hr drug/alcohol use: Substance 1 |
|
|
|
|
esq2_24hr |
String |
90
|
Recommended |
Past 24 hr drug/alcohol use: Substance 2 |
|
|
|
|
esq3_24hr |
String |
90
|
Recommended |
Past 24 hr drug/alcohol use: Substance 3 |
|
|
|
|
esq4_24hr |
String |
90
|
Recommended |
Past 24 hr drug/alcohol use: Substance 4 |
|
|
|
|
esq5_24hr |
String |
90
|
Recommended |
Past 24 hr drug/alcohol use: Substance 5 |
|
|
|
|
esq6_24hr |
String |
90
|
Recommended |
Past 24 hr drug/alcohol use: Substance 6 |
|
|
|
|
esq7_24hr |
String |
90
|
Recommended |
Past 24 hr drug/alcohol use: Substance 7 |
|
|
|
|
esq8_24hr |
String |
90
|
Recommended |
Past 24 hr drug/alcohol use: Substance 8 |
|
|
|
|
esq3 |
Integer |
|
Recommended |
Other tobacco/nicotine products in past 24 hrs |
0::1; -9
|
0=no; 1=yes; -9=missing
|
|
|
esq3_1 |
String |
200
|
Recommended |
If used other tobacco/nicotine products in past 24 hours: What kind and how much? |
|
|
|
|
esq4_cofftea |
Integer |
|
Recommended |
How many cups of coffee/tea in past 24 hrs |
|
|
|
|
esq4_soda |
Integer |
|
Recommended |
Glasses of soda in past 24 hrs |
|
|
|
|
esq5_cofftea |
Integer |
|
Recommended |
How many cups of coffee/tea in average day |
|
|
|
|
esq5_soda |
Integer |
|
Recommended |
Glasses of soda in average day |
|
|
|
|
esq6 |
Integer |
|
Recommended |
How much time spent exercising in past 24 hrs |
0::3; -9
|
0=less than 1 hour; 1=1-3 hours per week; 2=4-5 hours per week; 3=more than 5 hours; -9=missing
|
|
|
esq7 |
Integer |
|
Recommended |
How much time spent exercising per week |
0::4; -9
|
0=less than 1 hour; 1=1-3 hours per week; 2=4-5 hours per week; 3=6-10 hours per week; 4=more than 10 hours per week; -9=missing
|
|
|
esq8 |
Integer |
|
Recommended |
Gums bleeding |
0::1; -9
|
0=no; 1=yes; -9=missing
|
|
|
medical_8 |
Integer |
|
Recommended |
ASD or Communication Disorder |
1::3
|
1=no significant history; 2=past; 3= present
|
|
|
dental1 |
Integer |
|
Recommended |
Do you currently have any of the following dental hardware?: Lower Retainer |
0;1
|
1 = Yes ; 0 = No
|
|
|
dental2 |
Integer |
|
Recommended |
Do you currently have any of the following dental hardware?: Lower Spacer |
0;1
|
1 = Yes ; 0 = No
|
|
|
dental2_1 |
String |
30
|
Recommended |
Lower Spacer: If yes: How many? |
|
|
|
|
dental3 |
Integer |
|
Recommended |
Do you currently have any of the following dental hardware?: Metal fillings (amalgam, silver, gold)? |
0;1
|
1 = Yes ; 0 = No
|
|
|
dental3_1 |
String |
30
|
Recommended |
Metal fillings (amalgam, silver, gold)? If Yes, How many on top? |
|
|
|
|
dental3_2 |
String |
30
|
Recommended |
Metal fillings (amalgam, silver, gold)? If Yes, How many on bottom? |
|
|
|
|
dental4 |
Integer |
|
Recommended |
Do you currently have any of the following dental hardware?: Crowns? |
0;1
|
1 = Yes ; 0 = No
|
|
|
dental4_1 |
String |
30
|
Recommended |
Crowns? If Yes, How many on top? |
|
|
|
|
dental4_2 |
String |
30
|
Recommended |
Crowns? If Yes, How many on bottom? |
|
|
|
|
dental5 |
Integer |
|
Recommended |
Do you currently have any of the following dental hardware?: Gold teeth? |
0;1
|
1 = Yes ; 0 = No
|
|
|
dental5_1 |
String |
30
|
Recommended |
Gold teeth? If Yes, How many on top? |
|
|
|
|
dental5_2 |
String |
30
|
Recommended |
Gold teeth? If Yes, How many on bottom? |
|
|
|
|
dental6 |
Integer |
|
Recommended |
Do you currently have any of the following dental hardware?: Any other metal posts, implants or anything else? |
0;1
|
1 = Yes ; 0 = No
|
|
|
dental6_1 |
String |
86
|
Recommended |
Any other metal posts, implants or anything else? If Yes, What? |
|
|
|
|
dental6_2 |
String |
50
|
Recommended |
Any other metal posts, implants or anything else? If Yes, Where? |
|
|
|
|
mh6a2 |
Integer |
|
Recommended |
Have you ever taken any medications prescribed to you by a doctor for 12 months or longer for the following reasons: DO NOT COUNT OTC. - To help you sleep? |
0;1
|
0 = No; 1 = Yes
|
|
|
mh6a3 |
Integer |
|
Recommended |
Have you ever taken any medications prescribed to you by a doctor for 12 months or longer for the following reasons: DO NOT COUNT OTC. - To feel less depressed? |
0;1
|
0 = No; 1 = Yes
|
|
|
mh6a4 |
Integer |
|
Recommended |
Have you ever taken any medications prescribed to you by a doctor for 12 months or longer for the following reasons: DO NOT COUNT OTC. - For headaches? |
0;1
|
0 = No; 1 = Yes
|
|
|
mh6a5 |
Integer |
|
Recommended |
Have you ever taken any medications prescribed to you by a doctor for 12 months or longer for the following reasons: DO NOT COUNT OTC. - To have more energy? |
0;1
|
0 = No; 1 = Yes
|
|
|
mh6a6 |
Integer |
|
Recommended |
Have you ever taken any medications prescribed to you by a doctor for 12 months or longer for the following reasons: DO NOT COUNT OTC. - Women Only: For birth control? |
0;1
|
0 = No; 1 = Yes
|
|
|
mh6a7 |
Integer |
|
Recommended |
Have you ever taken any medications prescribed to you by a doctor for 12 months or longer for the following reasons: DO NOT COUNT OTC. - Containing steroids? |
0;1
|
0 = No; 1 = Yes
|
|
|
baseline_m_008 |
Integer |
|
Recommended |
In the past six months, how many emergency room visits were for medical problems not related to a psychiatric or mental health problem? |
|
|
mh4c |
|
sf1 |
Integer |
|
Recommended |
In general, would you say your health is: |
1::5;888
|
1= Excellent; 2= Very Good; 3= Good; 4= Fair; 5= Poor ; 888=Don't Know/not sure
|
mh1 |
|
tosurg |
Integer |
|
Recommended |
Number of outpatient surgery |
|
|
mh4b |
|
mh2 |
Integer |
|
Recommended |
MH2 Has your health always been (ANSWER IN MH1); or has it been better or worse? |
1;2;5;6
|
1=No, Worse;2=No, better; 5=Yes, Same; 6=Both better and worse
|
|
|
mh4a |
Integer |
|
Recommended |
MH4a How many times have you been in a hospital overnight (including surgery and pregnancy); excluding psychiatric or substance abuse treatment? |
|
|
|
|
mh5 |
Integer |
|
Recommended |
MH5 In the last 6 months; how many visits have you made to a doctor; clinic; or emergency room for your physical health? DO NOT COUNT CHIROPRACTORS OR ROUTINE PHYSICALS. |
|
|
|
|
mh6a1 |
Integer |
|
Recommended |
Have you ever taken any medications prescribed to you by a doctor for 12 months or longer for the following reasons: DO NOT COUNT OTC. - To make you feel less nervous? |
0;1
|
0 = No; 1 = Yes
|
|
|
mcd8 |
Integer |
|
Recommended |
7-day post-discharge follow-up with outpatient mental health care |
0;1
|
0 = No; 1 = Yes
|
|
|
mcd9 |
Integer |
|
Recommended |
30-day post-discharge follow-up with outpatient mental health care |
0;1
|
0 = No; 1 = Yes
|
|
|
encounter1_019 |
String |
100
|
Recommended |
Primary ICD Diagnosis Code |
|
|
mcd5 |
|
site |
String |
101
|
Recommended |
Site |
|
Study Site
|
|
|
study |
String |
100
|
Recommended |
Study; The code for each individual study |
|
|
|
|
mcd2 |
Integer |
|
Recommended |
7-day hospital inpatient all-cause readmission |
0;1
|
0 = No; 1 = Yes
|
|
|
mcd4 |
Integer |
|
Recommended |
30-day hospital inpatient all-cause readmission |
0;1
|
0 = No; 1 = Yes
|
|
|
mcd6 |
Integer |
|
Recommended |
7-day post-discharge follow-up with outpatient medical care |
0;1
|
0 = No; 1 = Yes
|
|
|
mcd7 |
Integer |
|
Recommended |
30-day post-discharge follow-up with outpatient medical care |
0;1
|
0 = No; 1 = Yes
|
|
|
ph_119 |
Integer |
|
Recommended |
Has your child been to the Emergency Room within the past year? |
0;1;6;7
|
0 = No; 1 = Yes; 6 = Don't know ; 7 = Refuse to answer
|
medhx_4a |
|
medhis_6q_drug7 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 7 |
|
|
medhx_6q_drug7 |
|
medhis_6q_drug8 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 8 |
|
|
medhx_6q_drug8 |
|
medhis_6q_drug9 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 9 |
|
|
medhx_6q_drug9 |
|
medhis_6q_drug10 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 10 |
|
|
medhx_6q_drug10 |
|
medhis_6q_drug11 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 11 |
|
|
medhx_6q_drug11 |
|
medhis_6q_drug12 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 12 |
|
|
medhx_6q_drug12 |
|
medhis_6q_drug13 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 13 |
|
|
medhx_6q_drug13 |
|
medhis_6q_drug14 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 14 |
|
|
medhx_6q_drug14 |
|
medhis_6q_drug15 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 15 |
|
|
medhx_6q_drug15 |
|
medhis_6q_drug16 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 16 |
|
|
medhx_6q_drug16 |
|
ph_9 |
Integer |
|
Recommended |
Has your child ever had a seizure or fit? |
0::1; 9998
|
0 = No (If No, please go to Question 10); 1 = Yes; 9998 = Did not answer
|
medhx_6p |
|
medhis_6q_drug17 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 17 |
|
|
medhx_6q_drug17 |
|
medhis_6q_drug18 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 18 |
|
|
medhx_6q_drug18 |
|
medhis_6q_drug19 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 19 |
|
|
medhx_6q_drug19 |
|
medhis_6q_drug20 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 20 |
|
|
medhx_6q_drug20 |
|
medhis_6q_drug21 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 21 |
|
|
medhx_6q_drug21 |
|
medhis_6q_drug22 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 22 |
|
|
medhx_6q_drug22 |
|
medhis_6q_drug23 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 23 |
|
|
medhx_6q_drug23 |
|
medhis_6q_drug24 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 24 |
|
|
medhx_6q_drug24 |
|
medhis_6q_drug25 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 25 |
|
|
medhx_6q_drug25 |
|
medhis_6q_drug26 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 26 |
|
|
medhx_6q_drug26 |
|
ph_9a |
Integer |
|
Recommended |
How many seizures or fits has your child ever had? #: |
0::1200; 9998
|
Number of occurrences; 9998 = N/A
|
medhx_6p_notes |
|
medhis_6q_drug27 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 27 |
|
|
medhx_6q_drug27 |
|
medhis_6q_drug28 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 28 |
|
|
medhx_6q_drug28 |
|
medhis_6q_drug29 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 29 |
|
|
medhx_6q_drug29 |
|
medhis_6q_drug30 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 30 |
|
|
medhx_6q_drug30 |
|
medhis_6r |
Integer |
|
Recommended |
Has your child ever had a gunshot wound? |
0;1
|
0 = No ; 1 = Yes
|
medhx_6r |
|
medhis_6r_notes |
String |
150
|
Recommended |
If your child has had a gunshot wound, how many times? |
|
|
medhx_6r_notes |
|
medhis_6s |
Integer |
|
Recommended |
Has your child had a wound from knife or any other weapon |
0;1
|
0 = No ; 1 = Yes
|
medhx_6s |
|
medhis_6s_times |
String |
150
|
Recommended |
If your child has had a wound from knife or any other weapon, how many times? |
|
|
medhx_6s_times |
|
medhis_6t |
Integer |
|
Recommended |
Has your child had any other severe harm done? |
0;1
|
0 = No ; 1 = Yes
|
medhx_6t |
|
medhis_6t_describe |
String |
150
|
Recommended |
If your child has had other severe harm, please fill in: |
|
|
medhx_6t_describe |
|
ph_neuro9 |
Integer |
|
Recommended |
Has your child ever had a serious head injury (whether unconscious or not)? |
0;1
|
0 = No; 1 = Yes
|
medhx_6i |
|
medhis_6t_times |
String |
150
|
Recommended |
If your child has had other severe harm, how many times? |
|
|
medhx_6t_times |
|
medhis_8b_describe |
String |
400
|
Recommended |
If your child has ever been in the hospital overnight or longer, please describe: |
|
|
medhx_8b_describe |
|
medhis_9a |
Integer |
|
Recommended |
Has your child ever had general anesthesia or sedation for any surgery or procedure? |
0;1;6
|
1 = Yes ; 0 = No ; 6 = Don''t know
|
medhx_9a |
|
medhis_9b |
String |
150
|
Recommended |
If your child has ever had general anesthesia or sedation for any surgery or procedure, how many times? |
|
|
medhx_9b |
|
medhis_9c |
String |
150
|
Recommended |
If your child has ever had general anesthesia or sedation for any surgery or procedure, at what age for the most recent time? |
|
|
medhx_9c |
|
q17_b14 |
Integer |
|
Recommended |
Has she/he ever been to a doctor for any of these things…Problems with Heart /Problemas del corazón |
0::2
|
0 = No, 1 = Yes, 2 = Not sure//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.
|
medhx_2o |
|
seq1c_2 |
Integer |
|
Recommended |
Has a health or education professoinal told you that your child has any of the following conditions? : Traumatic brain injury |
|
2= No;1= Yes ; -99= N/A ; 77= Refused ; 88= Missing
|
medhx_2c |
|
w1_m_cu_hrng |
Integer |
|
Recommended |
Has she/he ever been to a doctor for any of these things…Hearing Problem /Problema Auditivo |
0;1; -888; -999
|
0 = No; 1 = Yes; -999 = missing; -888 = not applicable//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.
|
medhx_2i |
|
wk_allergies |
Integer |
|
Recommended |
Has she/he ever been to a doctor for any of these things…Allergies /Alergias |
0;1
|
No = 0; Yes = 1
|
medhx_2b |
|
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
|
medhx_2h |
|
wk_asthma |
Integer |
|
Recommended |
Has she/he ever been to a doctor for any of these things…Asthma /Asma |
0;1
|
No = 0; Yes = 1;//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.
|
medhx_2a |
|
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.
|
medhx_2g |
|
cfmh_chd_cerpalsy |
Integer |
|
Recommended |
Has she/he ever been to a doctor for any of these things…Cerebral Palsy /Parálisis Cerebral |
1;0;999
|
0 = No; 1 = Yes //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.
|
medhx_2f |
|
medhis_1a |
Integer |
|
Recommended |
During the past year, has your child been to see a doctor, nurse, nurse practitioner, dentist, or any other health professional like that, OTHER than for regular checkups? |
0;1;6
|
1 = Yes ; 0 = No ; 6 = Don''t know
|
medhx_1a |
|
medhis_1a_other |
String |
150
|
Recommended |
During the past year, has your child been to see a doctor, nurse, nurse practitioner, dentist, or any other health professional like that, OTHER than for regular checkups? If yes, then why? |
|
|
medhx_1a_other |
|
medhis_2d |
Integer |
|
Recommended |
Has your child ever been to a doctor for any of these things: Bronchitis |
0;1
|
1 = Yes ; 0 = No
|
medhx_2d |
|
medhis_2e |
Integer |
|
Recommended |
Has your child ever been to a doctor for any of these things: Cancer/Leukemia |
0;1
|
1 = Yes ; 0 = No
|
medhx_2e |
|
medhis_2k |
Integer |
|
Recommended |
Has your child ever been to a doctor for any of these things: Lead Poisoning |
0;1
|
1 = Yes ; 0 = No
|
medhx_2k |
|
medhis_2n |
Integer |
|
Recommended |
Has your child ever been to a doctor for any of these things: Problems with Vision |
0;1
|
1 = Yes ; 0 = No
|
medhx_2n |
|
medhis_2p |
Integer |
|
Recommended |
Has your child ever been to a doctor for any of these things: Sickle Cell Anemia |
0;1
|
1 = Yes ; 0 = No
|
medhx_2p |
|
medhis_2q |
Integer |
|
Recommended |
Has your child ever been to a doctor for any of these things: Very Bad Headaches |
0;1
|
1 = Yes ; 0 = No
|
medhx_2q |
|
ex_vd2_dev_muscular_dystrophy |
String |
2
|
Recommended |
Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD2 Child of Interest (COI) Muscular Dystrophy (Y=Yes, N=No, NA=Not Available) |
|
Y = Yes; N = No; NA = Not available
|
medhx_2l |
|
medhis_2r |
Integer |
|
Recommended |
Has your child ever been to a doctor for any of these things: An Operation |
0;1
|
1 = Yes ; 0 = No
|
medhx_2r |
|
medhis_2s |
Integer |
|
Recommended |
Has your child ever been to a doctor for any of these things: Any Other Illness |
0;1
|
1 = Yes ; 0 = No
|
medhx_2s |
|
medhis_2_notes |
String |
400
|
Recommended |
Has your child ever been to a doctor for any of these things: If any operation, please specify: |
|
|
medhx_2_notes |
|
medhis_2_notes2 |
String |
550
|
Recommended |
Has your child ever been to a doctor for any of these things: If any other illness, please specify: |
|
|
medhx_2_notes2 |
|
medhis_4b |
Integer |
|
Recommended |
How many times has your child been to the emergency room in that past year? |
1::5
|
1 = 1 time ; 2 = 2 times ; 3 = 3-4 times ; 4 = 5-9 times ; 5 = 10 or more times
|
medhx_4b |
|
medhis_6b |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Sprains |
0;1
|
0 = No ; 1 = Yes
|
medhx_6b |
|
medhis_6b_notes |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Sprains - If yes, how many times? |
|
|
medhx_6b_notes |
|
medhis_6c |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Cuts or Scrapes |
0;1
|
0 = No ; 1 = Yes
|
medhx_6c |
|
medhis_6c_times |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Cuts or Scrapes - If yes, how many times? |
|
|
medhx_6c_times |
|
medhis_6d |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Stitches |
0;1
|
0 = No ; 1 = Yes
|
medhx_6d |
|
medhx_brokenbones_specify |
String |
255
|
Recommended |
If yes to broken bones, specify: |
|
|
medhx_6a_notes |
|
medhis_6d_notes |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Stitches - If yes, how many times? |
|
|
medhx_6d_notes |
|
medhis_6e |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Other Serious Wounds |
0;1
|
0 = No ; 1 = Yes
|
medhx_6e |
|
medhis_6e_describe |
String |
450
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Other Serious Wounds - If yes, please describe: |
|
|
medhx_6e_describe |
|
medhis_6e_times |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Other Serious Wounds - If yes, how many times? |
|
|
medhx_6e_times |
|
medhis_6f |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Falls |
0;1
|
0 = No ; 1 = Yes
|
medhx_6f |
|
medhis_6f_notes |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Falls - If yes, how many times? |
|
|
medhx_6f_notes |
|
medhis_6g_times |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Burns - If yes, how many times? |
|
|
medhx_6g_times |
|
medhis_6h |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: High Fever |
0;1
|
0 = No ; 1 = Yes
|
medhx_6h |
|
medhis_6h_times |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: High Fever - If yes, how many times? |
|
|
medhx_6h_times |
|
medhis_6i_times |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Head Injury - If yes, how many times? |
|
|
medhx_6i_times |
|
strconkidney |
String |
5
|
Recommended |
Does the child/patient have kidney disease? |
|
|
medhx_2j |
|
medhis_6j |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Knocked Unconscious |
0;1
|
0 = No ; 1 = Yes
|
medhx_6j |
|
medhis_6j_times |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Knocked Unconscious - If yes, how many times? |
|
|
medhx_6j_times |
|
medhis_6k |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Bruises |
0;1
|
0 = No ; 1 = Yes
|
medhx_6k |
|
medhis_6k_times |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Bruises - If yes, how many times? |
|
|
medhx_6k_times |
|
medhis_6l |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Asthma Attack |
0;1
|
0 = No ; 1 = Yes
|
medhx_6l |
|
medhis_6l_notes |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Asthma Attack - If yes, how many times? |
|
|
medhx_6l_notes |
|
medhis_6m |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Broken Teeth |
0;1
|
0 = No ; 1 = Yes
|
medhx_6m |
|
medhis_6m_times |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Broken Teeth - If yes, how many times? |
|
|
medhx_6m_times |
|
medhis_6n |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Animal Bite |
0;1
|
0 = No ; 1 = Yes
|
medhx_6n |
|
medhis_6n_notes |
String |
150
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Animal Bite - If yes, how many times? |
|
|
medhx_6n_notes |
|
ch_17_00 |
Integer |
|
Recommended |
Before you were 18, were/Has your child been burned? This includes when you/your child suffered an injury caused by fire or excessive heat that is not a sunburn. |
0;1; -8; -9
|
1=Yes; 0=No; -8= I don't know the answer to the question; -9= I don't want to answer the question
|
medhx_6g |
|
medhis_6o |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Overdose |
0;1
|
0 = No ; 1 = Yes
|
medhx_6o |
|
medhis_6o_notes |
Integer |
|
Recommended |
Has your child ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because of: Overdose - If yes, how many times? |
1::30
|
|
medhx_6o_notes |
|
medhis_6o_drug1 |
String |
150
|
Recommended |
Drug 1 that your child had overdosed on: |
|
|
medhx_6o_drug1 |
|
medhis_6o_drug2 |
String |
150
|
Recommended |
Drug 2 that your child had overdosed on: |
|
|
medhx_6o_drug2 |
|
medhis_6o_drug3 |
String |
150
|
Recommended |
Drug 3 that your child had overdosed on: |
|
|
medhx_6o_drug3 |
|
medhis_6o_drug4 |
String |
150
|
Recommended |
Drug 4 that your child had overdosed on: |
|
|
medhx_6o_drug4 |
|
medhis_6o_drug5 |
String |
150
|
Recommended |
Drug 5 that your child had overdosed on: |
|
|
medhx_6o_drug5 |
|
medhis_6o_drug6 |
String |
150
|
Recommended |
Drug 6 that your child had overdosed on: |
|
|
medhx_6o_drug6 |
|
medhis_6o_drug7 |
String |
150
|
Recommended |
Drug 7 that your child had overdosed on: |
|
|
medhx_6o_drug7 |
|
medhis_6o_drug8 |
String |
150
|
Recommended |
Drug 8 that your child had overdosed on: |
|
|
medhx_6o_drug8 |
|
childhospital |
Integer |
|
Recommended |
Has your child ever been overnight in the hospital? |
0;1;-99;88;77;6
|
0= No ; 1= Yes ; -99= N/A ; 88= Missing ; 77= Refused; 6 = Don't know
|
medhx_8a |
|
medhis_6o_drug9 |
String |
150
|
Recommended |
Drug 9 that your child had overdosed on: |
|
|
medhx_6o_drug9 |
|
medhis_6o_drug10 |
String |
150
|
Recommended |
Drug 10 that your child had overdosed on: |
|
|
medhx_6o_drug10 |
|
medhis_6o_drug11 |
String |
150
|
Recommended |
Drug 11 that your child had overdosed on: |
|
|
medhx_6o_drug11 |
|
medhis_6o_drug12 |
String |
150
|
Recommended |
Drug 12 that your child had overdosed on: |
|
|
medhx_6o_drug12 |
|
medhis_6o_drug13 |
String |
150
|
Recommended |
Drug 13 that your child had overdosed on: |
|
|
medhx_6o_drug13 |
|
medhis_6o_drug14 |
String |
150
|
Recommended |
Drug 14 that your child had overdosed on: |
|
|
medhx_6o_drug14 |
|
medhis_6o_drug15 |
String |
150
|
Recommended |
Drug 15 that your child had overdosed on: |
|
|
medhx_6o_drug15 |
|
medhis_6o_drug16 |
String |
150
|
Recommended |
Drug 16 that your child had overdosed on: |
|
|
medhx_6o_drug16 |
|
medhis_6o_drug17 |
String |
150
|
Recommended |
Drug 17 that your child had overdosed on: |
|
|
medhx_6o_drug17 |
|
medhis_6o_drug18 |
String |
150
|
Recommended |
Drug 18 that your child had overdosed on: |
|
|
medhx_6o_drug18 |
|
medhx_brokenbones |
Integer |
|
Recommended |
Has he/she ever been to a doctor, a nurse, nurse practitioner, the emergency room or a clinic because any of these things happened...Broken Bones /Fracturas |
0::2
|
0 = No, 1 = Yes, 2 = Not sure//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.
|
medhx_6a |
|
medhis_6o_drug19 |
String |
150
|
Recommended |
Drug 19 that your child had overdosed on: |
|
|
medhx_6o_drug19 |
|
medhis_6o_drug20 |
String |
150
|
Recommended |
Drug 20 that your child had overdosed on: |
|
|
medhx_6o_drug20 |
|
medhis_6o_drug21 |
String |
150
|
Recommended |
Drug 21 that your child had overdosed on: |
|
|
medhx_6o_drug21 |
|
medhis_6o_drug22 |
String |
150
|
Recommended |
Drug 22 that your child had overdosed on: |
|
|
medhx_6o_drug22 |
|
medhis_6o_drug23 |
String |
150
|
Recommended |
Drug 23 that your child had overdosed on: |
|
|
medhx_6o_drug23 |
|
medhis_6o_drug24 |
String |
150
|
Recommended |
Drug 24 that your child had overdosed on: |
|
|
medhx_6o_drug24 |
|
medhis_6o_drug25 |
String |
150
|
Recommended |
Drug 25 that your child had overdosed on: |
|
|
medhx_6o_drug25 |
|
medhis_6o_drug26 |
String |
150
|
Recommended |
Drug 26 that your child had overdosed on: |
|
|
medhx_6o_drug26 |
|
medhis_6o_drug27 |
String |
150
|
Recommended |
Drug 27 that your child had overdosed on: |
|
|
medhx_6o_drug27 |
|
medhis_6o_drug28 |
String |
150
|
Recommended |
Drug 28 that your child had overdosed on: |
|
|
medhx_6o_drug28 |
|
ms |
Integer |
|
Recommended |
Has she/he ever been to a doctor for any of these things…Multiple Sclerosis /Esclerosis múltiple |
1;0;-7; 9; -999
|
0=No; 1=Yes;-7=Refused; 9=Not evaluated; -999= Don't know/Missing Data //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.
|
medhx_2m |
|
medhis_6o_drug29 |
String |
150
|
Recommended |
Drug 29 that your child had overdosed on: |
|
|
medhx_6o_drug29 |
|
medhis_6o_drug30 |
String |
150
|
Recommended |
Drug 30 that your child had overdosed on: |
|
|
medhx_6o_drug30 |
|
medhis_6q |
Integer |
|
Recommended |
Has your child ever had an accidental poisoning? |
0;1
|
0 = No ; 1 = Yes
|
medhx_6q |
|
medhis_6q_notes |
Integer |
|
Recommended |
If your child has had accidental poisonings, how many times? |
1::30
|
|
medhx_6q_notes |
|
medhis_6q_drug1 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 1 |
|
|
medhx_6q_drug1 |
|
medhis_6q_drug2 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 2 |
|
|
medhx_6q_drug2 |
|
medhis_6q_drug3 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 3 |
|
|
medhx_6q_drug3 |
|
medhis_6q_drug4 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 4 |
|
|
medhx_6q_drug4 |
|
medhis_6q_drug5 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 5 |
|
|
medhx_6q_drug5 |
|
medhis_6q_drug6 |
String |
150
|
Recommended |
If your child has had accidental poisonings, then list poisons. Poison 6 |
|
|
medhx_6q_drug6 |
|
comqother |
String |
255
|
Recommended |
Respondent - Other (text) |
|
|
|
|
q6_menstrual |
Integer |
|
Recommended |
Are you currently pregnant or lactating? |
0 ::3
|
0= No; 1= Yes; 2= Don't know; 3= Refuse to answer
|
|
|
q7_menstrual |
Integer |
|
Recommended |
Have you had a hysterectomy? |
0 ::3
|
0= No; 1= Yes; 2= Don't know; 3= Refuse to answer
|
|
|
q9_demo |
Integer |
|
Recommended |
Have you had anything to eat or drink in the last two hours? |
0 :: 1
|
0= No; 1= Yes
|
|
|
q9_answer |
String |
2,000
|
Recommended |
Yes (please list what you've had to eat or drink in the last two hours) |
|
|
|
|
q10_demo |
Integer |
|
Recommended |
Are you currently taking a corticosteroid medication? |
0 :: 1; 3
|
0= No; 1= Yes; 3= Prefer Not to Answer
|
|
|
q11_demo |
Integer |
|
Recommended |
Are you currently taking a beta blocker medication? |
0 :: 1; 3
|
0= No; 1= Yes; 3= Prefer Not to Answer
|
|
|
q12_demo |
Integer |
|
Recommended |
Are you currently taking an antidepressant and/or a medication to reduce anxiety? |
1 :: 1; 3
|
0= No; 1= Yes; 3= Prefer Not to Answer
|
|
|
q2_menstrual |
Date |
|
Recommended |
What was the date of the first day of your last period? |
|
MM/DD/YYY
|
|
|
q3_menstrual |
Integer |
|
Recommended |
On average, how many days are there between the first day of your last period and the first day of your next period? (e.g., 30 days) |
|
Number of Days
|
|
|
same_past01 |
String |
500
|
Recommended |
Diagnosis/Type of Surgery |
|
|
|
|
same_past02 |
String |
100
|
Recommended |
Body System |
|
|
|
|
same_past03 |
Date |
|
Recommended |
Time of Medical History: Start Date |
|
MM/DD/YYYY
|
|
|
same_past04 |
Date |
|
Recommended |
Time of Medical History: Stop Date |
|
MM/DD/YYYY
|
|
|
same_past05 |
String |
100
|
Recommended |
Check if ongoing |
|
|
|
|
systemicsnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Systemic #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
respiratorysnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Respiratory #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
respiratorysnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Respiratory #3 - End Date |
|
MM/DD/YYYY
|
|
|
respiratoryonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Respiratory #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
respiratoryimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Respiratory #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
cardioassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Cardiovascular |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
cardiospecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Cardiovascular #1 - Specify |
|
|
|
|
cardiosnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Cardiovascular #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
cardiosnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Cardiovascular #1 - End Date |
|
MM/DD/YYYY
|
|
|
cardioonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Cardiovascular #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
cardioimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Cardiovascular #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
systemicsnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Systemic #1 - End Date |
|
MM/DD/YYYY
|
|
|
cardiospecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Cardiovascular #2 - Specify |
|
|
|
|
cardiosnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Cardiovascular #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
cardiosnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Cardiovascular #2 - End Date |
|
MM/DD/YYYY
|
|
|
cardioonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Cardiovascular #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
cardioimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Cardiovascular #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
cardiospecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Cardiovascular #3 - Specify |
|
|
|
|
cardiosnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Cardiovascular #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
cardiosnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Cardiovascular #3 - End Date |
|
MM/DD/YYYY
|
|
|
cardioonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Cardiovascular #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
cardioimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Cardiovascular #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
systemiconsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Systemic #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
gastroassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
gastrospecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #1 - Specify |
|
|
|
|
gastrosnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
gastrosnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #1 - End Date |
|
MM/DD/YYYY
|
|
|
gastroonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
gastroimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
gastrospecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #2 - Specify |
|
|
|
|
gastrosnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
gastrosnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #2 - End Date |
|
MM/DD/YYYY
|
|
|
gastroonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
systemicimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Systemic #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
gastroimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
gastrospecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #3 - Specify |
|
|
|
|
gastrosnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
gastrosnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #3 - End Date |
|
MM/DD/YYYY
|
|
|
gastroonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
gastroimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Gastrointestinal/Hepatobiliary #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
renalassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Renal/Urinary |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
renalspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Renal/Urinary #1 - Specify |
|
|
|
|
renalsnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
renalsnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #1 - End Date |
|
MM/DD/YYYY
|
|
|
systemicspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Systemic #2 - Specify |
|
|
|
|
renalonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
renalimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
renalspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Renal/Urinary #2 - Specify |
|
|
|
|
renalsnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
renalsnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #2 - End Date |
|
MM/DD/YYYY
|
|
|
renalonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
renalimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
renalspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Renal/Urinary #3 - Specify |
|
|
|
|
renalsnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
renalsnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #3 - End Date |
|
MM/DD/YYYY
|
|
|
systemicsnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Systemic #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
renalonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
renalimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Renal/Urinary #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
reproductiveassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Reproductive |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
reproductivespecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Reproductive #1 - Specify |
|
|
|
|
reproductivesnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Reproductive #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
reproductivesnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Reproductive #1 - End Date |
|
MM/DD/YYYY
|
|
|
reproductiveonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Reproductive #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
reproductiveimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Reproductive #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
reproductivespecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Reproductive #2 - Specify |
|
|
|
|
reproductivesnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Reproductive #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
systemicsnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Systemic #2 - End Date |
|
MM/DD/YYYY
|
|
|
reproductivesnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Reproductive #2 - End Date |
|
MM/DD/YYYY
|
|
|
reproductiveonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Reproductive #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
reproductiveimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Reproductive #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
reproductivespecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Reproductive #3 - Specify |
|
|
|
|
reproductivesnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Reproductive #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
reproductivesnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Reproductive #3 - End Date |
|
MM/DD/YYYY
|
|
|
reproductiveonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Reproductive #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
reproductiveimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Reproductive #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
muscskelassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Musculoskeletal |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
muscskelspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Musculoskeletal #1 - Specify |
|
|
|
|
systemiconsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Systemic #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
muscskelsnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
muscskelsnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #1 - End Date |
|
MM/DD/YYYY
|
|
|
muscskelonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
muscskelimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
muscskelspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Musculoskeletal #2 - Specify |
|
|
|
|
muscskelsnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
muscskelsnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #2 - End Date |
|
MM/DD/YYYY
|
|
|
muscskelonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
muscskelimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
muscskelspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Musculoskeletal #3 - Specify |
|
|
|
|
systemicimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Systemic #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
muscskelsnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
muscskelsnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #3 - End Date |
|
MM/DD/YYYY
|
|
|
muscskelonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
muscskelimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Musculoskeletal #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
bloodassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Blood |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
bloodspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Blood #1 - Specify |
|
|
|
|
bloodsnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Blood #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
bloodsnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Blood #1 - End Date |
|
MM/DD/YYYY
|
|
|
bloodonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Blood #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
bloodimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Blood #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
systemicspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Systemic #3 - Specify |
|
|
|
|
bloodspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Blood #2 - Specify |
|
|
|
|
bloodsnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Blood #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
bloodsnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Blood #2 - End Date |
|
MM/DD/YYYY
|
|
|
bloodonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Blood #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
bloodimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Blood #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
bloodspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Blood #3 - Specify |
|
|
|
|
bloodsnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Blood #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
bloodsnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Blood #3 - End Date |
|
MM/DD/YYYY
|
|
|
bloodonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Blood #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
bloodimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Blood #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
systemicsnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Systemic #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
ocularassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Ocular/Vision |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
ocularspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Ocular/Vision #1 - Specify |
|
|
|
|
ocularsnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
ocularsnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #1 - End Date |
|
MM/DD/YYYY
|
|
|
ocularonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
ocularimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
ocularspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Ocular/Vision #2 - Specify |
|
|
|
|
ocularsnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
ocularsnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #2 - End Date |
|
MM/DD/YYYY
|
|
|
ocularonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
systemicsnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Systemic #3 - End Date |
|
MM/DD/YYYY
|
|
|
ocularimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
ocularspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Ocular/Vision #3 - Specify |
|
|
|
|
ocularsnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
ocularsnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #3 - End Date |
|
MM/DD/YYYY
|
|
|
ocularonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
ocularimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Ocular/Vision #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
cancerassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
cancerspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #1 - Specify |
|
|
|
|
cancersnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
cancersnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #1 - End Date |
|
MM/DD/YYYY
|
|
|
systemiconsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Systemic #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
canceronsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
cancerimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
cancerspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #2 - Specify |
|
|
|
|
cancersnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
cancersnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #2 - End Date |
|
MM/DD/YYYY
|
|
|
canceronsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
cancerimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
cancerspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #3 - Specify |
|
|
|
|
cancersnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
cancersnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #3 - End Date |
|
MM/DD/YYYY
|
|
|
systemicimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Systemic #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
canceronsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
cancerimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Tumor/Cancer #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
otherassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Other |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
otherspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Other #1 - Specify |
|
|
|
|
othersnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Other #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
othersnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Other #1 - End Date |
|
MM/DD/YYYY
|
|
|
otheronsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Other #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
otherimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Other #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
otherspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Other #2 - Specify |
|
|
|
|
othersnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Other #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
dermassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Dermatological |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
othersnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Other #2 - End Date |
|
MM/DD/YYYY
|
|
|
otheronsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Other #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
otherimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Other #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
otherspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Other #3 - Specify |
|
|
|
|
othersnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Other #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
othersnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Other #3 - End Date |
|
MM/DD/YYYY
|
|
|
otheronsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Other #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
otherimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Other #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
hospnone |
Integer |
|
Recommended |
Hospitalizations - None |
0;1
|
0= Unchecked; 1= Checked
|
|
|
hospnotassessed |
Integer |
|
Recommended |
Hospitalizations - Not assessed |
0;1
|
0= Unchecked; 1= Checked
|
|
|
dermspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Dermatological #1 - Specify |
|
|
|
|
hospreason1 |
String |
500
|
Recommended |
Hospitalizations #1 - Reason |
|
|
|
|
hospadmit1 |
Date |
|
Recommended |
Hospitalizations #1 - Admission Date |
|
MM/DD/YYYY
|
|
|
hospdischg1 |
Date |
|
Recommended |
Hospitalizations #1 - Discharge Date |
|
MM/DD/YYYY
|
|
|
hospreason2 |
String |
500
|
Recommended |
Hospitalizations #2 - Reason |
|
|
|
|
hospadmit2 |
Date |
|
Recommended |
Hospitalizations #2 - Admission Date |
|
MM/DD/YYYY
|
|
|
hospdischg2 |
Date |
|
Recommended |
Hospitalizations #2 - Discharge Date |
|
MM/DD/YYYY
|
|
|
surgerynone |
Integer |
|
Recommended |
Surgeries and Procedures - None |
0;1
|
0= Unchecked; 1= Checked
|
|
|
surgerynotassessed |
Integer |
|
Recommended |
Surgeries and Procedures - Not assessed |
0;1
|
0= Unchecked; 1= Checked
|
|
|
surgerydescription1 |
String |
500
|
Recommended |
Surgeries and Procedures #1 - Description |
|
|
|
|
surgeryindication1 |
String |
500
|
Recommended |
Surgeries and Procedures #1 - Indication |
|
|
|
|
dermsnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Dermatological #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
surgerydate1 |
Date |
|
Recommended |
Surgeries and Procedures #1 - Surgery/Procedure Date |
|
MM/DD/YYYY
|
|
|
surgerydescription2 |
String |
500
|
Recommended |
Surgeries and Procedures #2 - Description |
|
|
|
|
surgeryindication2 |
String |
500
|
Recommended |
Surgeries and Procedures #2 - Indication |
|
|
|
|
surgerydate2 |
Date |
|
Recommended |
Surgeries and Procedures #2 - Surgery/Procedure Date |
|
MM/DD/YYYY
|
|
|
dermsnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Dermatological #1 - End Date |
|
MM/DD/YYYY
|
|
|
dermonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Dermatological #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
dermimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Dermatological #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
allergiesnone |
Integer |
|
Recommended |
Allergies - None |
0;1
|
0= Unchecked; 1= Checked
|
|
|
dermspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Dermatological #2 - Specify |
|
|
|
|
dermsnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Dermatological #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
dermsnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Dermatological #2 - End Date |
|
MM/DD/YYYY
|
|
|
dermonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Dermatological #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
dermimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Dermatological #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
dermspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Dermatological #3 - Specify |
|
|
|
|
dermsnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Dermatological #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
dermsnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Dermatological #3 - End Date |
|
MM/DD/YYYY
|
|
|
dermonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Dermatological #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
dermimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Dermatological #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
allergiesnotassessed |
Integer |
|
Recommended |
Allergies - Not assessed |
0;1
|
0= Unchecked; 1= Checked
|
|
|
endometabassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
endometabspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #1 - Specify |
|
|
|
|
endometabsnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
endometabsnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #1 - End Date |
|
MM/DD/YYYY
|
|
|
endometabonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
endometabimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
endometabspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #2 - Specify |
|
|
|
|
endometabsnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
endometabsnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #2 - End Date |
|
MM/DD/YYYY
|
|
|
endometabonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
allergiesdescription |
String |
500
|
Recommended |
Allergies - Describe |
|
|
|
|
endometabimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
endometabspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #3 - Specify |
|
|
|
|
endometabsnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
endometabsnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #3 - End Date |
|
MM/DD/YYYY
|
|
|
endometabonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
endometabimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Endocrine/Metabolic #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
othneuroassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Other Neurological |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
othneurospecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Other Neurological #1 - Specify |
|
|
|
|
othneurosnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Other Neurological #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
othneurosnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Other Neurological #1 - End Date |
|
MM/DD/YYYY
|
|
|
pastillnessnone |
Integer |
|
Recommended |
Other Illness/Conditions - None |
0;1
|
0= Unchecked; 1= Checked
|
|
|
othneuroonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Other Neurological #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
othneuroimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Other Neurological #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
othneurospecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Other Neurological #2 - Specify |
|
|
|
|
othneurosnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Other Neurological #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
othneurosnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Other Neurological #2 - End Date |
|
MM/DD/YYYY
|
|
|
othneuroonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Other Neurological #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
othneuroimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Other Neurological #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
othneurospecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Other Neurological #3 - Specify |
|
|
|
|
othneurosnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Other Neurological #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
othneurosnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Other Neurological #3 - End Date |
|
MM/DD/YYYY
|
|
|
pastillnessnotaccesse |
Integer |
|
Recommended |
Other Illness/Conditions - Not assessed |
0;1
|
0= Unchecked; 1= Checked
|
|
|
othneuroonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Other Neurological #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
othneuroimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Other Neurological #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
psychassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Psychiatric |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
psychspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Psychiatric #1 - Specify |
|
|
|
|
psychsnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Psychiatric #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
psychsnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Psychiatric #1 - End Date |
|
MM/DD/YYYY
|
|
|
psychonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Psychiatric #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
psychimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Psychiatric #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
psychspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Psychiatric #2 - Specify |
|
|
|
|
psychsnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Psychiatric #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
systemicassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Systemic |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
psychsnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Psychiatric #2 - End Date |
|
MM/DD/YYYY
|
|
|
psychonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Psychiatric #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
psychimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Psychiatric #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
psychspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Psychiatric #3 - Specify |
|
|
|
|
psychsnomedinput3 |
Date |
|
Recommended |
Other Illness/Conditions - Psychiatric #3 - Onset Date |
|
MM/DD/YYYY
|
|
|
psychsnomedoutput3 |
Date |
|
Recommended |
Other Illness/Conditions - Psychiatric #3 - End Date |
|
MM/DD/YYYY
|
|
|
psychonsetongoing3 |
Integer |
|
Recommended |
Other Illness/Conditions - Psychiatric #3 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
psychimpairment3 |
Integer |
|
Recommended |
Other Illness/Conditions - Psychiatric #3 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
respiratoryassessment |
Integer |
|
Recommended |
Other Illness/Conditions - Respiratory |
0;1;-9
|
0= No; 1= Yes; -9= Not Assessed
|
|
|
respiratoryspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Respiratory #1 - Specify |
|
|
|
|
systemicspecify1 |
String |
500
|
Recommended |
Other Illness/Conditions - Systemic #1 - Specify |
|
|
|
|
respiratorysnomedinput1 |
Date |
|
Recommended |
Other Illness/Conditions - Respiratory #1 - Onset Date |
|
MM/DD/YYYY
|
|
|
respiratorysnomedoutput1 |
Date |
|
Recommended |
Other Illness/Conditions - Respiratory #1 - End Date |
|
MM/DD/YYYY
|
|
|
respiratoryonsetongoing1 |
Integer |
|
Recommended |
Other Illness/Conditions - Respiratory #1 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
respiratoryimpairment1 |
Integer |
|
Recommended |
Other Illness/Conditions - Respiratory #1 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
respiratoryspecify2 |
String |
500
|
Recommended |
Other Illness/Conditions - Respiratory #2 - Specify |
|
|
|
|
respiratorysnomedinput2 |
Date |
|
Recommended |
Other Illness/Conditions - Respiratory #2 - Onset Date |
|
MM/DD/YYYY
|
|
|
respiratorysnomedoutput2 |
Date |
|
Recommended |
Other Illness/Conditions - Respiratory #2 - End Date |
|
MM/DD/YYYY
|
|
|
respiratoryonsetongoing2 |
Integer |
|
Recommended |
Other Illness/Conditions - Respiratory #2 - Ongoing? |
0;1
|
0= No; 1= Yes
|
|
|
respiratoryimpairment2 |
Integer |
|
Recommended |
Other Illness/Conditions - Respiratory #2 - Contributes to Impairment? |
0;1;-9
|
0= No; 1= Yes; -9= N/A
|
|
|
respiratoryspecify3 |
String |
500
|
Recommended |
Other Illness/Conditions - Respiratory #3 - Specify |
|
|
|