|
|
subjectkey |
GUID |
|
Required |
The NDAR Global Unique Identifier (GUID) for research subject |
NDAR*
|
|
guid |
|
|
src_subject_id |
String |
45
|
Required |
Subject ID how it's defined in lab/project |
|
|
CATIEID, case_id, id, patid, pid, randid, subject_id, subjectid, subjid, subnum |
|
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
date_con_collected_1, date_of_rating, intvdate, sdate, visit_date |
|
|
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.
|
age, bslage, intvage |
|
|
sex |
String |
20
|
Required |
Sex of subject at birth |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
gender |
| Query
|
othmed0a |
Integer |
|
Recommended |
Did the patient take any medications |
0;1
|
0 = No; 1 = Yes
|
any_con_meds_at_all, none_rpt |
|
|
drugterm |
String |
50
|
Recommended |
Original Drugterm |
|
|
|
|
|
drgterm2 |
String |
50
|
Recommended |
Combined DRUGTERM |
|
|
|
|
|
shrtcode |
String |
50
|
Recommended |
WHO Drug Dictionary, version 3Q 2000 numeric code identifying each drug corresponding to DRUGTERM |
|
|
|
| Query
|
medcode |
String |
25
|
Recommended |
Created Medication code |
|
|
conmedcode |
|
|
atc1lev3 |
String |
100
|
Recommended |
Anatomic-Therapeutic- Class 1, Level 3 |
|
|
|
|
|
atc2lev3 |
String |
100
|
Recommended |
Anatomic-Therapeutic- Class 2, Level 3 |
|
|
|
| Query
|
startdy |
Integer |
|
Recommended |
Start Day |
|
|
cntr_startdat_x, datestrt |
| Query
|
endday |
Integer |
|
Recommended |
Stop Day |
|
|
cntr_enddat_x, dateend |
| Query
|
othmed2 |
Integer |
|
Recommended |
2. Adjunctive or Concomitant |
1;2
|
1 = Adjunctive; 2 = Concomitant
|
|
| Query
|
othmed2a |
Integer |
|
Recommended |
2a. Primary Adjunctive |
1::10
|
1 = Insomnia; 2 = Anxiety; 3 = Agitation/Excitement; 4 = Aggression/Violence; 5 = Dysphoria/Depression; 6 = Catatonic Immobility; 7 = Substance Use Disorder; 8 = Cognitive Problems; 9 = Antipsychotic Cross-Titration; 10 = Out-of-Study Antipsychotic Use
|
|
| Query
|
othmed2b |
Integer |
|
Recommended |
2b. Secondary Adjunctive |
1::10
|
1 = Insomnia; 2 = Anxiety; 3 = Agitation/Excitement; 4 = Aggression/Violence; 5 = Dysphoria/Depression; 6 = Catatonic Immobility; 7 = Substance Use Disorder; 8 = Cognitive Problems; 9 = Antipsychotic Cross-Titration; 10 = Out-of-Study Antipsychotic Use
|
|
| Query
|
othmed2c |
Integer |
|
Recommended |
2c. Primary Concomitant |
11::20
|
11 = Parkinsonism; 12 = Akathisia; 13 = Tardive Dyskinesia; 14 = Prolactin/Sexual; 15 = Weight Gain; 16 = Hyperglycemia/Diabetes; 17 = Hyperlipidemia; 18 = High Blood Pressure; 19 = Constipation; 20 = Other, specify
|
|
| Query
|
othmed2e |
Integer |
|
Recommended |
2d. Secondary Concomitant |
11::20
|
11 = Parkinsonism; 12 = Akathisia; 13 = Tardive Dyskinesia; 14 = Prolactin/Sexual; 15 = Weight Gain; 16 = Hyperglycemia/Diabetes; 17 = Hyperlipidemia; 18 = High Blood Pressure; 19 = Constipation; 20 = Other, specify
|
|
| Query
|
othmed4 |
String |
100
|
Recommended |
3. Modal Daily Dose |
|
|
con_med_dose_1 |
| Query
|
othmed4a |
String |
10
|
Recommended |
3a. Modal Daily Dose Units |
|
CA = CA - Capsules; GI = GI - Drops; IU = IU - International Units; TB = TB - Tablets; U = U - Units; gm = gm - Grams; mL = Ml - Milliliter [cc]; mcg = mcg - Micrograms; mg = mg - Milligrams
|
|
| Query
|
flag |
Integer |
|
Recommended |
Baseline Medication Flag |
|
|
|
| Query
|
priflag |
Integer |
|
Recommended |
Prior Baseline Medication Flag |
|
|
|
| Query
|
conflag |
Integer |
|
Recommended |
Continuous Baseline Medication Flag |
|
|
|
| Query
|
postflag |
Integer |
|
Recommended |
Post-Baseline and in P1 Medication Flag |
|
|
|
| Query
|
postflg2 |
Integer |
|
Recommended |
Post-Baseline Medication Flag |
|
|
|
| Query
|
psy_med |
Integer |
|
Recommended |
Flag for Psychotropic medication |
|
|
|
| Query
|
any_psy |
Integer |
|
Recommended |
Any Psychotropic Con Med at Baseline |
0;1
|
0=No, 1=Yes
|
psychmed |
| Query
|
anyppsy |
Integer |
|
Recommended |
Any Psychotropic Con Med prior to Baseline |
|
|
|
| Query
|
anycpsy |
Integer |
|
Recommended |
Any Psychotropic Con Med ongoing at Baseline |
|
|
|
| Query
|
anynpsy |
Integer |
|
Recommended |
Any Psychotropic New in P1 Med at baseline |
|
|
|
| Query
|
anypsych |
Integer |
|
Recommended |
Any Conventional Antipsychotic at baseline |
|
|
|
| Query
|
anyppsyc |
Integer |
|
Recommended |
Any Prior Conv Antipsy at baseline |
|
|
|
| Query
|
anycpsyc |
Integer |
|
Recommended |
Any Continuous Conv Antipsy at baseline |
|
|
|
| Query
|
anynpsyc |
Integer |
|
Recommended |
Any New in P1 Conv Antipsy at baseline |
|
|
|
| Query
|
anypsyat |
Integer |
|
Recommended |
Any Atypical Antipsychotic at Baseline |
|
|
|
| Query
|
anyppsya |
Integer |
|
Recommended |
Any Prior Atypical Antipsychotic at baseline |
|
|
|
| Query
|
anycpsya |
Integer |
|
Recommended |
Any Cont Atypical Antipsychotic at baseline |
|
|
|
| Query
|
anynpsya |
Integer |
|
Recommended |
Any New in P1 Atypical Antipsychotic at baseline |
|
|
|
| Query
|
antipsy |
Integer |
|
Recommended |
Taking antipsychotic medication at baseline |
1::3
|
|
|
| Query
|
antichol |
Integer |
|
Recommended |
Taking anticholinergic meds at baseline |
|
|
|
| Query
|
statin |
Integer |
|
Recommended |
Statin Use at Baseline |
|
|
|
| Query
|
oth_chol |
Integer |
|
Recommended |
Other Chol and Trig Reducer Use at baseline |
|
|
|
| Query
|
inc_lit |
Integer |
|
Recommended |
Patient took at least one LITHIUM at baseline |
|
|
|
| Query
|
incc_lit |
Integer |
|
Recommended |
Incidence flag for patient continuously |
|
|
|
| Query
|
incn_lit |
Integer |
|
Recommended |
Patient newly took in P1 at least 1 LITHIUM |
|
|
|
| Query
|
n_med |
Integer |
|
Recommended |
Number of medication taking at baseline |
|
|
|
| Query
|
n_pmed |
Integer |
|
Recommended |
Number of med previously taking at baseline |
|
|
|
| Query
|
n_cmed |
Integer |
|
Recommended |
Number of med continuously taking at baseline |
|
|
|
| Query
|
n_nmed |
Integer |
|
Recommended |
Number of med newly taken in P1 |
|
|
|
| Query
|
n_psy |
Integer |
|
Recommended |
Number of Psychotropic med taking at baseline |
|
|
|
| Query
|
n_psypri |
Integer |
|
Recommended |
Number of Psychotropic med previously taking at baseline |
|
|
|
| Query
|
n_psycon |
Integer |
|
Recommended |
Number of Psychotropic meds continuosly taking at baseline |
|
|
|
| Query
|
n_psynew |
Integer |
|
Recommended |
Number of New in P1 Psychotropic meds since baseline |
|
|
|
| Query
|
daysrz |
Integer |
|
Recommended |
days since randomization |
|
|
date, exprrz, studyday, visitdt |
|
|
medcur5 |
String |
50
|
Recommended |
current medication 5 |
|
|
med5 |
|
|
medication_5_name |
String |
50
|
Recommended |
specify med 5 |
|
|
drug_name_5, medname5, medsp5 |
|
|
medication5_dosage |
String |
100
|
Recommended |
Fifth medication dosage |
|
0 = No medication; 999 = Missing
|
concommeds_1_dosage, mdose5 |
|
|
route5 |
String |
50
|
Recommended |
route 5 |
|
|
|
| Query
|
med5rz |
Integer |
|
Recommended |
med 5 start days since randomization |
|
|
|
| Query
|
cont5 |
Integer |
|
Recommended |
drug 5 continued |
0;1;-7
|
0=No (discontinued); 1=Yes; -7=Refused
|
|
| Query
|
med5drz |
Integer |
|
Recommended |
med 5 discont days since randomization |
|
|
|
| Query
|
medcur6 |
String |
50
|
Recommended |
current medication 6 |
|
|
med6 |
|
|
medication_6_name |
String |
50
|
Recommended |
specify med 6 |
|
|
drug_name_6, medname6, medsp6 |
|
|
medication6_dosage |
String |
100
|
Recommended |
Sixth medication dosage |
|
0 = No medication; 999 = Missing
|
mdose6 |
|
|
route6 |
String |
50
|
Recommended |
route 6 |
|
|
|
| Query
|
med6rz |
Integer |
|
Recommended |
med 6 start days since randomization |
|
|
|
| Query
|
cont6 |
Integer |
|
Recommended |
drug 6 continued |
0;1;-7
|
0=No (discontinued); 1=Yes; -7=Refused
|
|
| Query
|
med6drz |
Integer |
|
Recommended |
med 6 discont days since randomization |
|
|
|
| Query
|
medcur7 |
String |
50
|
Recommended |
current medication 7 |
|
|
med7 |
|
|
medication_7_name |
String |
50
|
Recommended |
specify med 7 |
|
|
drug_name_7, medname7, medsp7 |
| Query
|
medication7_dosage |
String |
100
|
Recommended |
Seventh medication dosage |
|
0 = No medication; 999 = Missing
|
mdose7 |
|
|
route7 |
String |
50
|
Recommended |
route 7 |
|
|
|
| Query
|
med7rz |
Integer |
|
Recommended |
med 7 start days since randomization |
|
|
|
| Query
|
cont7 |
Integer |
|
Recommended |
drug 7 continued |
0;1;-7
|
0=No (discontinued); 1=Yes; -7=Refused
|
aetrtnum |
| Query
|
med7drz |
Integer |
|
Recommended |
med 7 discont days since randomization |
|
|
|
| Query
|
medcur8 |
String |
50
|
Recommended |
current medication 8 |
|
|
med8 |
| Query
|
medication_8_name |
String |
50
|
Recommended |
specify med 8 |
|
|
drug_name_8, medname8, medsp8 |
| Query
|
medication8_dosage |
String |
100
|
Recommended |
Eighth medication dosage |
|
0 = No medication; 999 = Missing
|
mdose8 |
| Query
|
route8 |
String |
50
|
Recommended |
route 8 |
|
|
|
| Query
|
med8rz |
Integer |
|
Recommended |
med 8 start days since randomization |
|
|
|
| Query
|
cont8 |
Integer |
|
Recommended |
drug 8 continued |
0;1;-7
|
0=No (discontinued); 1=Yes; -7=Refused
|
|
| Query
|
med8drz |
Integer |
|
Recommended |
med 8 discont days since randomization |
|
|
|
| Query
|
medcur9 |
String |
50
|
Recommended |
current medication 9 |
|
|
med9 |
| Query
|
medication_9_name |
String |
50
|
Recommended |
specify med 9 |
|
|
drug_name_9, medname9, medsp9 |
| Query
|
medication9_dosage |
String |
100
|
Recommended |
Ninth medication dosage |
|
|
mdose9 |
| Query
|
route9 |
String |
50
|
Recommended |
route 9 |
|
|
|
| Query
|
med9rz |
Integer |
|
Recommended |
med 9 start days since randomization |
|
|
|
| Query
|
cont9 |
Integer |
|
Recommended |
drug 9 continued |
0;1;-7
|
0=No (discontinued); 1=Yes; -7=Refused
|
|
| Query
|
med9drz |
Integer |
|
Recommended |
med 9 discont days since randomization |
|
|
|
| Query
|
medcur10 |
String |
50
|
Recommended |
current medication 10 |
|
|
med10 |
| Query
|
medication_10_name |
String |
500
|
Recommended |
specify med 10 |
|
|
medname10, medsp10 |
| Query
|
medication10_dosage |
String |
50
|
Recommended |
Tenth medication dosage |
|
|
mdose10 |
| Query
|
route10 |
String |
50
|
Recommended |
route 10 |
|
|
|
| Query
|
med10rz |
Integer |
|
Recommended |
med 10 start days since randomization |
|
|
|
| Query
|
cont10 |
Integer |
|
Recommended |
drug 10 continued |
0;1;-7
|
0=No (discontinued); 1=Yes; -7=Refused
|
|
| Query
|
med10drz |
Integer |
|
Recommended |
med 10 discont days since randomization |
|
|
|
| Query
|
medcur11 |
String |
50
|
Recommended |
current medication 11 |
|
|
med11 |
| Query
|
medication_11_name |
String |
250
|
Recommended |
Current medication 11 |
|
|
medname11, medsp11 |
| Query
|
medication11_dosage |
String |
100
|
Recommended |
medication 11 dosage |
|
|
mdose11 |
| Query
|
route11 |
String |
50
|
Recommended |
route 11 |
|
|
|
| Query
|
med11rz |
Integer |
|
Recommended |
med 11 start days since randomization |
|
|
|
| Query
|
cont11 |
Integer |
|
Recommended |
drug 11 continued |
0;1;-7
|
0=No (discontinued); 1=Yes; -7=Refused
|
|
| Query
|
med11drz |
Integer |
|
Recommended |
med 11 discont days since randomization |
|
|
|
| Query
|
medcur12 |
String |
50
|
Recommended |
current medication 12 |
|
|
med12 |
| Query
|
medication_12_name |
String |
50
|
Recommended |
Medication 12 name |
|
|
medname12, medsp12 |
| Query
|
medication12_dosage |
String |
100
|
Recommended |
medication 12 dosage |
|
|
mdose12 |
| Query
|
route12 |
String |
50
|
Recommended |
route 12 |
|
|
|
| Query
|
med12rz |
Integer |
|
Recommended |
med 12 start days since randomization |
|
|
|
| Query
|
cont12 |
Integer |
|
Recommended |
drug 12 continued |
0;1;-7
|
0=No (discontinued); 1=Yes; -7=Refused
|
|
| Query
|
med12drz |
Integer |
|
Recommended |
med 5 discont days since randomization |
|
|
|
| Query
|
site |
String |
101
|
Recommended |
Site |
|
Study Site
|
cntr_site_x, site_no, site_uid, siteid |
| Query
|
visit |
String |
60
|
Recommended |
Visit name |
|
e.g., Baseline, 6-Month Follow Up, Year 2, Daily
|
cntr_interval, int1, interval, timept, visit_name |
|
|
dsmvers |
String |
10
|
Recommended |
version/name of assessment |
|
|
form_name |
|
|
date_updated |
Date |
|
Recommended |
Date record updated |
|
|
edit_date |
|
|
session_id |
String |
20
|
Recommended |
session ID/screening ID |
|
|
screeningid, session |
| Query
|
completed |
Integer |
|
Recommended |
Checks if completed |
-1::3
|
0=No; 1=Yes; 2=Yes, lost; 3=Unverified; -1= Not applicable
|
cntr_frmcomp, formcomp, frmcomp, tststfld |
| Query
|
conmedno |
Integer |
|
Recommended |
Check if NO concomitant medications were used |
0;1
|
0=No; 1=Yes
|
cntr_nomeds, meds01, nomeds |
|
|
medication_name |
String |
255
|
Recommended |
Name of medication |
|
|
cmd002, cmname, cntr_meds, desc, drug, drug_d, gdrug, med, medication, meds |
|
|
ddose |
String |
50
|
Recommended |
daily dose |
|
-9=unknown
|
cmd006, cmdose, cntr_dose, cntr_units, dosage, dose_d |
| Query
|
cmunit |
Integer |
|
Recommended |
Units |
|
1 = micrograms (mkg); 2 = milligrams (mg); 3 = grams (g); 4 = tablet(s); 5 = capsule(s); 6 = gtt; 7 = meq; 8 = international units (IU); 9 = units (U); 10=Percent (%); 11=Compount/more than one medicine combind; 12=Grains (gr); 13=mg/kg; 99 = Other (specify); 14 = ml; 15 = mg/mL; 16 = mcg/mL; 17 = tbls; 18 = 3tts; 19 = cc; 20 = ss; 21 = puff; 22 = spray/squirt; 23 = suppository; 24 = teaspoon; 25 = uL; 26 = unknown; 27 = oz;28=millicurie; 29=microcurie
|
cmd007, units |
|
|
cmunito |
String |
200
|
Recommended |
Unit other specify |
|
|
cmd007a, cmunitn, cmunitsp, unit, unit_d |
| Query
|
cmroute |
Integer |
|
Recommended |
Route |
|
1 = oral; 2 = intravenous; 3 = subcutaneous; 4 = topical; 5 = inhalation; 6 = transdermal; 7 = rectal; 8 = intramuscular; 9 = sublingual; 10 = PEG; 99 = Other (specify); 999 =unknown; 11=oral/intramuscular; 12 = Nasal; 13 = Vaginal; 14 = Auricular; 15 = Intra-articular; 16 = Intraocular; 17 = Depot
|
cmd005, cntr_route, concommeds_1_route, route, route_1 |
|
|
cmrouto |
String |
200
|
Recommended |
Route other specify |
|
|
cmd005a, cmrte, cmrtspec, route |
| Query
|
cmfreq |
Integer |
|
Recommended |
Frequency |
|
1 = QD; 2 = BID; 3 = TID; 4 = QID; 5 = QHS; 6 = CONT IV; 7 = PRN; 8=Q4H; 9=Q6H; 10=Q8H; 11=Q12H; 12=BIS; 13=QS; 14=QM; 15=U; 99 = Other (specify); 16=QOD; 17=qam; 18=qw; 19=q30m; 20=q1h; 21=q5h; 22=biw; 23=qpm; 24=q15m; 25=q3h; 26 = q6pm; 27=tiw; 28 = ac; 29 = q2h;30=once; 31=Unknown
|
cmd008, cntr_freq, concommeds_1_freq, freq |
|
|
cmfreqo |
String |
200
|
Recommended |
Frequency other specify |
|
|
cmd008a, cmfreqn, cmfrqspe, con_meds_freq_1, freq |
|
|
cmind |
String |
200
|
Recommended |
Indication |
|
|
cmd003, cntr_indicate, cntr_purpose, concommeds_1_purpose, indicate, indication |
|
|
cmstrtdt |
Date |
|
Recommended |
Start Date |
|
|
cmd009, cmedstdt, concommeds_1_startdate, start_date_1 |
| Query
|
cmcont |
Integer |
|
Recommended |
Continuing at end of study? |
1;2
|
1=Yes; 2=No
|
cmcontn, cntr_contmed, conconmeds_1_cont |
|
|
cmstpdt |
Date |
|
Recommended |
Stop Date |
|
|
cmd010a, cmd011, cmedspdt, concommeds_1_enddate, end_date_1 |
| Query
|
cmae |
Integer |
|
Recommended |
Was this for treatment of an AE |
|
1=Yes; 2=No; -9=Unknown
|
cmd004, cmtae, con_med_for_ae_1 |
|
|
cmaeid |
String |
100
|
Recommended |
If Yes, Specify Adverse Event (Use AE Identifier) |
|
-9=Unknown
|
cmd004a, conc_med_indication_1 |
| Query
|
cmf_allergy |
Integer |
|
Recommended |
Allergy/asthma medication |
1::3
|
1=no medication; 2=taken less than 50% of the weeks in the study; 3=taken 50% or more of weeks in the study
|
|
| Query
|
cmf_sleep |
Integer |
|
Recommended |
Sleep medication |
1::3
|
1=no medication; 2=taken less than 50% of the weeks in the study; 3=taken 50% or more of weeks in the study
|
|
| Query
|
cmf_vitamin |
Integer |
|
Recommended |
Vitamins |
1::3
|
1=no medication; 2=taken less than 50% of the weeks in the study; 3=taken 50% or more of weeks in the study
|
|
| Query
|
cmf_gi |
Integer |
|
Recommended |
GI medication |
1::3
|
1=no medication; 2=taken less than 50% of the weeks in the study; 3=taken 50% or more of weeks in the study
|
|
| Query
|
cmf_bc |
Integer |
|
Recommended |
Birth control |
1::3
|
1=no medication; 2=taken less than 50% of the weeks in the study; 3=taken 50% or more of weeks in the study
|
|
| Query
|
cmf_enuresis |
Integer |
|
Recommended |
Enuresis medication |
1::3
|
1=no medication; 2=taken less than 50% of the weeks in the study; 3=taken 50% or more of weeks in the study
|
|
| Query
|
cmf_corticosteroid |
Integer |
|
Recommended |
Corticosteroid medication |
1::3
|
1=no medication; 2=taken less than 50% of the weeks in the study; 3=taken 50% or more of weeks in the study
|
|
| Query
|
cmd001 |
Integer |
|
Recommended |
Medication number |
|
-9=Unknown
|
|
| Query
|
cmd010 |
Integer |
|
Recommended |
Continuing? (If No, complete Q11. If Yes, end questionnaire.) |
0;1; -9
|
0=No; 1=Yes; -9=Unknown
|
contmed |
|
|
cmd24001 |
String |
50
|
Recommended |
Last 24 hours: Medication name (use generic name) |
|
|
|
|
|
cmd24002 |
String |
150
|
Recommended |
Last 24 hours: Purpose/indication |
|
|
purpose |
| Query
|
cmd24003 |
Float |
|
Recommended |
Last 24 hours: Strength/Dosage |
|
|
|
| Query
|
cmd24004 |
Integer |
|
Recommended |
Last 24 hours: Units |
1::7
|
1=Capsule/tablet; 2=Milligram; 3=Gram; 4=Cubic cm/mL; 5=Grains; 6=Ounce; 7=Other (specify below);
|
|
|
|
cmd24004a |
String |
30
|
Recommended |
Last 24 hours: If "Other", specify units |
|
|
|
|
|
cmd24005 |
Date |
|
Recommended |
Last 24 hours: When was the medication taken? (mm/dd/yyyy) |
|
|
|
|
|
cmd24006 |
String |
20
|
Recommended |
Last 24 hours: What time was the last medication taken? (hh:mm, 24-hour clock; enter 55:55 if unknown) |
|
|
|
|
|
study |
String |
100
|
Recommended |
Study; The code for each individual study |
|
e.g., the name of the study in multi-grant collections
|
cntr_studyid, studyid |
| Query
|
subtrial_name |
Integer |
|
Recommended |
Name of subtrial |
1::3
|
1=Crossover; 2=Guanfacine; 3= Open Label MPH
|
|
| Query
|
aef001 |
Integer |
|
Recommended |
Adverse Event number |
|
-9=unknown
|
cmaenum, ctaenum |
| Query
|
pmtot |
Integer |
|
Recommended |
Total pages |
|
|
cmtot |
| Query
|
cmany |
Integer |
|
Recommended |
Did subject receive any medication |
0;1
|
0=No; 1=Yes
|
|
| Query
|
pmmednum |
Integer |
|
Recommended |
Medication/treatment number |
|
|
mednum |
| Query
|
pmstdt |
Integer |
|
Recommended |
Date medication/treatment began in days from the randomization date |
|
|
cmstdt, dateadd, daystart, daystart_d |
| Query
|
pmstop |
Integer |
|
Recommended |
Date medication/treatment stopped in days from the randomization date |
|
|
cmstop, datedisc, dayend, dayend_d |
| Query
|
meds05a |
Integer |
|
Recommended |
Unknown |
1;0
|
1=Yes; 0=No
|
|
| Query
|
meds06a |
Integer |
|
Recommended |
Ongoing |
|
1=Yes; 0=No
|
cmedongo |
| Query
|
anyopsyc |
Integer |
|
Recommended |
Any Conventional Antipsych in OC Phase |
1
|
1=Yes; missing=otherwise
|
|
| Query
|
anychol |
Integer |
|
Recommended |
Any Cholinesterase Inhibitor at Baseline |
1
|
1=Yes; missing=otherwise; indicated med taken at baseline or within 14 days prior to baseline
|
|
| Query
|
anynchol |
Integer |
|
Recommended |
Any New Cholinest Inhibitor Since Baseline |
1
|
1=Yes; missing=otherwise; medication added post-baseline
|
|
| Query
|
anydpap |
Integer |
|
Recommended |
Any Antidepressant or Antipsych at BL |
1
|
1=Yes; missing=otherwise; indicated med taken at baseline or within 14 days prior to baseline
|
|
| Query
|
anyndpap |
Integer |
|
Recommended |
Any New Antidepressant or Antipsych Since BL |
1
|
1=Yes; missing=otherwise; medication added post-baseline
|
|
| Query
|
anyhyper |
Integer |
|
Recommended |
Any Anti-Hypertensive Medications at BL |
1
|
1=Yes; missing=otherwise; indicated med taken at baseline or within 14 days prior to baseline
|
|
| Query
|
anynhype |
Integer |
|
Recommended |
Any New Anti- Hypertensive Med Since BL |
1
|
1=Yes; missing=otherwise; medication added post-baseline
|
|
| Query
|
anygastr |
Integer |
|
Recommended |
Any Gastrointestinal Medication at BL |
1
|
1=Yes; missing=otherwise; indicated med taken at baseline or within 14 days prior to baseline
|
|
| Query
|
anyngast |
Integer |
|
Recommended |
Any New Gastrointestinal Med at BL |
1
|
1=Yes; missing=otherwise; medication added post-baseline
|
|
| Query
|
anyopsy |
Integer |
|
Recommended |
Any Psychotropic Med in OC Phase |
1
|
1=Yes; missing=otherwise
|
|
| Query
|
n_omed |
Integer |
|
Recommended |
# of med taken per patient in OC Phase |
|
Number of medications taken
|
|
| Query
|
n_psyoc |
Integer |
|
Recommended |
Number of Psychotropic meds taken in OC |
|
Number of medications taken
|
|
| Query
|
b1_day |
Integer |
|
Recommended |
Baseline Day - Phase 1/1A |
|
Number of days from study baseline to first day of the phase Based on visit dates
|
|
| Query
|
boc_day |
Integer |
|
Recommended |
Baseline Visit Day- Open Choice Phase |
|
Number of days from study baseline to start date of phase
|
|
| Query
|
es_day |
Integer |
|
Recommended |
Day Discontinued from Study |
|
Number of days from study baseline to date of study discontinuation (excluding follow-up phase) Based on visit dates
|
|
| Query
|
visitid |
Integer |
|
Recommended |
MetaTrial Visit ID |
|
System variable: unique code for each type of visit -use to merge files
|
|
| Query
|
visitnum |
Integer |
|
Recommended |
Visit number |
|
|
|
| Query
|
ocflag |
Integer |
|
Recommended |
Medication Taken During OC Phase Flag |
0;1
|
0=No; 1=Yes
|
|
| Query
|
anyopsya |
Integer |
|
Recommended |
Medication Taken During OC Phase Flag |
0;1
|
0=No; 1=Yes
|
|
| Query
|
visday |
Integer |
|
Recommended |
Number of days from study baseline to date of visit |
|
|
cntr_visitdat_x, daycml, dayctl_d |
| Query
|
page |
Integer |
|
Recommended |
Page of form |
|
|
page_d |
| Query
|
slot |
Integer |
|
Recommended |
Slot on Concomitant Medication Log form |
|
|
slot_d |
|
|
compound |
String |
100
|
Recommended |
Generic name of compound |
|
|
compound_d |
|
|
extra |
String |
100
|
Recommended |
Additional compounds in Concomitant Medication |
|
|
extra_d |
| Query
|
drugcont |
Integer |
|
Recommended |
Is Concomitant Medication still being used? |
0;1
|
0 = No;1 = Yes
|
cont, cont_d |
|
|
medcon |
String |
100
|
Recommended |
Medical Condition for which Concomitant Medication was taken |
|
|
integer, medcon_d |
| Query
|
days |
Integer |
|
Recommended |
Number of Days at Current Dose |
0::9999
|
|
|
| Query
|
med_sequence |
Integer |
|
Recommended |
Med Sequence number |
|
|
|
| Query
|
week |
Float |
|
Recommended |
Week in level/study |
|
99=week 10-week 14
|
intid, week1 |
| Query
|
vis_type |
Integer |
|
Recommended |
Visit type |
0::2
|
1=Phone/remote; 0=doctor's office/In person; 2=No, not phone interview
|
phone |
| Query
|
cntr_othrtrt |
Integer |
|
Recommended |
Received any treatments other than medic |
1;2
|
1=Yes;2=No
|
othrtrt |
| Query
|
cntr_conttrt |
Integer |
|
Recommended |
Continue Other Treatment |
1;2
|
1=Yes;2=No
|
conttrt |
| Query
|
cntr_adddat_x |
Integer |
|
Recommended |
Day Medication Added |
|
|
|
|
|
treatment_name |
String |
200
|
Recommended |
treatment name |
|
e.g., Control, Intervention, Experimental, Placebo
|
cntr_treatmnt, treatmnt |
| Query
|
med1drz |
Integer |
|
Recommended |
med 1 discontinued days since randomization |
|
|
cntr_discdat_x |
| Query
|
trtgroup |
String |
2
|
Recommended |
Treatment Group |
N1;N2;R1;R2;R3
|
N1=Non-Responder Entering Fluvoxamine; N2=Non-Responder Entering Fluoxetine; R1=Maintenance; R2=Responder Entering Fluvoxamine; R3=Responder Entering Fluoxetine
|
|
| Query
|
study_id |
Integer |
|
Recommended |
Study ID number |
|
46=Acute Phase; 47=Stabilization Phase
|
|
| Query
|
hi_31a5 |
Integer |
|
Recommended |
Medication 1 days from baseline started |
|
|
startdays |
| Query
|
hi_31a6 |
Integer |
|
Recommended |
Medication 1 days from baseline stopped |
|
|
stopdays |
| Query
|
ci_enrolled |
Integer |
|
Recommended |
Participant enrolled |
0;1
|
0=No; 1=Yes
|
|
|
|
comments |
String |
4,000
|
Recommended |
Comments about assessment |
|
|
conmeds_comment, efirstlan, notes |
| Query
|
lineno |
Integer |
|
Recommended |
Line number (lines per participant) |
0::150
|
|
concommeds_1_code |
| Query
|
aescode |
Integer |
|
Recommended |
Staff code number of person completing this form |
|
999= Missing Data
|
con_collected_by_1, rater |
| Query
|
medication1_weeks |
Float |
|
Recommended |
Total weeks of medication 1 |
|
|
|
| Query
|
days_baseline |
Integer |
|
Recommended |
Days since baseline |
|
|
|
| Query
|
visnum |
Float |
|
Recommended |
Numeric Visit Number |
|
-1.5 = Pre-Screening; -1 = Screening; 0 = Baseline; ## = Visit ## (from 1 to 10); Whole numbers = standard monthly visits; #.001 - #.009 = Unscheduled; #.1 = End of Phase 1; #.2 = End of Phase 2; #.3 = End of Phase 3; #.4 = End of Open Choice Phase; #.5 = End of Study; #.6 = Genetic Analysis; 1000=all visits
|
|
| Query
|
me2 |
Integer |
|
Recommended |
Status |
0;1
|
0 = Past [Inactive]; 1 = Active
|
|
| Query
|
anymeds |
Integer |
|
Recommended |
Has the subject taken any medications 30 days/1 month prior to or during this study OR taken any antipsychotics at any time? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
adhgen1 |
String |
50
|
Recommended |
Generic name of medication name provided |
|
|
concommeds_1_name |
|
|
med_class |
String |
50
|
Recommended |
Medication class for the prescription |
|
|
|
|
|
dode |
String |
10
|
Recommended |
Date of Data Entry |
|
|
date_of_entry |
|
|
other_reason_nc |
String |
100
|
Recommended |
Other reason form was not completed |
|
|
if_not_please_specify |
| Query
|
anymedhist |
Integer |
|
Recommended |
No Medication History |
1;2
|
1= Yes; 2= No
|
if_subject_had_no_medications_enter_1_here |
| Query
|
months1 |
Float |
|
Recommended |
Number of months on this medication |
|
0 = No medication; 9999=NK
|
_concommeds_1_notspec, concommeds_1_mos |
| Query
|
t1wk |
Integer |
|
Recommended |
Weeks since Treatment Session 1 |
|
|
|
| Query
|
concommeds_1_source |
Integer |
|
Recommended |
Source of Information |
1::10;99
|
1=Subject; 2=Health Professional; 3=Chart/Medical Record; 4=Family/friends/associate; ; 5 = Prescribing Physician; 6 = Therapist; 7 = Pharmacy; 9=Other; 99=Unknown; 10 = Research staff
|
|
|
|
medname1 |
String |
50
|
Recommended |
Medication Name 1 |
|
|
drug_name_1 |
|
|
medname2 |
String |
50
|
Recommended |
Medication Name 2 |
|
|
drug_name_2 |
|
|
medname3 |
String |
50
|
Recommended |
Medication Name 3 |
|
|
drug_name_3 |
|
|
medname4 |
String |
50
|
Recommended |
Medication Name 4 |
|
|
drug_name_4 |
|
|
medname13 |
String |
50
|
Recommended |
Medication Name 13 |
|
|
|
|
|
medname14 |
String |
50
|
Recommended |
Medication Name 14 |
|
|
|
|
|
medname15 |
String |
50
|
Recommended |
Medication Name 15 |
|
|
|
|
|
medname16 |
String |
50
|
Recommended |
Medication Name 16 |
|
|
|
|
|
medname17 |
String |
50
|
Recommended |
Medication Name 17 |
|
|
|
|
|
medname18 |
String |
50
|
Recommended |
Medication Name 18 |
|
|
|
|
|
medname19 |
String |
50
|
Recommended |
Medication Name 19 |
|
|
|
|
|
medname20 |
String |
50
|
Recommended |
Medication Name 20 |
|
|
|
| Query
|
acet |
Integer |
|
Recommended |
Acetaminophen/Paracetamol |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
antihist |
Integer |
|
Recommended |
2nd generation antihistamine (loratadine, fexofenadine, certirizine, etc.) |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
aspirin |
Integer |
|
Recommended |
Aspirin |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
calcium |
Integer |
|
Recommended |
Calcium (alone or with Vitamin D) |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
diphen |
Integer |
|
Recommended |
Diphenhydramine |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
fishoil |
Integer |
|
Recommended |
Fish oil/Omega-3 |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
gingko |
Integer |
|
Recommended |
Gingko biloba |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
glucosa |
Integer |
|
Recommended |
Glucosamine |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
h2blocker |
Integer |
|
Recommended |
H2 blocker (cimetidine, famotidine, ranitidine) |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
iron |
Integer |
|
Recommended |
Iron supplement |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
melatonin |
Integer |
|
Recommended |
Melatonin |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
multiv |
Integer |
|
Recommended |
Multivitamin |
0;1;8;9
|
0= Unchecked/No; 1= Checked/Yes; 8= NA; 9= Missing
|
|
| Query
|
nicotine |
Integer |
|
Recommended |
Does the child use nicotine |
0;1;9
|
1 = Yes; 0 = No; 9 = Unknown
|
|
| Query
|
nsaids |
Integer |
|
Recommended |
Used nonprescription NSAIDS (e.g., Aspirin, Ibuprofen) for joint pain or arthritis more than half the days of the month, past 30 days |
0;1
|
0=No; 1=Yes
|
|
| Query
|
ppinhib |
Integer |
|
Recommended |
Proton pump inhibitor (omeprazole, pantoprazole, lansoprazole, etc) |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
vitb12 |
Integer |
|
Recommended |
Vitamin B12 (alone or with other B vitamins) |
0;1
|
0= Unchecked; 1= Checked
|
|
| Query
|
vitc |
Integer |
|
Recommended |
Vitamin C |
0;1;8;9
|
0= Unchecked/No; 1= Checked/Yes; 8= NA; 9= Missing
|
|
| Query
|
vitd |
Integer |
|
Recommended |
Vitamin D (alone or with calcium) |
0;1;8;9
|
0= Unchecked/No; 1= Checked/Yes; 8= NA; 9= Missing
|
|
| Query
|
prscrptns |
Integer |
|
Recommended |
For prescriptions that you took in the last two weeks, did you bring all the prescription medications or a list of the prescription medications from your pharmacy or physician? |
0::2
|
0= No I did not bring them; 1= Yes I brought them; 2= I didn't take any medications
|
|
|
|
lab020 |
Date |
|
Recommended |
Date of PI/clinician signature |
|
|
date_con_review_inves_1 |
|
|
validity |
String |
13
|
Recommended |
Validity rating |
Yes;No;Questionnable
|
|
|
|
|
resp_source |
Integer |
|
Recommended |
Respondent Source |
1::6
|
1= subject; 2= parent; 3= clinician; 4= teacher; 5= trainer; 6= fidelity reviewer
|
source |
|
|
totalmthantipsychmed |
Integer |
|
Recommended |
Total Months on Anti-Psychotic Medication |
|
|
|
|
|
totalmthmoodstable |
Integer |
|
Recommended |
Total Months on Mood Stabilizers |
|
|
|
|
|
lifetimeantipsychprovided |
Integer |
|
Recommended |
Was information on lifetime antipsychotic medication provided? |
1;2
|
1= Yes; 2= No
|
|
|
|
lifetimeantipsychcalc |
Date |
|
Recommended |
Date lifetime antipsychotic medication exposure calculated |
|
|
|
|
|
lifetimeantipsychmg |
Integer |
|
Recommended |
Lifetime Total Exposure to antipsychotic medication (mg) |
|
|
|
|
|
prevlifemedhist |
Float |
|
Recommended |
Lifetime Total Exposure |
|
Total Lifetime Exposure Measure of Anti-Psychiatric Drugs, measured in grams
|
|
|
|
lifetimeantipsychcomments |
String |
500
|
Recommended |
Additional Comments on lifetime antipsychotic medication |
|
|
|
|
|
concommeds_1_source_oth |
String |
500
|
Recommended |
Specify other source of information on medication |
|
|
|
|
|
cmtype |
Integer |
|
Recommended |
Drug classification: |
1::9
|
1 = Antipsychotic; 2 = Antidepressant; 3 = Mood Stabilizer; 4 = Benzodiazepine; 5 = Sedative; 6 = Stimulant; 7 = Anticholinergic; 8 = ECT Therapy; 9 = Other
|
|
|
|
cmtype_oth |
String |
250
|
Recommended |
Please specify the other drug classification: |
|
|
|
|
|
cmtotaldose |
Float |
|
Recommended |
Total daily dose: |
0.00::9999.99
|
|
|
|
|
custom_src_id |
String |
30
|
Recommended |
Subject ID how it's defined in lab/project (used for source IDs that change depending on timepoint/visit/etc.) |
|
|
|
|
|
who_groupcode |
String |
10
|
Recommended |
Group code from WHO dictionary. Coded centrally. |
|
|
|
|
|
who_grouptext |
String |
100
|
Recommended |
Group text description from WHO dictionary. Coded centrally. |
|
|
|
|
|
dose |
Float |
|
Recommended |
Prescribed Dose in Phase (mg) |
|
|
|
|
|
prn_frequency |
Float |
|
Recommended |
If PRN, average frequency |
|
Times per month
|
|
|
|
startdate |
Date |
|
Recommended |
Date intervention started MM/DD/YYYY |
|
For interventions prior to the study, days and months may be missing.
|
|
|
|
stopdate |
Date |
|
Recommended |
Date intervention stopped MM/DD/YYYY |
|
For interventions prior to the study, days and months may be missing.
|
|
|
|
start_year |
Integer |
|
Recommended |
Date medication started (YYYY) |
|
Can be used instead of startdate
|
|
|
|
stop_year |
Integer |
|
Recommended |
Date medication stopped (YYYY) |
|
Can be used instead of stopdate
|
|
|
|
who_atccode |
String |
10
|
Recommended |
ATC code from WHO dictionary. Coded centrally. |
|
|
|
|
|
start_month |
String |
2
|
Recommended |
Date medication started (MM) |
01;02;03;04;05;06;07;08;09;10;11;12
|
Can be used instead of startdate
|
|
|
|
stop_month |
String |
2
|
Recommended |
Date medication stopped (MM) |
01;02;03;04;05;06;07;08;09;10;11;12
|
Can be used instead of startdate
|
|
|
|
frequency1_cm |
Integer |
|
Recommended |
Medication 1 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
taking_another_med2_cm |
Integer |
|
Recommended |
Are you taking another medication? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
stdate2 |
String |
20
|
Recommended |
Medication start date 2 |
|
mm/dd/yyyy or write out month year
|
|
|
|
spdate2 |
String |
20
|
Recommended |
Medication stop date 2 |
|
mm/dd/yyyy or write out month year
|
|
|
|
indication_med2_cm |
String |
1,000
|
Recommended |
Medication 2 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
medication2_dosage |
String |
100
|
Recommended |
Second medication dosage |
|
0 = No medication; 999 = Missing
|
|
|
|
units2_cm |
Integer |
|
Recommended |
Medication 2 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
route2_cm |
Integer |
|
Recommended |
Medication 2 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
frequency2_cm |
Integer |
|
Recommended |
Medication 2 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
taking_another_med3_cm |
Integer |
|
Recommended |
Are you taking another medication? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
stdate3 |
String |
20
|
Recommended |
Medication start date 3 |
|
mm/dd/yyyy or write out month year
|
|
|
|
spdate3 |
String |
20
|
Recommended |
Medication stop date 3 |
|
mm/dd/yyyy or write out month year
|
|
|
|
indication_med3_cm |
String |
1,000
|
Recommended |
Medication 3 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
medication3_dosage |
String |
100
|
Recommended |
Third medication dosage |
|
0 = No medication; 999 = Missing
|
|
|
|
units3_cm |
Integer |
|
Recommended |
Medication 3 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
route3_cm |
Integer |
|
Recommended |
Medication 3 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
frequency3_cm |
Integer |
|
Recommended |
Medication 3 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
taking_another_med4_cm |
Integer |
|
Recommended |
Are you taking another medication? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
stdate4 |
String |
20
|
Recommended |
Medication start date 4 |
|
mm/dd/yyyy or write out month year
|
|
|
|
spdate4 |
String |
20
|
Recommended |
Medication stop date 4 |
|
mm/dd/yyyy or write out month year
|
|
|
|
taking_any_meds1_cm |
Integer |
|
Recommended |
Are you taking any medications/supplements/treatments? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
indication_med4_cm |
String |
1,000
|
Recommended |
Medication 4 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
medication4_dosage |
String |
100
|
Recommended |
Fourth medication dosage |
|
0 = No medication; 999 = Missing
|
|
|
|
units4_cm |
Integer |
|
Recommended |
Medication 4 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
route4_cm |
Integer |
|
Recommended |
Medication 4 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
frequency4_cm |
Integer |
|
Recommended |
Medication 4 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
taking_another_med5_cm |
Integer |
|
Recommended |
Are you taking another medication? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
stdate5 |
String |
20
|
Recommended |
Medication start date 5 |
|
mm/dd/yyyy or write out month year
|
|
|
|
spdate5 |
String |
20
|
Recommended |
Medication stop date 5 |
|
mm/dd/yyyy or write out month year
|
|
|
|
indication_med5_cm |
String |
1,000
|
Recommended |
Medication 5 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
units5_cm |
Integer |
|
Recommended |
Medication 5 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
stdate1 |
String |
20
|
Recommended |
Medication start date 1 |
|
mm/dd/yyyy or write out month year
|
|
|
|
route5_cm |
Integer |
|
Recommended |
Medication 5 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
frequency5_cm |
Integer |
|
Recommended |
Medication 5 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
taking_another_med6_cm |
Integer |
|
Recommended |
Are you taking another medication? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
stdate6 |
String |
20
|
Recommended |
Medication start date 6 |
|
mm/dd/yyyy or write out month year
|
|
|
|
spdate6 |
String |
20
|
Recommended |
Medication stop date 6 |
|
mm/dd/yyyy or write out month year
|
|
|
|
indication_med6_cm |
String |
1,000
|
Recommended |
Medication 6 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
units6_cm |
Integer |
|
Recommended |
Medication 6 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
route6_cm |
Integer |
|
Recommended |
Medication 6 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
frequency6_cm |
Integer |
|
Recommended |
Medication 6 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
taking_another_med7_cm |
Integer |
|
Recommended |
Are you taking another medication? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
spdate1 |
String |
20
|
Recommended |
Medication stop date 1 |
|
mm/dd/yyyy or write out month year
|
|
|
|
stdate7 |
String |
20
|
Recommended |
Medication start date 7 |
|
mm/dd/yyyy or write out month year
|
|
|
|
spdate7 |
String |
20
|
Recommended |
Medication stop date 7 |
|
mm/dd/yyyy or write out month year
|
|
|
|
indication_med7_cm |
String |
1,000
|
Recommended |
Medication 7 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
units7_cm |
Integer |
|
Recommended |
Medication 7 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
route7_cm |
Integer |
|
Recommended |
Medication 7 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
frequency7_cm |
Integer |
|
Recommended |
Medication 7 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
taking_another_med8_cm |
Integer |
|
Recommended |
Are you taking another medication? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
stdate8 |
String |
20
|
Recommended |
Medication start date 8 |
|
mm/dd/yyyy or write out month year
|
|
|
|
spdate8 |
String |
20
|
Recommended |
Medication stop date 8 |
|
mm/dd/yyyy or write out month year
|
|
|
|
indication_med8_cm |
String |
1,000
|
Recommended |
Medication 8 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
indication_med1_cm |
String |
1,000
|
Recommended |
Medication 1 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
units8_cm |
Integer |
|
Recommended |
Medication 8 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
route8_cm |
Integer |
|
Recommended |
Medication 8 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
frequency8_cm |
Integer |
|
Recommended |
Medication 8 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
taking_another_med9_cm |
Integer |
|
Recommended |
Are you taking another medication? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
start_date_of_med9_cm |
Date |
|
Recommended |
Start Date of Medication 9 |
|
MM/DD/YYYY
|
|
|
|
stop_date_of_med9_cm |
Date |
|
Recommended |
Stop Date of Medication 9 |
|
MM/DD/YYYY
|
|
|
|
indication_med9_cm |
String |
1,000
|
Recommended |
Medication 9 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
units9_cm |
Integer |
|
Recommended |
Medication 9 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
route9_cm |
Integer |
|
Recommended |
Medication 9 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
frequency9_cm |
Integer |
|
Recommended |
Medication 9 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
medication1_dosage |
String |
150
|
Recommended |
First medication dosage |
|
0 = No medication; 999 = Missing
|
|
|
|
taking_another_med10_cm |
Integer |
|
Recommended |
Are you taking another medication? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
start_date_of_med10_cm |
Date |
|
Recommended |
Start Date of Medication 10 |
|
MM/DD/YYYY
|
|
|
|
stop_date_of_med10_cm |
Date |
|
Recommended |
Stop Date of Medication 10 |
|
MM/DD/YYYY
|
|
|
|
indication_med10_cm |
String |
1,000
|
Recommended |
Medication 10 Indication (Why are you taking this medication/supplement/treatment?) |
|
|
|
|
|
units10_cm |
Integer |
|
Recommended |
Medication 10 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
route10_cm |
Integer |
|
Recommended |
Medication 10 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
frequency10_cm |
Integer |
|
Recommended |
Medication 10 Frequency (How often do you take this medication/treatment/supplement?) |
1::9
|
1 = Once daily; 2 = Twice daily; 3 = Three times daily; 4 = Four times daily; 5 = Weekly; 6 = Monthly; 7 = Every other day; 8 = Every three months; 9 = As needed
|
|
|
|
units1_cm |
Integer |
|
Recommended |
Medication 1 Units |
0::14
|
0 = mg; 1 = tablet; 2 = mcg; 3 = ml; 4 = g; 5 = IU; 6 = Injection; 7 = Puff; 8 = %; 9 = Capsule; 10 = IUD; 11 = Tablespoon; 12 = Spray; 13 = Piece; 14 = Drop
|
|
|
|
route1_cm |
Integer |
|
Recommended |
Medication 1 Route |
0::12
|
1 = Oral; 2 = Intravenous; 3 = Subcutaneous; 4 = Intramuscular; 5 = Topical; 6 = Inhaled; 7 = Sublingual; 8 = Rectal; 9 = Eyedrops; 10 = Intra-articular; 11 = Nasal spray; 12 = Vaginal
|
|
|
|
primary_reason_other |
String |
100
|
Recommended |
If the primary reason for change is Other reason, please specify. |
|
|
|
|
|
secondary_reason_medchange |
Integer |
|
Recommended |
If there is a recommended change at today''s visit, what is the secondary reason for the change? |
1::7
|
1=Symptoms; 2=Side effects; 3=Planned dose titration; 4=Patient choice; 5=Drug availability; 6=Randomization; 7=Other reason
|
|
|
|
secondary_reason_sym |
Integer |
|
Recommended |
If the secondary reason for change is Symptoms, please specify how the symptoms changed. |
1::4
|
1=New; 2=Persistent; 3=Worsened; 4=Improved
|
|
|
|
secondary_reason_side |
Integer |
|
Recommended |
If the secondary reason for change is Side Effects, please specify how the side effects changed. |
1::4
|
1=New; 2=Persistent; 3=Worsened; 4=Improved
|
|
|
|
secondary_reason_other |
String |
100
|
Recommended |
If the secondary reason for change is Other reason, please specify. |
|
|
|
|
|
medcur1 |
String |
50
|
Recommended |
current medication 1 |
|
|
|
|
|
medcur2 |
String |
50
|
Recommended |
current medication 2 |
|
|
|
|
|
medcur3 |
String |
50
|
Recommended |
current medication 3 |
|
|
|
|
|
medcur4 |
String |
50
|
Recommended |
current medication 4 |
|
|
|
|
|
timepoint_label |
String |
50
|
Recommended |
Timepoint/visit label |
|
e.g., Baseline, 6-Month Follow Up, Year 2; Morning, At Bedtime
|
|
|
|
missed_doses |
Float |
|
Recommended |
What percent of total recommended doses were missed in the last week? |
0::100;999
|
Percent; 999=N/A
|
|
|
|
change_inmed |
Integer |
|
Recommended |
Is there a recommended change in medication at todays visit? |
0;1
|
0=No; 1=Yes
|
|
|
|
type_of_medchange |
Integer |
|
Recommended |
If there is a recommended change at today''s visit, what type of change? |
1::5
|
1=Medication Discontinued; 2=Dose Decreased; 3=Dose Increased; 4=New medication; 5=Started Randomized Medication
|
|
|
|
date_of_medchange |
Date |
|
Recommended |
If there is a recommended change at today''s visit, record date of change. |
|
MM/DD/YYYY
|
|
|
|
primary_reason_medchange |
Integer |
|
Recommended |
If there is a recommended change at today''s visit, what is the primary reason for the change? |
1::7
|
1=Symptoms; 2=Side effects; 3=Planned dose titration; 4=Patient choice; 5=Drug availability; 6=Randomization; 7=Other reason
|
|
|
|
primary_reason_sym |
Integer |
|
Recommended |
If the primary reason for change is Symptoms, please specify how the symptoms changed. |
1::4
|
1=New; 2=Persistent; 3=Worsened; 4=Improved
|
|
|
|
primary_reason_side |
Integer |
|
Recommended |
If the primary reason for change is Side Effects, please specify how the side effects changed. |
1::4
|
1=New; 2=Persistent; 3=Worsened; 4=Improved
|
|
|
|
prescribed_med_nr |
Integer |
|
Recommended |
Next, we would like to know if you have been prescribed any of the following common medications. The names and purposes are just examples of what and why someone might be prescribed something. Prefer not to say. |
0;1
|
0 = No/not selected; 1 = Yes/selected
|
|
|
|
prescribed_med_noalc |
Integer |
|
Recommended |
Has a doctor ever prescribed a medication for you and said not to take it with any alcoholic beverage? |
1;2;999
|
1 = Yes; 2 = No; 999 = Prefer not to say
|
|
|
|
prescribed_med_noalc_text |
String |
200
|
Recommended |
Has a doctor ever prescribed a medication for you and said not to take it with any alcoholic beverage?- Which medication was that? |
|
|
|
|
|
prescribed_med_sed |
Integer |
|
Recommended |
Next, we would like to know if you have been prescribed any of the following common medications. The names and purposes are just examples of what and why someone might be prescribed something. Category: Sedatives or Depressants. Examples: Xanax (alprazolam) Librium, Valium (diazepam); Flexeril; Roboxin; Soma; Ambien; Sonata; Lunesta. Usually given for: Anxiety, muscle relaxant, insomnia. |
0;1
|
0 = No/not selected; 1 = Yes/selected
|
|
|
|
prescribed_med_pain |
Integer |
|
Recommended |
Next, we would like to know if you have been prescribed any of the following common medications. The names and purposes are just examples of what and why someone might be prescribed something. Category: Pain Relievers. Examples: OxyContin; Vicodin; Norco; Oxycodone; Percocet; Codeine; Darvon; Dilaudid; Demerol. Usually given for: Pain relief. |
0;1
|
0 = No/not selected; 1 = Yes/selected
|
|
|
|
prescribed_med_stim |
Integer |
|
Recommended |
Next, we would like to know if you have been prescribed any of the following common medications. The names and purposes are just examples of what and why someone might be prescribed something. Category: Stimulants. Examples: Ritalin; Concerta; Adderall. Usually given for: Sleepiness, lethargy, ADHD. |
0;1
|
0 = No/not selected; 1 = Yes/selected
|
|
|
|
prescribed_med_bp |
Integer |
|
Recommended |
Next, we would like to know if you have been prescribed any of the following common medications. The names and purposes are just examples of what and why someone might be prescribed something. Category: High Blood Pressure. Examples: Lopressor; Norvasc; Accupril. Usually given for: High Blood Pressure. |
0;1
|
0 = No/not selected; 1 = Yes/selected
|
|
|
|
prescribed_med_diab |
Integer |
|
Recommended |
Next, we would like to know if you have been prescribed any of the following common medications. The names and purposes are just examples of what and why someone might be prescribed something. Category: Diabetes. Examples: Insulin; Glucophage (metformin). Usually given for: Diabetes. |
0;1
|
0 = No/not selected; 1 = Yes/selected
|
|
|
|
prescribed_med_antid |
Integer |
|
Recommended |
Next, we would like to know if you have been prescribed any of the following common medications. The names and purposes are just examples of what and why someone might be prescribed something. Category: Antidepressants. Examples: Vilazodone (Viibryd); Citalopram (Celexa); Sertraline (Zoloft); Fluoxetine (Prozac); Trazodone (Desyrel); Escitalopram (Lexapro); Paroxetine (Paxil, Paxil CR); Venlafaxine (Effexor, Effexor XR). Usually given for: Depression. |
0;1
|
0 = No/not selected; 1 = Yes/selected
|
|
|
|
prescribed_med_na |
Integer |
|
Recommended |
Next, we would like to know if you have been prescribed any of the following common medications. The names and purposes are just examples of what and why someone might be prescribed something. Category: None of the above. |
0;1
|
0 = No/not selected; 1 = Yes/selected
|
|