CDE Detailed Report
Subdomain Name: General Health History
CRF: Medical History
Displaying 1 - 50 of 117
CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
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C22651 | Medical history sensori-neural indicator | MedHistSensNrlInd | Indicator of whether the participant/subject has been affected by sensori-neural impairment | Indicator of whether the participant/subject has been affected by sensori-neural impairment | Sensori-neural impairment | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:25:24.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C10515 | Scoliosis diagnosis indicator | ScolDiagnosInd | The indicator of whether the participant/subject has been diagnosed with scoliosis | The indicator of whether the participant/subject has been diagnosed with scoliosis | Scoliosis | Yes;No;Unknown | History reported and/or confirmed in medical record;History NOT reported and NOT confirmed in medical record;History reported as unknown or could not be collected | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C52358 | Epilepsy type | EpilepsyTyp | Type of epilepsy | Type of epilepsy | Epilepsy type | Medically intractable;Well controlled | Medically intractable;Well controlled | Alphanumeric |
Choose one. |
Adult;Pediatric | Supplemental | 1.00 | 2017-01-12 11:32:55.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17474 | Cardiovascular history cardiac surgery indicator | CardioHistCardSurgInd | Indicator as to whether the participant/subject has had cardiac surgery or mechanical intervention | Indicator as to whether the participant/subject has had cardiac surgery or mechanical intervention | Cardiac surgery/mechanical intervention | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C22662 | Medical history recurrent lower respiratory tract infection indicator | MedHistRecLwRespTrInfInd | Indicator of whether the participant/subject has been diagnosed with recurrent lower respiratory tract infections | Indicator of whether the participant/subject has been diagnosed with recurrent lower respiratory tract infections | Recurrent lower respiratory tract infections | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:32:03.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C13520 | Dysphagia indicator | DysphagiaInd | Did the participant/subject have dysphagia (difficulty swallowing) identified at bedside assessment? The dysphagia screening should utilize a validated tool that incorporates a swallow assessment and an assessment of level of consciousness and neurological function | Did the participant/subject have dysphagia (difficulty swallowing) identified at bedside assessment? The dysphagia screening should utilize a validated tool that incorporates a swallow assessment and an assessment of level of consciousness and neurological functio | Dysphagia indicator | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
The dysphagia screening should utilize a validated tool that incorporates a swallow assessment and an assessment of level of consciousness and neurological function. |
Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17486 | Psychiatric history clinical depressive diagnosis indicator | PsychHistClinDepressDiagnosInd | Indicator as to whether the participant/subject had a depressive disorder diagnosis | Indicator as to whether the participant/subject had a depressive disorder diagnosis | Depressive disorder diagnosis | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C00328 | Prior traumatic injury type | PriorTraumInjryType | General location of traumatic injury, if evidence of prior traumatic injury | General location of traumatic injury, if evidence of prior traumatic injury | Prior traumatic injury type | Brain Injury;Spine Injury;Other Extracranial Injury | Brain Injury;Spine Injury;Other Extracranial Injury | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-19 21:21:51.533 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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C22673 | Medical history autism indicator | MedHistAutInd | Indicator of whether participant/subject has Autism | Indicator of whether participant/subject has Autism | Autism | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:40:25.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17464 | Cardiovascular history abnormal echocardiogram left ventricular hypertrophy indicator | CardioHistAbnrmlECGLVHInd | Indicator as to whether the participant/subject has or had an abnormal echocardiogram (ECG) specifically exhibiting left ventricular hypertrophy (LVH) | Indicator as to whether the participant/subject has or had an abnormal echocardiogram (EKG) specifically exhibiting left ventricular hypertrophy (LVH) | LVH | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C19769 | Medical history pulmonary aspiration diagnosis indicator | MedHistPlmnryAspirDiagInd | Indicator of history of aspiration | Indicator of history of aspiration | Pulmonary aspiration diagnosis indicator | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-05 00:00:00.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C22652 | Medical history recurrent ear infection indicator | MedHistReccEarInfInd | Indicator of whether the participant/subject has been affected by recurrent ear infections | Indicator of whether the participant/subject has been affected by recurrent ear infections | Recurrent ear infections | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:25:54.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C10516 | Scoliosis maximum spine curvature measurement | ScolMaxSpnCrvtrMsrmnt | The maximum curvature of the spine in degrees for a participant/subject who has been diagnosed with scoliosis | The maximum curvature of the spine in degrees for a participant/subject who has been diagnosed with scoliosi | Scoliosis maximum spine curvature measurement | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
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C17475 | Cardiovascular history cardiac surgery type | CardioHistCardSurgTyp | Type of cardiac surgery or mechanical intervention the participant/subject underwent | Type of cardiac surgery or mechanical intervention the participant/subject underwent | If yes, indicate type (choose all that apply) | Coronary artery bypass graft;Cardiac valve surgery, including non-open surgery;Pacemaker;Implantable cardiac defibrillator;Other, specify | Coronary artery bypass graft (CABG);Cardiac valve surgery, including non-open surgery (i.e. percutaneous valvuloplasty);Pacemaker;Implantable cardiac defibrillator;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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C00312 | Body system category | BodySysCat | Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems | Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body system | Body System | Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: | Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: | Alphanumeric |
Record the appropriate body system for each line of medical history. |
Review of Symptoms from Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf | Adult;Pediatric | Core | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2002895 | |||||||
C22663 | Medical history gastroesophageal reflux disease (GERD) indicator | MedHistGERDInd | Indicator of whether the participant/subject has/had gastroesophageal reflux disease | Indicator of whether the participant/subject has/had gastroesophageal reflux disease | Gastroesophageal reflux disease | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:33:08.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C14126 | Seizure classification type | SeizClassTyp | The type of seizures present by classification | The type of seizures present by classificatio | Seizure classification type | Generalized;Focal;Unclassified | Generalized;Focal;Unclassified seizures are considered unidentifiable due to lack of data and do not fit in to the aforementioned categories for Generalized and Focal Seizures | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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C17488 | Psychiatric history psychotic diagnosis type | PsychHistPsychoticDiagnosTyp | Type of psychotic disorder the participant/subject has been diagnosed with, if any | Type of psychotic disorder the participant/subject has been diagnosed with, if any | If yes, choose all disorders that apply | Schizophrenia;Bipolar disorder;Depression with psychotic features;Dementia with psychotic ideation;Other, specify | Schizophrenia;Bipolar disorder;Depression with psychotic features;Dementia with psychotic ideation;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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C05460 | Seizure indicator | SeizInd | Indicator of seizure activity | Indicator of seizure activity | Seizures/Epilepsy | Yes;No;Suspected;Unknown | Yes;No;Suspected;Unknown | Alphanumeric | McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24(2):287–293. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. 1999;66(1):26–31. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C22674 | Medical history obsessive compulsive disorder indicator | MedHistOCDInd | Indicator of whether participant/subject has Obsessive Compulsive Disorder (OCD) | Indicator of whether participant/subject has Obsessive Compulsive Disorder (OCD) | Obsessive Compulsive Disorder (OCD) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:40:50.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17465 | Cardiovascular history abnormal echocardiogram other text | CardioHistAbnrmlECGOtherTxt | Text description of any abnormal characteristics other than left ventricular hypertrophy (LVH), or decreased left ventricular (LV) function that the participant/subject has ever exhibited on an echocardiogram (ECG) | Text description of any abnormal characteristics other than left ventricular hypertrophy (LVH), or decreased left ventricular (LV) function that the participant/subject has ever exhibited on an echocardiogram (EKG) | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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C19835 | Pain indicator | PainInd | Indicator of pain present | Indicator of pain present | Pain indicator | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-05 00:00:00.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C22653 | Medical history respiratory support indicator | MedHistRespSuppInd | Indicator of whether the participant/subject utilizes respiratory support/ventilation assist | Indicator of whether the participant/subject utilizes respiratory support/ventilation assist | Respiratory support/ventilation assist | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:26:36.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C10520 | Vision affected by disease indicator | VisAffectDisInd | The indicator of whether the disease/disorder has affected the participant's/subject's vision | The indicator of whether the disease/disorder has affected the participant's/subject's vision | Is vision affected | Yes;No;Unknown | History reported and/or confirmed in medical record;History NOT reported and NOT confirmed in medical record;History reported as unknown or could not be collected | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17476 | Cardiovascular history condition indicator | CardioHistCondInd | Indicator as to whether the participant/subject has or had a cardiac condition or complication | Indicator as to whether the participant/subject has or had a cardiac condition or complication | Cardiac condition | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C00313 | Medical history condition SNOMED CT code | MedclHistCondSNOMEDCTCode | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | Medical History Term | Alphanumeric |
Code each of the medical history conditions using SNOMED CT |
SNOMED CT Codes (http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html) | Adult;Pediatric | Core | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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C22664 | Medical history delayed gastric empty indicator | MedHistDlyGasEmpInd | Indicator of whether the participant/subject has/had delayed gastric emptying | Indicator of whether the participant/subject has/had delayed gastric emptying | Delayed gastric emptying | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:33:37.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C14127 | Seizure generalized classification type | SeizGenClassTyp | The type of generalized epileptic seizures, considered to originate at some point within, and rapidly engage, bilaterally distributed networks and may include such bilateral networks as ortical and subcortical structures, but do not necessarily include the entire cortex, experienced by the participant/subject | The type of generalized epileptic seizures, considered to originate at some point within, and rapidly engage, bilaterally distributed networks and may include such bilateral networks as ortical and subcortical structures, but do not necessarily include the entire cortex, experienced by the participant/subjec | Seizure generalized classification type | Tonic clonic;Absence;Typical;Atypical;Myoclonic absence;Eyelid myoclonia;Myoclonic;Myoclonic atonic;Myoclonic tonic;Clonic;Tonic;Atonic;Epileptic spasms, focal or generalized | Tonic clonic (in any combination);Absence;Absence-Typical;Absence-Atypical;Absence-Myoclonic absence;Absence-Eyelid myoclonia;Myoclonic (not otherwise specified);Myoclonic-Myoclonic atonic;Myoclonic-Myoclonic tonic;Clonic;Tonic;Atonic;Epileptic spasms, focal or generalized | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17489 | Psychotic disorder indicator | PsychoDisorderInd | Indicator as to whether the participant/subject has had a psychotic disorder diagnosis | Indicator as to whether the participant/subject has had a psychotic disorder diagnosi | Psychotic disorder diagnosis | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C06020 | Urinary incontinence past three months indicator | UrinIncntPstThreeMoInd | Indicator of involuntary urine leakage (incontinence) within the last three months. Urinary incontinence is defined by International Continence Society (Abrams et al. 2002) as the complaint of any involuntary leakage of urine | Indicator of involuntary urine leakage (incontinence) within the last three months. Urinary incontinence is defined by International Continence Society (Abrams et al. 2002) as the complaint of any involuntary leakage of urin | Urinary incontinence past three months frequency | No;Yes;Not applicable;Unknown | No;Yes;Not applicable;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-17 09:26:36.973 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C22675 | Medical history oppositional defiance indicator | MedHIstOppDefInd | Indicator of whether participant/subject displays oppositional defiance | Indicator of whether participant/subject displays oppositional defiance | Oppositional defiance | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:41:22.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17466 | Cardiovascular history arrhythmia atrial fibrillation indicator | CardioHistArrhythAtrialFibInd | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of atrial fibrillation | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of atrial fibrillation | Atrial Fibrillation | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C19836 | Pain anatomic site text | PainAntmicSiteTxt | Anatomic Site of body pain | Anatomic Site of body pain | If yes, where | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-05 00:00:00.0 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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C22654 | Medical history respiratory support type | MedHistRespSuppTyp | Type of respiratory support utilized by a participant/subject | Type of respiratory support utilized by a participant/subject | If yes, indicate type | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:27:42.0 | Medical History | General Health History | Participant History and Family History | 500 |
Free-Form Entry |
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C10521 | Hearing affected by disease indicator | HearAffectDisInd | The indicator of whether the disease/disorder has affected the participant's/subject's hearing | The indicator of whether the disease/disorder has affected the participant's/subject's hearing | Is hearing affected | Yes;No;Unknown | History reported and/or confirmed in medical record;History NOT reported and NOT confirmed in medical record;History reported as unknown or could not be collected | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17477 | Cardiovascular history congenital heart disease indicator | CardioHistCongHeartDiseaseInd | Indicator as to whether the participant/subject has or had a congenital heart disease | Indicator as to whether the participant/subject has or had a congenital heart disease | Congenital heart disease | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C00314 | Medical history taken date and time | MedclHistTakenDateTime | Date (and time, if applicable and known) the participant's medical history was taken | Date (and time, if applicable and known) the participant 's medical history was taken | Date Medical History Taken | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
Adult;Pediatric | Core | 3.20 | 2024-02-29 15:42:39.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
2179659 | ||||||||||
C22665 | Medical history chronic constipation indicator | MedHIstChrnConsInd | Indicator of whether the participant/subject has/had chronic constipation | Indicator of whether the participant/subject has/had chronic constipation | Chronic constipation | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:34:16.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C14130 | Seizure focal classification type | SeizFocClassTyp | The type of focal epileptic seizures, considered to originate within networks limited to one hemisphere, which may be discretely localized or more widely distributed, and may originate in subcortical structures, experience by the participant/subject | The type of focal epileptic seizures, considered to originate within networks limited to one hemisphere, which may be discretely localized or more widely distributed, and may originate in subcortical structures, experience by the participant/subjec | Seizure focal classification type | Without impairment of consciousness or responsiveness;With observable motor or autonomic components;Involving subjective sensory or psychic phenomena only;With impairment of consciousness or responsiveness;Evolving to a bilateral, convulsive seizure | Without impairment of consciousness or responsiveness;Without impairment of consciousness or responsiveness-With observable motor or autonomic components (roughly corresponds to the concept of "simple partial seizure");Without impairment of consciousness or responsiveness-Involving subjective sensory or psychic phenomena only (corresponds to the concept of "aura");With impairment of consciousness or responsiveness (roughly corresponds to the concept of "complex partial seizure");Evolving to a bilateral, convulsive seizure (involving tonic, clonic, or tonic and clonic components replaces the term "secondarily generalized seizure") | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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C18666 | Body system category other text | BodySysCatOTH | The free-text field related to 'Body system category', specifying other text. Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured | The free-text field related to 'Body system category', specifying other text. Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured | Other, specify | Alphanumeric | Review of Symptoms from Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf | Adult;Pediatric | Supplemental | 1.10 | 2023-11-07 08:40:35.0 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
2002895 | |||||||||
C06192 | Fecal incontinence past three month average frequency | FclInctPstThrMoAvgFreq | Average frequency of incontinence to solid or liquid stools within the last three months. Fecal incontinence is defined as involuntary passage of stools | Average frequency of incontinence to solid or liquid stools within the last three months. Fecal incontinence is defined as involuntary passage of stool | Fecal incontinence past three month average frequency | Never;Not applicable;Less than once per month;Not every day but at least once per week;Not every week but at least once per month;Once every month;One episode per day;Two or more episodes per day;Unknown | Never;Not applicable;Less than once per month;Not every day but at least once per week;Not every week but at least once per month;Once every month;One episode per day;Two or more episodes per day;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-17 09:26:36.973 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C22676 | Medical history disruptive behavior disorder indicator | MedHistDisrpBehDisInd | Indicator of whether participant/subject has disruptive behavior disorder | Indicator of whether participant/subject has disruptive behavior disorder | Disruptive behavior disorder | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:41:51.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17467 | Cardiovascular history arrhythmia atrial flutter indicator | CardioHistArrhythAtrialFlutInd | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of atrial flutter | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of atrial flutter | Atrial Flutter | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C19856 | Medical history gastrostomy tube since last visit indicator | MedHistGtubeSLVInd | Indicator of Gtube placed since last study visit | Indicator of Gtube placed since last study visit | Gastrostomy tube | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-06 00:00:00.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C22655 | Medical history respiratory distress syndrome indicator | MedHistRespDstSyndInd | Indicator of whether the participant/subject has been diagnosed with respiratory distress syndrome | Indicator of whether the participant/subject has been diagnosed with respiratory distress syndrome | Respiratory distress syndrome | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:28:37.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C10522 | Speech affected by disease indicator | SpchAffectDisInd | The indicator of whether the disease/disorder has affected the participant's/subject's speech | The indicator of whether the disease/disorder has affected the participant's/subject's speech | Is speech affected? | Yes;No;Unknown | History reported and/or confirmed in medical record;History NOT reported and NOT confirmed in medical record;History reported as unknown or could not be collected | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17478 | Cardiovascular history heart failure indicator | CardioHistHeartFailureInd | Indicator as to whether the participant/subject has ever experienced heart failure | Indicator as to whether the participant/subject has ever experienced heart failure | Heart failure | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C00315 | Medical history global assessment indicator | MedclHistGlobalAssmtInd | Indicator of whether the participant has a history of any medical problems/conditions | Indicator of whether the participant has a history of any medical problems/conditions | Does the participant/subject have a history of any medical problems/conditions in the following body systems | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one. If this question is answered NO then the rest of the form is blank. If the question is answered YES then the medical history for at least one body system should be recorded. |
Adult;Pediatric | Core | 3.10 | 2024-02-29 15:42:39.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3145578 | ||||||||
C22666 | Medical history oropharyngeal dysphagia indicator | MedHistOrphDysInd | Indicator of whether the participant/subject has/had oropharyngeal dysphagia | Indicator of whether the participant/subject has/had oropharyngeal dysphagia | Oropharyngeal dysphagia | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-07-27 11:34:45.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
||||||||||
C14536 | Seizure diagnosis method type | SeizDiagnosMethdTyp | Describes how the diagnosis of seizure was established | Describes how the diagnosis of seizure was establishe | Seizure diagnosis method type | Clinical manifestations;EEG;Unknown | Clinical manifestations;EEG;Not documented or Cannot be determined | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |