CDE Detailed Report
Disease: Huntington's Disease
Sub-Domain: Epidemiology/Environmental History
CRF: PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B)
Displaying 1 - 50 of 54
Sub-Domain: Epidemiology/Environmental History
CRF: PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B)
Displaying 1 - 50 of 54
| 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 / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C10264 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - ovary removal preparkinson's disease indicator | PDDOCMERQOvryRemovlPrePDInd | Indicator for whether the participant/subject has ever had one or both ovaries surgically removed before he or she was diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for whether the participant/subject has ever had one or both ovaries surgically removed before he or she was diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Before you were diagnosed with PD, did you ever have one or both ovaries surgically removed? (0=No, 1=Yes, 9=Uncertain) | 0;1;9;N | No;Yes;Uncertain;Male | Alphanumeric |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10232 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age twenty one forty zip code | PDDOCMERQAge2140ZipCode | Zip code for the location that the participant/subject spent the majority of his or her time from 21-40 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code for the location that the participant/subject spent the majority of his or her time from 21-40 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code/Postal Code | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C18055 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - specify other chemical fume text | PDDOCMERQSpecifyOthrChemFumTxt | Text specifying the other chemicals or fumes that the participant/subject has worked with for more than 6 months | Text specifying the other chemicals or fumes that the participant/subject has worked with for more than 6 months | Specify | Alphanumeric | Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-20 10:46:24.96 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10243 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - parkinson diagnosis year date | PDDOCMERQPrknsnDiagYrDate | Date of the year when the participant/subject was diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Date of the year when the participant/subject was diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | If you have been diagnosed with Parkinson's disease, in what year were you diagnosed? | Date or Date & Time |
Year should be recorded as YYYY. |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10222 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age zero ten city location | PDDOCMERQAge010CityLoc | Location of the city that the participant/subject spent the majority of his or her time from 0-10 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the city that the participant/subject spent the majority of his or her time from 0-10 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | City | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10254 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - smoke status predPD indicator | PDDOCMERQSmkStatPrePDInd | Indicator for whether the participant/subject smoked cigarettes regularly, at least one cigarette per day for at least six months, before being diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for whether the participant/subject smoked cigarettes regularly, at least one cigarette per day for at least six months, before being diagnosed with Parkinson's Disease (PD), as a part of PD - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Before you were diagnosed with PD, did you ever smoke cigarettes regularly, that is at least 1 cigarette per day for at least 6 months?(0=No, 1=Yes, 9=Uncertain) | 0;1;9 | No;Yes;Uncertain | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10265 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - ovary removal year date | PDDOCMERQOvrRemvlYrDate | Date of the year when the participant/subject had their ovaries removed, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Date of the year when the participant/subject had their ovaries removed, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | If yes, in what year did the surgery occur? | Date or Date & Time |
Year should be recorded as YYYY. |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10233 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age twenty one forty country location | PDDOCMERQAge2140CntryLoc | Location of the country that the participant/subject spent the majority of his or her time from 21-40 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the country that the participant/subject spent the majority of his or her time from 21-40 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Country | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10244 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - longest held occupation prePD text | PDDOCMERQLngstHldOccPrePDVTxt | Text describing the longest held occupation that the participant/subject had before being diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Text describing the longest held occupation that the participant/subject had before being diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Before you were diagnosed with PD, what was your longest held occupation? | Alphanumeric |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10223 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age zero ten state province location | PDDOCMERQAge010StateProvLoc | Location of the state/province that the participant/subject spent the majority of his or her time from 0-10 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the state/province that the participant/subject spent the majority of his or her time from 0-10 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | State/Province | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10255 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - smoke year duration | PDDOCMERQSmkYrDur | Duration for how many years the participant/subject smoked cigarettes regularly, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Duration for how many years the participant/subject smoked cigarettes regularly, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | If yes, for how many years did you smoke cigarettes regularly? | Numeric Values | Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10266 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - nonsteroidal anti-inflammatory drug regular use indicator | PDDOCMERQNSAIDRegUseInd | Indicator for the regular use of over-the-counter nonsteroidal anti-inflammatory (NSAID) 9e.g. aspirin/Entrophen, Novasen, Apo-ASA, Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for the regular use of over-the-counter nonsteroidal anti-inflammatory, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Regular use of over-the-counter nonsteroidal anti-inflammatory (NSAID) 9e.g. aspirin/Entrophen, Novasen, Apo-ASA, Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin) | 0;1;2;9 | No;Yes, past use;Currently using;Uncertain | Numeric Values |
For each medication category listed below, indicate whether or not you ever used any of these medications regularly (2 or more tablets per week for 6 months or longer). NOTE: The medication examples are not all inclusive |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10234 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age forty one sixty city location | PDDOCMERQAge4160CtyLoc | Location of the city that the participant/subject spent the majority of his or her time from 41-60 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the city that the participant/subject spent the majority of his or her time from 41-60 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | City | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10245 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - occupation duration | PDDOCMERQOccDur | Duration of how long the participant/subject held his or her longest occupation before being diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Duration of how long the participant/subject held his or her longest occupation before being diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | For how many years did you have this occupation? | Numeric Values |
Year should be recorded as YYYY. |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10224 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age zero ten zip code | PDDOCMERQAge010ZipCode | Zip code for the location that the participant/subject spent the majority of his or her time from 0-10 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code for the location that the participant/subject spent the majority of his or her time from 0-10 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code/Postal Code | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10256 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - smoke cigarette per day number | PDDOCMERQSmkCigPerDayDur | Number of cigarettes the participant/subject smoked per day when her or she smoked regularly, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Number of cigarettes the participant/subject smoked per day when her or she smoked regularly, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | If yes, during the time that you smoked regularly, about how much did you smoke per day? | Numeric Values |
Record number of cigarettes smoked per day |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10267 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - first year of use date | PDDOCMERQFrstYrUseDate | Date of the first year of first use, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Date of the first year of first use, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Year of first use | Date or Date & Time |
If currently using, leave year of last use blank |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10235 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age forty one sixty state province location | PDDOCMERQAge4160StateProvLoc | Location of the state/province that the participant/subject spent the majority of his or her time from 41-60 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the state/province that the participant/subject spent the majority of his or her time from 41-60 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | State/Province | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10246 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - current occupation text | PDDOCMERQCrrntOccTxt | Text describing the participant's/subject's current occupation, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Text describing the participant's/subject's current occupation, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | What is your current occupation? | Alphanumeric |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10257 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - pack smoke per day number | PDDOCMERQPcksSmkdPerDay | Number of packs of cigarettes the participant/subject smoked per day when her or she smoked regularly, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Number of packs of cigarettes the participant/subject smoked per day when her or she smoked regularly, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Number of pack(s) smoked per day | Numeric Values |
Record the number of pack(s) of cigarettes smoked per day |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10225 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age zero ten country location | PDDOCMERQAge010CntryLoc | Location of the country that the participant/subject spent the majority of his or her time from 0-10 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the country that the participant/subject spent the majority of his or her time from 0-10 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Country | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10268 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - last year of use date | PDDOCMERQLstYrUseDate | Date of the last year of last use, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Date of the last year of last use, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Year of last use | Date or Date & Time |
If currently using, leave year of last use blank |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10236 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age forty one sixty zip code location | PDDOCMERQAge4160ZpCdLoc | Zip code for the location that the participant/subject spent the majority of his or her time from 41-60 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code for the location that the participant/subject spent the majority of his or her time from 41-60 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code/Postal Code | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10247 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - pesticide job ever indicator | PDDOCMERQPstcdeJbEvrInd | Indicator for whether the participant/subject has ever held a job which used any type of pesticides, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for whether the participant/subject has ever held a job which used any type of pesticides, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Over your lifetime, have you ever had a job in which you used any type of pesticide, including herbicides, insecticides, fungicides, or fumigants? (0=No, 1=Yes, 9=Uncertain) | 0;1;9 | No;Yes;Uncertain | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10258 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - current smoke status | PDDOCMERQCrrntSmkStatus | Status for whether the participant/subject smokes regularly now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Status for whether the participant/subject smokes regularly now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Do you smoke cigarettes regularly now?(0=No, 1=Yes, 9=Uncertain) | 0;1;9 | No;Yes;Uncertain | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10226 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age eleven twenty city location | PDDOCMERQAge1120CtyLoc | Location of the city that the participant/subject spent the majority of his or her time from 11-20 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the city that the participant/subject spent the majority of his or her time from 11-20 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | City | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10269 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - average dose number | PDDOCMERQAvgDoseNum | Number of doses measured in number of tablets per week, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Number of doses measured in number of tablets per week, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Average dose measured in number of tablets per week | Numeric Values |
Answer for each medication category (Q9a, Q9.1a, Q9.2a, Q9.3a, Q9.4a, Q9.5a) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10237 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age forty one sixty country location | PDDOCMERQAge4160CntryLoc | Location of the country that the participant/subject spent the majority of his or her time from 41-60 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the country that the participant/subject spent the majority of his or her time from 41-60 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Country | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10248 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - pesticide exposure ever indicator | PDDOCMERQPstcdeExposrEvrInd | Indicator for whether the participant/subject has ever been exposed to any pesticides, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for whether the participant/subject has ever been exposed to any pesticides, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Over your lifetime, were you ever exposed to pesticides including herbicides, insecticides, fungicides, or fumigants used on your home, lawn, garden or on a pet? (0=No, 1=Yes, 9=Uncertain) | 0;1;9 | No;Yes;Uncertain | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10259 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - current smoke per day duration | PDDOCMERQCrrntSmkCigsPerDayNum | Number of cigarettes the participant/subject smokes currently, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Number of cigarettes the participant/subject smokes currently, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | If yes, how much do you smoke per day? | Numeric Values |
Record number of cigarettes smoked per day |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10227 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age eleven twenty state province location | PDDOCMERQAge1120StateProvLoc | Location of the state/province that the participant/subject spent the majority of his or her time from 11-20 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the state/province that the participant/subject spent the majority of his or her time from 11-20 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | State/Province | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10270 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - regular use Cox-2 indicator | PDDOCMERQRegUseCOX2Ind | Indicator for the regular use of Cox-2-Inhibitor (Bextra, Celebrex, Vioxx, Meloxicam, Piroxicam), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for the regular use of Cox-2-Inhibitor (Bextra, Celebrex, Vioxx, Meloxicam, Piroxicam), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Regular use of Cox-2-Inhibitor (Bextra, Celebrex, Vioxx, Meloxicam, Piroxicam) | 0;1;2;9 | No;Yes, past use;Currently using;Uncertain | Numeric Values |
For each medication category listed below, indicate whether or not you ever used any of these medications regularly (2 or more tablets per week for 6 months or longer). NOTE: The medication examples are not all inclusive. |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10238 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age sixty one present city location | PDDOCMERQAge61PresCtyLoc | Location of the city that the participant/subject spent the majority of his or her time from 61 years till now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the city that the participant/subject spent the majority of his or her time from 61 years till now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | City | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10249 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - chemical solvent work over six month indicator | PDDOCMERQChemSlvntWrkOvr6MoInd | Indicator for whether the participant/subject has ever worked with chemical solvents for more than six months, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for whether the participant/subject has ever worked with chemical solvents for more than six months, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Over your lifetime, have you ever worked with chemical solvents for more than 6 months? (0=No, 1=Yes, 9=Uncertain) | 0;1;9 | No;Yes;Uncertain | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10260 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - current pack smoke per day number | PDDOCMERQCrrntPckSmkPerDayNum | Number of packs of cigarettes smoked per day currently, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Number of packs of cigarettes smoked per day currently, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Number of pack(s) smoked per day | Numeric Values |
Record the number of pack(s) of cigarettes smoked per day |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10228 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age eleven twenty zip code | PDDOCMERQAge1120ZpCode | Zip code for the location that the participant/subject spent the majority of his or her time from 11-20 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code for the location that the participant/subject spent the majority of his or her time from 11-20 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code/Postal Code | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10271 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - regular use other nonsteroidal anti-inflammatory drug Indicator | PDDOCMERQRegUseOthrNSAIDInd | Indicator for the regular use of other nonsterodial anti-inflammatory (NSAID) (e.g., Clinoril, Indocin/Indocid, Naprosyn, Orudis, Relafen, Toradol, Voltaren), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for the regular use of other nonsteroidial anti-inflammatory (NSAID) (e.g., Clinoril, Indocin/Indocid, Naprosyn, Orudis, Relafen, Toradol, Voltaren), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Regular use of other nonsterodial anti-inflammatory (NSAID) (e.g., Clinoril, Indocin/Indocid, Naprosyn, Orudis, Relafen, Toradol, Voltaren) | 0;1;2;9 | No;Yes, past use;Currently using;Uncertain | Numeric Values |
For each medication category listed below, indicate whether or not you ever used any of these medications regularly (2 or more tablets per week for 6 months or longer). NOTE: The medication examples are not all inclusive. |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10239 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age sixty one present state province location | PDDOCMERQAge61PresStateProvLoc | Location of the state/province that the participant/subject spent the majority of his or her time from 61 years till now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the state/province that the participant/subject spent the majority of his or her time from 61 years till now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | State/Province | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10250 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - heavy metal work over six months indicator | PDDOCMERQHvyMtalWrkOvr6MoInd | Indicator for whether the participant/subject has ever worked with heavy metals for more than 6 months, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for whether the participant/subject has ever worked with heavy metals for more than 6 months, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Over your lifetime, have you ever worked with heavy metals for more than 6 months? (0=No, 1=Yes, 9=Uncertain) | 0;1;9 | No;Yes;Uncertain | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10261 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - living with smoker preparkinson's disease Indicator | PDDOCMERQLvngSmkrPrePDInd | Indicator for whether the participant/subject lived with a smoker before he or she was diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for whether the participant/subject lived with a smoker before he or she was disgnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Before you were diagnosed with PD, did you live with a smoker?(0=No, 1=Yes, 9=Uncertain) | 0;1;9 | No;Yes;Uncertain | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10229 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age eleven twenty country location | PDDOCMERQAge1120CntryLoc | Location of the country that the participant/subject spent the majority of his or her time from 11-20 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the country that the participant/subject spent the majority of his or her time from 11-20 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Country | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10272 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - regular use lipid lower statin indicator | PDDOCMERQRegUseLLSInd | Indicator for the regular use of lipid lowering statin drug (e.g., Baycol, Lescol, Lipitor, Mevacor, Pravachol, Zocor, Crestor), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for the regular use of lipid lowering statin drug (e.g., Baycol, Lescol, Lipitor, Mevacor, Pravachol, Zocor, Crestor), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Regular use of lipid lowering statin drug (e.g., Baycol, Lescol, Lipitor, Mevacor, Pravachol, Zocor, Crestor) | 0;1;2;9 | No;Yes, past use;Currently using;Uncertain | Numeric Values |
For each medication category listed below, indicate whether or not you ever used any of these medications regularly (2 or more tablets per week for 6 months or longer). NOTE: The medication examples are not all inclusive. |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10240 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age sixty one present zip code | PDDOCMERQAge61PresZpCode | Zip code for the location that the participant/subject spent the majority of his or her time from 61 years till now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code for the location that the participant/subject spent the majority of his or her time from 61 years till now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Zip code/Postal Code | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10251 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - other chemical work over six months indicator | PDDOCMERQOthrChemWrkOvr6MoInd | Indicator for whether the participant/subject has ever worked with any other chemicals or fumes for more than 6 months, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for whether the participant/subject has ever worked with any other chemicals or fumes for more than 6 months, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Over your lifetime, have you ever worked with any other chemicals or fumes for more than 6 months? (0=No, 1=Yes, 9=Uncertain) | 0;1;9 | No;Yes;Uncertain | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10262 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - head injury concussion preparkinson's disease indicator | PDDOCMERQHdInjConcussPrePDInd | Indicator for whether the participant/subject has ever had a head injury and lost consciousness or diagnosed with a concussion by a doctor, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for whether the participant/subject has ever had a head injury and lost consciousness or diagnosed with a concussion by a doctor, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Before you were diagnosed with PD, did you ever have a head injury where you lost consciousness or were diagnosed with a concussion by a doctor?(0=No, 1=Yes, 9=Uncertain) | 0;1;9 | No;Yes;Uncertain | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10230 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age twenty one forty city location | PDDOCMERQAge2140CtyLoc | Location of the city that the participant/subject spent the majority of his or her time from 21-40 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location of the city that the participant/subject spent the majority of his or her time from 21-40 years, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | City | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10273 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - regular use estrogen hormone replacement indicator | PDDOCMERQRegUseEHRInd | Indicator for the regular use of estrogen-containing hormone replacement drug (e.g., Estinyl, Estratabs, Premarin, Prempro), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Indicator for the regular use of estrogen-containing hormone replacement drug (e.g., Estinyl, Estratabs, Premarin, Prempro), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Regular use of estrogen-containing hormone replacement drug (e.g., Estinyl, Estratabs, Premarin, Prempro) | 0;1;2;9 | No;Yes, past use;Currently using;Uncertain | Numeric Values |
For each medication category listed below, indicate whether or not you ever used any of these medications regularly (2 or more tablets per week for 6 months or longer). NOTE: The medication examples are not all inclusive. |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10241 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age sixty one present country location | PDDOCMERQAge61PresCntryLoc | Location for the country that the participant/subject spent the majority of his or her time from 61 years till now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Location for the country that the participant/subject spent the majority of his or her time from 61 years till now, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Country | Alphanumeric |
What was your place of residence for the majority of the time in each of the following time periods? (if unknown, enter N) |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10252 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - caffeine intake preparkinson's disease number | PDDOCMERQCaffneIntkePrePDNum | Number of cups of caffeine-containing beverages the participant/subject drank each day, during the times that he or she was drinking caffeine-containing beverages, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Number of cups of caffeine-containing beverages the participant/subject drank each day, during the times that he or she was drinking caffeine-containing beverages, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Before you were diagnosed with PD, on average, how many cups of caffeine-containing beverage (e.g. coffee, tea, soda) did you drink each day, during the times you were drinking caffeine-containing beverages? | Numeric Values |
No instructions available |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C10263 | Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - head injury concussion year date | PDDOCMERQHdInjConcussYrDate | Date of the year when the participant/subject had a head injury occur, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | Date of the year when the participant/subject had a head injury occur, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) | If yes, in what year did the head injury occur? | Date or Date & Time |
Year should be recorded as YYYY. |
Copyright © 2005 PD-DOC and the NIEHS/Parkinson Institute Working Group on Environmental Risk Questionnaires. This questionnaire was supported by PD-DOC grant (U01NS050095). | Adult | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | PD DOC Mini Environmental Risk Questionnaire for Parkinson's Disease Patients Baseline (PD DOC MERQ-PD-B) | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
