CDE Detailed Report
Subdomain Name: General Health History
CRF: welcome
Displaying 1 - 18 of 18
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C19519 | Disease condition associated name | DiseaseConditionAssociatedName | Name of associated disease/condition | Name of associated disease/condition | Associated Disease/Condition | Thyroid condition;Diabetes mellitus;Rheumatoid arthritis;Systemic lupus erythematosus (SLE);Muscle disease;Epilepsy/Seizures;Cancer;Other disease/condition, specify | Thyroid condition;Diabetes mellitus;Rheumatoid arthritis;Systemic lupus erythematosus (SLE);Muscle disease;Epilepsy/Seizures;Cancer;Other disease/condition, specify | Alphanumeric |
The questions in the following table should be explicitly asked to ensure a complete medical history is documented for conditions associated with Myotonic Dystrophy. |
Adult;Pediatric | Supplemental | 1.00 | 2014-07-11 08:54:47.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value 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 | Constitutional symptoms (e.g., fever, weight loss);Eyes;Ears, Nose, Mouth, Throat;Cardiovascular;Respiratory;Gastrointestinal;Genitourinary;Musculoskeletal;Integumentary (skin and/or breast);Neurological;Psychiatric;Endocrine;Hematologic/Lymphatic;Allergic/Immunologic;Hepatobiliary | Constitutional symptoms (e.g., fever, weight loss);Eyes;Ears, Nose, Mouth, Throat;Cardiovascular;Respiratory;Gastrointestinal;Genitourinary;Musculoskeletal;Integumentary (skin and/or breast);Neurological;Psychiatric;Endocrine;Hematologic/Lymphatic;Allergic/Immunologic;Hepatobiliary | Alphanumeric |
Record the code number associated with the appropriate body system for each line of medical history. The numeric codes are provided for studies that will record the data on paper CRFs. In a database the body system can be used without the numeric codes. |
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 | 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 | |||||||
| C19520 | Subject affected indicator | SubjectAffectedInd | Indicator for the subject's being affected | Indicator for the subject's being affected | Subject Affected? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-07-11 09:17:35.0 | 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.). |
No references available | Adult;Pediatric | Supplemental | 3.20 | 2024-02-29 15:42:39.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
2179659 | |||||||||
| C19521 | Thyroid condition type | ThyroidConditionTyp | Type of thyroid condition | Type of thyroid condition | Type | Hypothyroidism;Hyperthyroidism;Hashimoto's | Hypothyroidism;Hyperthyroidism;Hashimoto's | Alphanumeric |
Indicate the type of thyroid condition |
Adult;Pediatric | Supplemental | 1.00 | 2014-07-11 09:23:34.0 | 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 | Yes;No | Alphanumeric |
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. |
No references available | Adult;Pediatric | Supplemental | 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 | |||||||
| C19522 | Muscle disease hereditary type specify text | MusclDiseasHerditryTypSpcfyTxt | Specify text for type of hereditary muscle disease | Specify text for type of hereditary muscle disease | Type | Alphanumeric |
Hereditary, specify |
Adult;Pediatric | Supplemental | 1.00 | 2014-07-11 09:59:25.0 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C00316 | Medical history condition end date and time | MedclHistCondEndDateTime | Date (and time, if applicable and known) for the end of an event in the participant's medical history | Date (and time, if applicable and known) for the end of an event in the participant's medical history | End Date | 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.). |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:44.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
3145557 | |||||||||
| C19523 | Muscle disease inflammatory type specify text | MusclDiseasInflmtryTypSpcfyTxt | Specify text for type of inflammatory muscle disease | Specify text for type of inflammatory muscle disease | Type | Alphanumeric |
Inflammatory, specify |
Adult;Pediatric | Supplemental | 1.00 | 2014-07-11 09:59:25.0 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C00317 | Medical history condition start date and time | MedclHistCondStrtDateTime | Date (and time, if applicable and known) for the start of an event in the participant's medical history | Date (and time, if applicable and known) for the start of an event in the participant's medical history | Start Date | 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.). |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:43.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
2543596 | |||||||||
| C19524 | Diagnosis date | DiagnosisDate | Date of diagnosis | Date of diagnosis | Diagnosis Date | Date or Date & Time | Adult;Pediatric | Supplemental | 1.00 | 2014-07-11 10:02:43.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C00319 | Medical history condition ongoing indicator | MedclHistCondOngoingInd | Indicator of whether a medical condition/disease experienced by the participant is ongoing | Indicator of whether a medical condition/disease experienced by the participant is ongoing | Ongoing? | Yes;No | Yes;No | Alphanumeric |
Check Yes or No to indicate if the medical condition/disease is still present. |
No references available | Adult;Pediatric | Supplemental | 4.00 | 2024-02-29 15:42:44.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2736881 | |||||||
| C19676 | Muscle disease hereditary type | MuscDisHeredTyp | Specify if muscle disease type is hereditary | Specify if muscle disease type is hereditary | Type | Hereditary, specify | Hereditary, specify | Alphanumeric |
Indicate type of muscle disease |
Adult;Pediatric | Supplemental | 1.00 | 2015-02-18 00:00:00.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00322 | Medical history condition text | MedclHistCondTxt | Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history | Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history | Medical History Term | Alphanumeric |
Record one Medical History term per line. Surgeries in the medical history should also be recorded under this CDE. See the data dictionary for additional information on coding the condition 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 | 4000 |
Free-Form Entry |
2003874 | ||||||||
| C19677 | Muscle disease inflammatory type | MuscDisInflammTyp | Specify if muscle disease type is inflammatory | Specify if muscle disease type is inflammatory | Type | Inflammatory, specify | Inflammatory, specify | Alphanumeric |
Indicate type of muscle disease |
Adult;Pediatric | Supplemental | 1.00 | 2015-02-18 00:00:00.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C06358 | Diabetes mellitus type | DiabetesMellitusTyp | Type of diabetes mellitus | Type of diabetes mellitus | Type | Type 1;Type 2 | Type 1;Type 2 | Alphanumeric | Adult;Pediatric | Supplemental | 4.00 | 2024-02-29 15:41:20.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17461 | Cancer history type text | CancerHistTypTxt | Text description of the type of cancer the participant/subject was or is diagnosed with | Text description of the type of cancer the participant/subject was or is diagnosed wit | Type | Alphanumeric |
Type of cancer: |
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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| C18793 | Medical history condition other text | MedHistCondOTH | The free-text field related to 'Medical history condition type', specifying other text. Pre-specified medical condition/disease asked about when collecting the medical history from the participant or found documented in the medical record | The free-text field related to 'Medical history condition type', specifying other text. Pre-specified medical condition/disease asked about when collecting the medical history from the participant or found documented in the medical record | Other disease/condition, specify: | Alphanumeric | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:42.0 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
