CDE Detailed Report

Disease: Cerebral Palsy
Sub-Domain: General Health History
CRF: Medical History

Displaying 101 - 117 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 / 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
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 diagnosis. 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

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

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 urine. 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

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

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

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

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

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

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

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

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/subject. 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

C18666 Body system other text BodySysOTH 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 Free-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 interview and physical examination of all the body systems. 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 1.00 2014-05-27 13:34:46.0 Medical History General Health History Participant History and Family History 4000

Free-Form Entry

2002895
C00314 Medical history taken date and time MedclHistTakenDateTime Date (and time, if applicable and known) the participant/subject's medical history was taken Date (and time, if applicable and known) the participant/subject'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 3.00 2013-07-25 08:54:08.2 Medical History General Health History Participant History and Family History

Free-Form Entry

2179659
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 stools. 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

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

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

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

CSV