CDE Detailed Report

Disease: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage
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CRF: Medical History

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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
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 (and time) the medical condition/disease stopped. For surgeries, start and stop dates will most likely be the same date. 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 Exploratory 3.10 2024-02-29 15:42:44.0 Medical History [php] [php_1]

Free-Form Entry

 3145557
C52622 Medical history cardiac catheterization recency rate MedHistCardCathRecenRt The element related to the recency of cardiac catheterization the participant/subject has had The element related to the recency of cardiac catheterization the participant/subject has had If YES, indicate recency: <= 2 weeks;> 2 weeks ago;Unknown <= 2 weeks;> 2 weeks ago;Unknown Alphanumeric Adult;Pediatric Exploratory 1.00 2017-01-26 13:49:14.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52700 Hypercoagulable disorder type text HypercoagDisrdrTypeTxt The free-text field related to the type of hypercoagulable disorder The free-text field related to the type of hypercoagulable disorder If YES, specify type: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Medical History [php] [php_1] 255

Free-Form Entry
C17480 Diabetes mellitus complications type EndocrineHistDiabMellCompliTyp Type(s) of complications related to diabetes mellitus the participant/subject has experienced or is experiencing Type(s) of complications related to diabetes mellitus the participant/subject has experienced or is experiencing Complicaitons of diabetes Nephropathy;Neuropathy;Retinopathy;Other, specify;None Nephropathy;Neuropathy;Retinopathy;Other, specify;None Alphanumeric

Choose all that apply

 Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History [php] [php_1]

Multiple Pre-Defined Values Selected
C52601 Medical history transient ischemic attack recency rate MedHistTIARecenRt The element related to the recency of transient ischemic attacks (TIAs) the participant/subject has had The element related to the recency of transient ischemic attacks (TIAs) the participant/subject has had Recency of TIA < 24 hours ago;24h - 7d ago;7d - 3 mos ago;> 3 mos ago < 24 hours ago;24h - 7d ago;7d - 3 mos ago;> 3 mos ago Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 14:29:36.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52623 Aortic thoracic aneurysm specify text AorticThorAneurSpTxt The free-text field related to the type of aortic or thoracic aneurysm The free-text field related to the type of aortic or thoracic aneurysm If YES, specify type: Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 13:49:14.0 Medical History [php] [php_1] 255

Free-Form Entry
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 Exploratory 3.10 2024-02-29 15:42:43.0 Medical History [php] [php_1]

Free-Form Entry

 2543596
C52701 Bleeding disorder type text BleedDisorderTypeTxt Free-text field related to the type of bleeding disorder Free-text field related to the type of bleeding disorder If YES, specify type: Alphanumeric Adult;Pediatric Supplemental 1.00 2016-10-13 12:39:16.0 Medical History [php] [php_1] 255

Free-Form Entry
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, indicate type(s) 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

Choose all that apply

 Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History [php] [php_1]

Multiple Pre-Defined Values Selected
C52602 Medical history migraine aura indicator MedHistMigrAuraInd The indicator related to the participant/subject having migraine(s) with aura The indicator related to the participant/subject having migraine(s) with aura If YES, migraine(s) with aura No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 14:49:56.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52624 Hypertension first diagnosed age value HypertensFirstDiagAgeVal Free-text field related to the age hypertension was first diagnosed Free-text field related to the age hypertension was first diagnosed If YES, age hypertension first diagnosed: Alphanumeric

years

 Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Medical History [php] [php_1] 255

Free-Form Entry
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;Unknown Yes;No;Unknown Alphanumeric

Choose Yes or No to indicate if the medical condition/disease is still present.

 No references available Adult;Pediatric Exploratory 4.00 2024-02-29 15:42:44.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected

 2736881
C52702 Connective tissue disease other type text ConnTissDisTypTxt The free-text field related to other type of connective tissue disease The free-text field related to other type of connective tissue disease If YES, specify type: Alphanumeric Adult;Pediatric Supplemental 1.00 2016-10-19 12:03:19.0 Medical History [php] [php_1] 255

Free-Form Entry
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

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 Supplemental 1.10 2023-11-07 08:40:35.0 Medical History [php] [php_1] 4000

Free-Form Entry

 2002895
C52603 Medical history migraine active last year indicator MedHistMigrActivLstYrInd The indicator related to the participant/subject having had an active migraine within the last year The indicator related to the participant/subject having had an active migraine within the last year Active migraine within last year? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 14:49:56.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52628 Blood pressure mean measurement BloodPressMeanMeasr Mean measurement of the participant's/subject's blood pressure Mean measurement of the participant's/subject's blood pressure Average blood pressure: < 120/70;120 - 140/70 - 90;< 140/> 90;> 140/< 90;> 140/90 < 120/70;120 - 140/70 - 90;< 140/> 90;> 140/< 90;> 140/90 Numeric Values

(if checked before)

 Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C00321 Medical history for body system indicator MedclHistBodySysInd Indicator of whether the participant/subject has a history of medical problems/conditions for the specific body system Indicator of whether the participant/subject has a history of medical problems/conditions for the specific body syste 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 for each body system.

 No references available Adult;Pediatric Exploratory 3.00 2013-07-22 16:57:17.79 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52703 Sleep apnea type text SleepApneaTypTxt The free-text field related to the type of sleep apnea The free-text field related to the type of sleep apnea If YES, specify type: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Medical History [php] [php_1] 255

Free-Form Entry
C19057 Diabetes mellitus complications other text EndocrineHistDiabMellCompliOTH The free-text field related to 'Diabetes mellitus complications type' specifying other text. Type(s) of complications related to diabetes mellitus the participant/subject has experienced or is experiencing The free-text field related to 'Diabetes mellitus complications type' specifying other text. Type(s) of complications related to diabetes mellitus the participant/subject has experienced or is experiencing Other, specify: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History [php] [php_1] 4000

Free-Form Entry
C52604 Medical history carotid endarterectomy anatomic site MedHistCarotEndarcAnatSite The element related to the location of a carotid endarterectomy the participant/subject has had The element related to the location of a carotid endarterectomy the participant/subject has had If YES, indicate location Left side;Right side;Both;Unknown Left side;Right side;Both;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 14:49:56.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52692 Hypertension past teatment text HypertensPastTreatTxt The free-text field related to past treatment used for hypertension The free-text field related to past treatment used for hypertension past treatment for hypertension: Alphanumeric Adult;Pediatric Exploratory 3.00 2013-07-20 10:21:25.65 Medical History [php] [php_1] 500

Free-Form Entry
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 condition Alphanumeric

Record one Medical History term per line. Make sure to record if the following events are in the medical history which are Core items: Any stroke; Ischemic stroke; Hemorrhagic stroke; Hemorrhagic stroke type; 4) Transient ischemic attack (TIA); Carotid stenosis; Epilepsy/ Seizure disorder; Central nervous system infection; Dementia; Head trauma; Head trauma type; Atrial fibrillation (AF)/ flutter; Rheumatic heart disease

 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 [php] [php_1] 4000

Free-Form Entry

 2003874
C52706 Mitochondrial encephalomyopathy lactic acidosis stroke like episodes indicator MELASInd The indicator related to whether the participant/subject has or had mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) The indicator related to whether the participant/subject has or had mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) If YES, do you have/have you had Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes No;Yes;Unknown No;Yes;Unknown Alphanumeric

Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes - MELAS

 Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C19058 Psychiatric history psychotic diagnosis other text PsychHistPsychoticDiagnosOTH The free-text field related to 'Psychiatric history psychotic diagnosis type' specifying other text. Type of psychotic disorder the participant/subject has been diagnosed with, if any The free-text field related to 'Psychiatric history psychotic diagnosis type' specifying other text. Type of psychotic disorder the participant/subject has been diagnosed with, if any Other, specify: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History [php] [php_1] 4000

Free-Form Entry
C52605 Medical history carotid artery stenting anatomic site MedHistCarotArtStentAnatSite The element related to the location of carotid artery stenting the participant/subject has had The element related to the location of carotid artery stenting the participant/subject has had If YES, indicate location Left side;Right side;Both;Unknown Left side;Right side;Both;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 14:49:56.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52693 High cholesterol treatment type HighCholesTreatTyp Type of treatment for high blood cholesterol Type of treatment for high blood cholesterol If YES, indicate treatment(s) Diet;None;Statins;Other medicines Diet;None;Statins;Other medicines Alphanumeric

Choose all that apply

 Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Medical History [php] [php_1]

Multiple Pre-Defined Values Selected
C06246 Medical history condition type MedHistCondTyp Type of pre-specified medical condition/disease asked about when collecting the medical history from the participant or found documented in the medical record Type of pre-specified medical condition/disease asked about when collecting the medical history from the participant/subject or found documented in the medical record Has a doctor or other medical professional ever told you that you have or have had the following? None;Unknown (any cardiovascular disorder);Cardiac pacemaker;Other cardiac disorders, specify;Hypertension;Hypotension;Orthostatic hypotension;Deep vein thrombosis;Neuropathy (alcoholic, diabetic, and others);Myocardial infarction;Stroke;Family history of cardiovascular disease;Other, specify:;Cardiac surgery, specify;Hemorrhagic stroke;Unruptured aneurysm;Dural sinus thrombosis/cerebral venous thrombosis;Ischemic Stroke;Transient Ischemic Attack (TIA);Arteriovenous malformation;Cavernous malformation;Transient monocular blindness;Migraines;Carotid stenosis;Carotid endarterectomy;Carotid artery stenting;Seizure episode;Epilepsy/Seizures;Meningitis;Dementia;Depression;Depressive disorder diagnosis;Current clinical anxiety;Anxiety Disorder;Psychotic Disorder/Schizophrenia;Atrial fibrillation/flutter;Coronary artery disease;Diabetes mellitus;Hypercholesterolemia;Cancer;Bleeding disorder;Sleep apnea;Hemorrhoids;Moyamoya Syndrome;Neurofibromatosis type 1 (NF1);Inborn errors of metabolism;Mitochondrial disease;Hereditary hemorrhagic telangiectasia (HHT);Ehlers-Danlos Syndrome Type IV;Marfan Syndrome;Fibromuscular dysplasia;Central nervous system infection;Head trauma;Neck trauma;Rheumatic heart disease;Angina;Valvular heart disease;Coronary stent or PTCA;Congestive heart failure;Congenital heart disease;Cardiac catheterization;Peripheral arterial disease;Aortic or thoracic aneurysm;Hypertriglyceridemia;Infection within two weeks;Dental disease;Sickle cell anemia;Hypercoagulable disorder;Lupus;Other connective tissue disease;Renal (kidney) failure;Nephrotic syndrome;Chronic liver failure;Iron deficiency/anemia;Inflammatory bowel disease;Down Syndrome;Sturge-Weber Syndrome;Coarctation of the aorta;Alpha 1-antitrypsin deficiency;Pheochromocytoma None;Unknown (any cardiovascular disorder);Cardiac pacemaker;Other cardiac disorders, specify;Hypertension;Hypotension;Orthostatic hypotension;Deep vein thrombosis;Neuropathy (alcoholic, diabetic, and others);Myocardial infarction;Stroke;Family history of cardiovascular disease;Other, specify:;Cardiac surgery, specify;Hemorrhagic stroke;Unruptured aneurysm;Dural sinus thrombosis/cerebral venous thrombosis;Ischemic Stroke;Transient Ischemic Attack (TIA);Arteriovenous malformation (AVM);Cavernous malformation;Transient monocular blindness;Migraines;Carotid stenosis;Carotid endarterectomy (CEA);Carotid artery stenting (CAS);Seizure episode;Epilepsy/Seizures;Meningitis;Dementia;Depression;Depressive disorder diagnosis;Current clinical anxiety;Anxiety Disorder;Psychotic Disorder/Schizophrenia;Atrial fibrillation/flutter;Coronary artery disease;Diabetes mellitus;Hypercholesterolemia;Cancer;Bleeding disorder;Sleep apnea;Hemorrhoids;Moyamoya Syndrome;Neurofibromatosis type 1 (NF1);Inborn errors of metabolism;Mitochondrial disease;Hereditary hemorrhagic telangiectasia (HHT);Ehlers-Danlos Syndrome Type IV;Marfan Syndrome;Fibromuscular dysplasia;Central nervous system infection;Head trauma;Neck trauma;Rheumatic heart disease;Angina;Valvular heart disease;Coronary stent or PTCA;Congestive heart failure;Congenital heart disease;Cardiac catheterization;Peripheral arterial disease;Aortic or thoracic aneurysm;Hypertriglyceridemia;Infection within two weeks;Dental disease;Sickle cell anemia;Hypercoagulable disorder;Lupus;Other connective tissue disease;Renal (kidney) failure;Nephrotic syndrome;Chronic liver failure;Iron deficiency/anemia;Inflammatory bowel disease;Down Syndrome;Sturge-Weber Syndrome;Coarctation of the aorta;Alpha 1-antitrypsin deficiency;Pheochromocytoma Alphanumeric

Core elements for SAH studies: Stroke, Unruptued aneurysm, Hypertension; Supplementa; - Highly Recommended elements: Transient ischemic attack, Arteriovenous malformation; Exploratory elements: Dural sinys thrombosis/cerebral venous thrombosis, carotid stenosis, carotid endarterectomy, carotid artery stenting, seizure episode, epilepsy/seizure disprder, central nervous system infection, meningitis, dementia, current clinical depression, depressive disorder diagnosis, current clinical anxiety, anxiety disorder diagnosis, psychotic disorder, head trauma, neck trauma, atrial fibrillation/flutter, rheumatic heart disease, coronary artery disease, myocardial infarction, angina, valvular heart disease, cardiac surgery, coronary stent or PTCA, Congestive heart failure, Congential heart disease, Cardiac catheterization, peripheral arterial disease, hypertriglyceridemia, cancer, sickle cell anemia, hypercoagulable disorder, lupus, other connective disease, sleep apnea, nephrotic syndrome, chronic liver failure, iron deficiency/anemia, inflammatory bowel disease, hemorrhoids, Moyamoya disease, Down Syndrome, Neurofibromatosis type I, Sturge-Weber Syndrome, inborn errors of metabolism, mitochondrial disease, hereditary hemorrhagic telangiectasia, fibromuscular dysplasia, coarctation or the aorta, Alphai-antitrypsin deficiency, pheochromocytoma, menarche, menopause

 Adult;Pediatric Supplemental 4.00 2024-02-29 15:42:40.0 Medical History [php] [php_1]

Multiple Pre-Defined Values Selected
C52709 Menopause begin age value MenopauseBeginAgeVal The age at which menopause began for the participant/subject The age at which menopause began for the participant/subject Age: Numeric Values Adult Exploratory 3.00 2013-06-11 00:00:00.0 Medical History [php] [php_1]

Free-Form Entry
C19078 Cardiovascular history cardiac surgery other text CardioHistCardSurgOTH The free-text field related to 'Cardiovascular history cardiac surgery type' specifying other text. Type of cardiac surgery or mechanical intervention the participant/subject underwent The free-text field related to 'Cardiovascular history cardiac surgery type' specifying other text. Type of cardiac surgery or mechanical intervention the participant/subject underwent Other, specify: Alphanumeric Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Medical History [php] [php_1] 4000

Free-Form Entry
C52617 Head trauma result type HdTrmResTyp The element related to the result of head trauma The element related to the result of head trauma If YES, indicate if head trauma resulted in any of the following Loss of consciousness > 30 minutes;Post traumatic amnesia > 24 hours;Abnormal brain imaging findings;None of the above Loss of consciousness > 30 minutes;Post traumatic amnesia > 24 hours;Abnormal brain imaging findings;None of the above Alphanumeric

Choose all that apply

 Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Medical History [php] [php_1]

Multiple Pre-Defined Values Selected
C52695 Cancer diagnosis type CancerDiagTyp The element related to the type of cancer diagnosis the participant/subject has or had The element related to the type of cancer diagnosis the participant/subject has or had Type(s) of cancer Brain;Breast;Colorectal;Endometrial;Esophagus;Prostate;Renal;Skin;Other specify;Lung Brain;Breast;Colorectal;Endometrial;Esophagus;Prostate;Renal;Skin;Other specify;Lung Alphanumeric Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Medical History [php] [php_1]

Multiple Pre-Defined Values Selected
C10539 Diabetes first diagnosis age value DiabetFrstDiagnosisAgeVal Value representing the age, in years, at which the participant was first diagnosed with diabetes mellitus Value representing the age, in years, at which the participant was first diagnosed with diabetes mellitus Age diabetes first diagnosed: Numeric Values

years

 Adult;Pediatric Supplemental 3.10 2024-02-29 15:41:16.0 Medical History [php] [php_1]

Free-Form Entry

 year
C52710 Menarche begin age value MenarcheBeginAgeVal The age at which menarche began for the participant/subject The age at which menarche began for the participant/subject Age: Numeric Values Adult;Pediatric Exploratory 3.00 2013-06-11 00:00:00.0 Medical History [php] [php_1]

Free-Form Entry
C22679 Medical history first depressive episode diagnosis age value MedHistFrstDepEpDiagAgeVal Value of a participant's/subject's age when first depressive episode was diagnosed Value of a participant's/subject's age when first depressive episode was diagnosed If YES, age experienced first depressive episode/diagnosed with depression Numeric Values

years

 Adult;Pediatric Supplemental 1.00 2016-07-27 11:43:54.0 Medical History [php] [php_1]

Free-Form Entry

 year
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 [php] [php_1]

Single Pre-Defined Value Selected

 2002895
C52618 Medical history neck trauma recency rate MedHistNeckTraumaRecenRt The element related to the recency of neck trauma The element related to the recency of neck trauma If YES, indicate recency: < 8 days before current stroke/TIA;8 days - 4 weeks ago;> 4 weeks ago;Unknown < 8 days before current stroke/TIA;8 days - 4 weeks ago;> 4 weeks ago;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 13:49:14.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52696 Infection within two weeks type InfectionWthnTwoWksTyp The element related to the type of infection(s) within the last two weeks the participant/subject has had The element related to the type of infection(s) within the last two weeks the participant/subject has had If YES, indicate type(s) Otitis media;Respiratory infection;Urinary tract infection;Cellulitis;Sepsis;Mastoiditis;Viral gastroenteritis;Fever lasting > 48 hours;Other infection, specify: Otitis media;Respiratory infection;Urinary tract infection (UTI);Cellulitis;Sepsis;Mastoiditis;Viral gastroenteritis;Fever lasting > 48 hours;Other infection, specify: Alphanumeric

Choose all that apply

 Adult;Pediatric Supplemental 3.00 2013-07-17 09:26:36.973 Medical History [php] [php_1]

Multiple Pre-Defined Values Selected
C10541 Diabetes treatment type DiabetTreatTyp Type of treatment the participant/subject is receiving or has received for diabetes mellitus Type of treatment the participant/subject is receiving or has received for diabetes mellitus Treatment for diabetes Diet;Oral medication;Insulin;None Diet;Oral medication;Insulin;None Alphanumeric

Choose all that apply

 Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Medical History [php] [php_1]

Multiple Pre-Defined Values Selected
C52597 Medical history ischemic stroke range MedHistIschemicStrokeRng The element related to the number of ischemic strokes the participant/subject has had The element related to the number of ischemic strokes the participant/subject has had Number of ischemic strokes >= 2;1;None;Unknown >= 2;1;None;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 13:49:14.0 Medical History [php] [php_1]

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 [php] [php_1] 255

Free-Form Entry
C52619 Medical history atrial fibrillation other cause indicator MedHistAtrlFibOthCauseInd The indicator related to other cause of atrial fibrillation The indicator related to other cause of atrial fibrillation Other cause of AF No;Yes;Unknown No;Yes;Unknown Alphanumeric

AF: atrial fibrillation

 Adult;Pediatric Exploratory 1.00 2017-01-27 08:23:58.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52697 Infection within two weeks other text InfectionWthnTwoWksOTH The free-text field related to the type of infection(s) within the last two weeks the participant/subject has had The free-text field related to the type of infection(s) within the last two weeks the participant/subject has had Other infection, specify: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-17 09:26:36.973 Medical History [php] [php_1] 255

Free-Form Entry
C10543 Cancer head or neck radiation treatment indicator CancerHeadNeckRadiatTreatInd Indicator as to whether the participant's/subject's cancer is or was treated with head or neck radiation Indicator as to whether the participant's/subject's cancer is or was treated with head or neck radiatio Did you receive head or neck radiation to treat the cancer? Yes;No/Not documented;Unknown Yes;No/Not documented;Unknown Alphanumeric Adult;Pediatric Exploratory 3.00 2013-07-11 15:03:49.2 Medical History [php] [php_1]

Single Pre-Defined Value Selected
C52598 Medical history ischemic stroke recency rate MedHistIschemicStrokeRecenRt The element related to the recency of ischemic strokes the participant/subject has had The element related to the recency of ischemic strokes the participant/subject has had Recency of ischemic strokes < 3 mos ago;>= 3 mos ago;Unknown < 3 mos ago;>= 3 mos ago;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 13:49:14.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected
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 Core 3.20 2024-02-29 15:42:39.0 Medical History [php] [php_1]

Free-Form Entry

 2179659
C52620 Medical history atrial fibrillation other cause text MedHistAtrlFibOthCauseTxt The free-text field related to other cause of atrial fibrillation The free-text field related to other cause of atrial fibrillation If YES, specify other cause Alphanumeric Adult;Pediatric Exploratory 1.00 2017-01-27 08:23:58.0 Medical History [php] [php_1] 255

Free-Form Entry
C52698 Dental disease type text DentalDisTypTxt The free-text field to specify the type of dental disease The free-text field to specify the type of dental disease If YES, specify type: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-17 09:26:36.973 Medical History [php] [php_1] 255

Free-Form Entry
C17473 Cardiovascular history cardiac surgery date CardioHistCardSurgDate Date of most recent cardiac surgery or mechanical intervention performed on the participant/subject Date of most recent cardiac surgery or mechanical intervention performed on the participant/subject Date of most recent cardiac surgery: Date or Date & Time Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Medical History [php] [php_1]

Free-Form Entry
C52599 Medical history hemorrhagic stroke type MedHistHemorrStrokeTyp The element related to the type of hemorrhagic stroke the participant/subject has had The element related to the type of hemorrhagic stroke the participant/subject has had If YES, indicate type(s) Intracerebral hemorrhage (ICH);Subarachnoid hemorrhage (SAH);Hemorrhage unspecified;Unknown Intracerebral hemorrhage (ICH);Subarachnoid hemorrhage (SAH);Hemorrhage unspecified;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-26 14:10:41.0 Medical History [php] [php_1]

Multiple Pre-Defined Values Selected
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.

 No references available Adult;Pediatric Supplemental 3.10 2024-02-29 15:42:39.0 Medical History [php] [php_1]

Single Pre-Defined Value Selected

 3145578
CSV