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
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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
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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

C10231 Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - age twenty one forty state province location PDDOCMERQAge2140StateProvLoc Location of the state/province 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 state/province 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) 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

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

C10242 Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - parkinson diagnosis indicator PDDOCMERQPrknsnDiagInd Indicator for whether the participant/subject has ever been 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 been diagnosed with Parkinson's Disease, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) Have you been diagnosed with Parkinsons disease or another parkinsonism syndrome? (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

C10274 Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - regular use of progesterone hormone replacement (PHR) indicator PDDOCMERQRegUsePHRInd Indicator for the regular use of progesterone-containing hormone replacement drug (e.g., Provera, Prometrium), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) Indicator for the regular use of progesterone-containing hormone replacement drug (e.g., Provera, Prometrium), as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) Regular use of progesterone-containing hormone replacement drug (e.g., Provera, Prometrium) 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

C10253 Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) - current caffeine intake number PDDOCMERQCrrntCaffneIntkeNum Number of cups of caffeine-containing beverages the participant/subject drinks on a typical day, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) Number of cups of caffeine-containing beverages the participant/subject drinks on a typical day, as a part of Parkinson's Disease - Mini Environmental Risk Questionnaire (PD-DOC-MERQ) At present, how many cups of a caffeine containing beverage do you drink on a typical day? 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CSV