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 51 - 54 of 54
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
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

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

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

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

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