CDE Detailed Report
Disease: Friedreich's Ataxia
Subdomain Name: General Health History
CRF: Medical History
Displaying 1 - 47 of 47
Subdomain Name: General Health History
CRF: Medical History
Displaying 1 - 47 of 47
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C17468 | Cardiovascular history arrhythmia bradycardia indicator | CardioHistArrhythBradycardInd | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of bradycardia | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of bradycardia | Bradycardia | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00313 | Medical history condition SNOMED CT code | MedclHistCondSNOMEDCTCode | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | Medical History Term | Alphanumeric |
Code each of the medical history conditions using SNOMED CT |
SNOMED CT Codes (http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html) | Adult;Pediatric | Core | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C17479 | Cardiovascular history ischemia heart disease indicator | CardioHistIschHeartDiseaseInd | Indicator as to whether the participant/subject has or had ischemia heart disease | Indicator as to whether the participant/subject has or had ischemia heart disease | Ischemia heart disease | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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 | If Yes, treated with head or neck radiation? | Yes;No/Not documented;Unknown | Yes;No/Not documented;Unknown | Alphanumeric |
History can also be obtained from a family member, friend, or chart/ medical record. If the informant is unable to answer the question or is deemed unreliable (e.g., the participant/ subject has dementia) the history should be obtained from the medical record. Unknown includes the scenario where information in not documented in the medical record. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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 |
Choose all that apply |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C17469 | Cardiovascular history arrhythmia indicator | CardioHistArrhythInd | Indicator as to whether the participant/subject has or had a cardiac arrhythmia | Indicator as to whether the participant/subject has or had a cardiac arrhythmia | Arrhythmia | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00314 | Medical history taken date and time | MedclHistTakenDateTime | Date (and time, if applicable and known) the participant's medical history was taken | Date (and time, if applicable and known) the participant 's medical history was taken | Date Medical History Taken | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
No references available | Adult;Pediatric | Core | 3.20 | 2024-02-29 15:42:39.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
2179659 | |||||||||
| 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 | Indicate the complications of diabetes | Nephropathy;Neuropathy;Retinopathy;Other, specify;None | Nephropathy;Neuropathy;Retinopathy;Other, specify;None | Alphanumeric |
Choose all that apply |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C10546 | Depression first episode diagnosed age value | DepressFrstEpisodDiagAgeVale | Value representing the age, in years, at which the participant/subject experienced her or his first depressive episode or was first diagnosed with depression, whichever is earlier | Value representing the age, in years, at which the participant/subject experienced her or his first depressive episode or was first diagnosed with depression, whichever is earlier | Age at which participant/subject experienced first depressive episode or was first diagnosed with depression, whichever is earlier | Numeric Values |
Answer should be recorded in years. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
year | |||||||||
| 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 |
Choose all that apply |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C17470 | Cardiovascular history arrhythmia other text | CardioHistArrhythOtherTxt | Text description of any cardiac arrhythmia the participant/subject has or had in a form other than atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, or bradycardia | Text description of any cardiac arrhythmia the participant/subject has or had in a form other than atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, or bradycardia | Other, specify | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| 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 | Documented medical history: | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:39.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3145578 | ||||||||
| C17482 | Diabetes mellitus indicator | EndocrineHistDiabetesMellInd | Indicator as to whether the participant/subject has diabetes mellitus (type I or type II) | Indicator as to whether the participant/subject has diabetes mellitus (type I or type II) | Diabetes mellitus (type I or type II) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17460 | Cancer history indicator | CancerHistInd | Indicator as to whether the participant/subject has or had cancer | Indicator as to whether the participant/subject has or had cance | Cancer | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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 |
Choose all that apply |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C17471 | Cardiovascular history arrhythmia supraventricular tachycardia indicator | CardioHistArrhythSupraTachInd | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of supraventricular tachycardia | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of supraventricular tachycardia | Supraventricular tachycardia | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00316 | Medical history condition end date and time | MedclHistCondEndDateTime | Date (and time, if applicable and known) for the end of an event in the participant's medical history | Date (and time, if applicable and known) for the end of an event in the participant's medical history | End Date | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:44.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
3145557 | |||||||||
| C17483 | Psychiatric history clinical anxiety diagnosis indicator | PsychHistClinAnxietyDiagnosInd | Indicator as to whether the participant/subject has had an anxiety diagnosis | Indicator as to whether the participant/subject has had an anxiety diagnosi | Anxiety disorder diagnosis | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17461 | Cancer history type text | CancerHistTypTxt | Text description of the type of cancer the participant/subject was or is diagnosed with | Text description of the type of cancer the participant/subject was or is diagnosed wit | If Yes, type of cancer diagnosed with | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C17472 | Cardiovascular history arrhythmia ventricular tachycardia indicator | CardioHistArrhythVentTachInd | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of ventricular tachycardia | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of ventricular tachycardia | Ventricular tachycardia | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00317 | Medical history condition start date and time | MedclHistCondStrtDateTime | Date (and time, if applicable and known) for the start of an event in the participant's medical history | Date (and time, if applicable and known) for the start of an event in the participant's medical history | Start Date | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:43.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
2543596 | |||||||||
| C17484 | Psychiatric history clinical anxiety past year indicator | PsychHistClinAnxietyPastYrInd | Indicator as to whether the participant/subject had clinical anxiety within the last year | Indicator as to whether the participant/subject had clinical anxiety within the last year | Clinical anxiety within the past year | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17462 | Cardiovascular history abnormal echocardiogram decreased left ventricular function indicator | CardioHistAbnrmlECGDecLVFnInd | Indicator as to whether the participant/subject has or had an abnormal echocardiogram (ECG) specifically exhibiting decreased left ventricular (LV) function | Indicator as to whether the participant/subject has or had an abnormal echocardiogram (EKG) specifically exhibiting decreased left ventricular (LV) function | Decreased LV function | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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 surgery | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C00319 | Medical history condition ongoing indicator | MedclHistCondOngoingInd | Indicator of whether a medical condition/disease experienced by the participant is ongoing | Indicator of whether a medical condition/disease experienced by the participant is ongoing | Ongoing? | Yes;No | Yes;No | Alphanumeric |
Check Yes or No to indicate if the medical condition/disease is still present. |
No references available | Adult;Pediatric | Supplemental | 4.00 | 2024-02-29 15:42:44.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2736881 | |||||||
| C17485 | Psychiatric history clinical depression past year indicator | PsychHistClinDepressPastYrInd | Indicator as to whether the participant/subject has had clinical depression within the last year | Indicator as to whether the participant/subject has had clinical depression within the last year | Clinical depression within the past year | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17463 | Cardiovascular history abnormal echocardiogram indicator | CardioHistAbnrmlECGInd | Indicator as to whether the participant/subject has or had an abnormal echocardiogram (ECG) | Indicator as to whether the participant/subject has or had an abnormal echocardiogram (EKG) | Abnormal echocardiogram | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17474 | Cardiovascular history cardiac surgery indicator | CardioHistCardSurgInd | Indicator as to whether the participant/subject has had cardiac surgery or mechanical intervention | Indicator as to whether the participant/subject has had cardiac surgery or mechanical intervention | Cardiac surgery/mechanical intervention | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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 | Core | 3.00 | 2013-07-22 16:57:17.79 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17486 | Psychiatric history clinical depressive diagnosis indicator | PsychHistClinDepressDiagnosInd | Indicator as to whether the participant/subject had a depressive disorder diagnosis | Indicator as to whether the participant/subject had a depressive disorder diagnosis | Depressive disorder diagnosis | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17464 | Cardiovascular history abnormal echocardiogram left ventricular hypertrophy indicator | CardioHistAbnrmlECGLVHInd | Indicator as to whether the participant/subject has or had an abnormal echocardiogram (ECG) specifically exhibiting left ventricular hypertrophy (LVH) | Indicator as to whether the participant/subject has or had an abnormal echocardiogram (EKG) specifically exhibiting left ventricular hypertrophy (LVH) | LVH | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17475 | Cardiovascular history cardiac surgery type | CardioHistCardSurgTyp | Type of cardiac surgery or mechanical intervention the participant/subject underwent | Type of cardiac surgery or mechanical intervention the participant/subject underwent | If Yes, indicate type | Coronary artery bypass graft;Cardiac valve surgery, including non-open surgery;Pacemaker;Implantable cardiac defibrillator;Other, specify | Coronary artery bypass graft (CABG);Cardiac valve surgery, including non-open surgery (i.e. percutaneous valvuloplasty);Pacemaker;Implantable cardiac defibrillator;Other, specify | Alphanumeric |
Choose all that apply |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C00322 | Medical history condition text | MedclHistCondTxt | Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history | Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history | Medical History Term | Alphanumeric |
Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description. |
No references available | Adult;Pediatric | Core | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
2003874 | ||||||||
| C17487 | Psychiatric history psychotic diagnosis text | PsychHistPsychoticDiagnosTxt | Text identification of any psychotic disorder diagnosis made for the participant/patient | Text identification of any psychotic disorder diagnosis made for the participant/patien | Psychotic disorder diagnosis description | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C17465 | Cardiovascular history abnormal echocardiogram other text | CardioHistAbnrmlECGOtherTxt | Text description of any abnormal characteristics other than left ventricular hypertrophy (LVH), or decreased left ventricular (LV) function that the participant/subject has ever exhibited on an echocardiogram (ECG) | Text description of any abnormal characteristics other than left ventricular hypertrophy (LVH), or decreased left ventricular (LV) function that the participant/subject has ever exhibited on an echocardiogram (EKG) | Other, specify | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C17476 | Cardiovascular history condition indicator | CardioHistCondInd | Indicator as to whether the participant/subject has or had a cardiac condition or complication | Indicator as to whether the participant/subject has or had a cardiac condition or complication | Cardiac condition | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C06358 | Diabetes mellitus type | DiabetesMellitusTyp | Type of diabetes mellitus | Type of diabetes mellitus | Indicate type | Type 1;Type 2 | Type 1;Type 2 | Alphanumeric | Adult;Pediatric | Supplemental | 4.00 | 2024-02-29 15:41:20.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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, choose all disorders that apply | 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 |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C17466 | Cardiovascular history arrhythmia atrial fibrillation indicator | CardioHistArrhythAtrialFibInd | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of atrial fibrillation | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of atrial fibrillation | Atrial fibrillation | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17477 | Cardiovascular history congenital heart disease indicator | CardioHistCongHeartDiseaseInd | Indicator as to whether the participant/subject has or had a congenital heart disease | Indicator as to whether the participant/subject has or had a congenital heart disease | Congenital heart disease | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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 | Indicate age when diabetes was first diagnosed | Numeric Values |
Answer should be recorded in years. |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:41:16.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
year | |||||||||
| C17489 | Psychotic disorder indicator | PsychoDisorderInd | Indicator as to whether the participant/subject has had a psychotic disorder diagnosis | Indicator as to whether the participant/subject has had a psychotic disorder diagnosi | Psychotic disorder diagnosis | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17467 | Cardiovascular history arrhythmia atrial flutter indicator | CardioHistArrhythAtrialFlutInd | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of atrial flutter | Indicator as to whether the participant/subject has or had a cardiac arrhythmia in the form of atrial flutter | Atrial flutter | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00312 | Body system category | BodySysCat | Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems | Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body system | Body System | Constitutional symptoms (e.g., fever, weight loss);Eyes;Ears, Nose, Mouth, Throat;Cardiovascular;Respiratory;Gastrointestinal;Genitourinary;Musculoskeletal;Integumentary (skin and/or breast);Psychiatric;Endocrine;Hematologic/Lymphatic;Allergic/Immunologic;Hepatobiliary | Constitutional symptoms (e.g., fever, weight loss);Eyes;Ears, Nose, Mouth, Throat;Cardiovascular;Respiratory;Gastrointestinal;Genitourinary;Musculoskeletal;Integumentary (skin and/or breast);Psychiatric;Endocrine;Hematologic/Lymphatic;Allergic/Immunologic;Hepatobiliary | Alphanumeric |
Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.;Each body system is pre-populated on the case report form. Record the physical exam results for each. |
Review of Symptoms from Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2002895 | |||||||
| C17478 | Cardiovascular history heart failure indicator | CardioHistHeartFailureInd | Indicator as to whether the participant/subject has ever experienced heart failure | Indicator as to whether the participant/subject has ever experienced heart failure | Heart failure | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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 | Indicate the treatments taken for diabetes | Diet;Oral medication;Insulin;None | Diet;Oral medication;Insulin;None | Alphanumeric |
Choose all that apply |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| 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 |
Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.;Each body system is pre-populated on the case report form. Record the physical exam results for each. |
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 | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
2002895 |
