CDE Detailed Report

Disease: Friedreich's Ataxia
Sub-Domain: General Health History
CRF: History Data Source and Reliability

Displaying 1 - 6 of 6
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
C08147 Data source DataSource Source of the data provided on the case report form Source of the data provided on the case report form Indicate how the medical/family history information was obtained Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Alphanumeric

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No references available Adult;Pediatric Exploratory 3.00 2013-07-20 10:46:24.96 History Data Source and Reliability General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C11133 History data not obtained reason HistDataNotObtRsn Reason(s) the medical/family history data were not obtained from the participant/subject and instead were obtained from alternate source(s). Reason(s) the medical/family history data were not obtained from the participant/subject and instead were obtained from alternate source(s). If the medical/family history information was not obtained from the participant/subject, indicate the reason(s) the information were obtained from alternate source(s). Dementia;Aphasia;Other cognitive impairment;Not fluent in examiner's language;Poor historian;Too young;Other, specify Dementia;Aphasia;Other cognitive impairment;Not fluent in examiner's language;Poor historian;Too young;Other, specify Alphanumeric

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No references available Adult;Pediatric Exploratory 3.00 2013-07-11 15:03:49.2 History Data Source and Reliability General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C11134 History data reliability type HistDataReliablTyp Overall assessment of the reliability of the medical/family history data obtained Overall assessment of the reliability of the medical/family history data obtained Overall assessment fo the reliability of the medical/family history information obtained Definitely reliable;Probably reliable;Not reliable Definitely reliable;Probably reliable;Not reliable Alphanumeric

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No references available Adult;Pediatric Exploratory 3.00 2013-07-11 15:03:49.2 History Data Source and Reliability General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17501 Medical history information source family text MedHistInfoSourceFmlyTxt Text specifying the relation of the family member, from whom medical/family history information was obtained, to the participant. Text specifying the relation of the family member, from whom medical/family history information was obtained, to the participant. Family, specify relation Alphanumeric No references available Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 History Data Source and Reliability General Health History Participant History and Family History 255

Free-Form Entry

C18667 Data source other text DataSourcOTH The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form Other, specify Alphanumeric

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No references available Adult;Pediatric Exploratory 1.00 2014-05-27 13:34:46.0 History Data Source and Reliability General Health History Participant History and Family History 4000

Free-Form Entry

C18824 History data not obtained other text HistDataNotObtOTH The free-text field related to 'History data not obtained reason' specifying other text. Reason(s) the medical/family history data were not obtained from the participant/subject and instead were obtained from alternate source(s). The free-text field related to 'History data not obtained reason' specifying other text. Reason(s) the medical/family history data were not obtained from the participant/subject and instead were obtained from alternate source(s).` Other, specify Alphanumeric

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No references available Adult;Pediatric Exploratory 3.00 2013-07-11 15:03:49.2 History Data Source and Reliability General Health History Participant History and Family History 4000

Free-Form Entry

CSV