CDE Detailed Report
Disease: Stroke
Subdomain Name: General Health History
CRF: Prior Functional Status
Displaying 1 - 9 of 9
Subdomain Name: General Health History
CRF: Prior Functional Status
Displaying 1 - 9 of 9
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C11086 | School placement type | SchoolPlacementTyp | The description of the type of education the participant/subject receives with details of being with or without assistance | The description of the type of education the participant/subject receives with details of being with or without assistanc | School placement | Full-time regular education without aide;Full-time regular education with one to one aide;Regular education with pull-out for certain areas;Special education w/minimal inclusion (e.g., lunch);Full time special education with no inclusion;Special (MR/DD) school;Home-schooled;Not in school;Other, specify | Full-time regular education without aide;Full-time regular education with one to one aide;Regular education with pull-out for certain areas;Special education w/minimal inclusion (e.g., lunch);Full time special education with no inclusion;Special (MR/DD) school;Home-schooled;Not in school;Other, specify | Alphanumeric |
This element can be collected to describe the participant/ subject prior to the stroke event and also to assess the participant/ subject at subsequent time points after the stroke event. |
No references available | Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Prior Functional Status | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C14639 | Ambulatory status | AmbulatStatus | Status that reflects the participant's ability to walk | Status that reflects the participant's ability to walk | Ambulatory status | Able to ambulate independently (no help from another person) w/ or w/o device;With assistance (from person);Unable to ambulate;Unknown | Patient ambulating without assistance (no help from another person) with or without a device. This means Patient is able to ambulate without help from another person. The use of a device, such as a cane, still meets this definition.;Patient ambulating with assistance of another person.;Patient is on bed rest. Patient is only getting out of bed to the bedside commode (or up in chair) and is primarily in the bed (or immobile).;Unknown or not documented. It is unable to determine from documentation. | Alphanumeric |
Choose one that describes the participant's/subject's ability prior to the qualifying stroke event. |
Get With The Guidelines (GWTG) Stroke Patient Management Tool Coding Instructions (Updated on 11/4/2009); Paul Coverdell National Acute Stroke Registry SPS3 | Adult;Pediatric | Core | 3.10 | 2024-02-29 15:49:22.0 | Prior Functional Status | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C18768 | Therapy or rehabilitation other text | TherpyRehabOTH | The free-text field related to 'Therapy or rehabilitation type' specifying other text. Type of therapy or rehabilitation services received by the participant/subject | The free-text field related to 'Therapy or rehabilitation type' specifying other text. Type of therapy or rehabilitation services received by the participant/subject | Other, specify | Alphanumeric |
Choose all that apply. This element can be collected to describe the participant/ subject prior to the stroke event and also to assess the participant/ subject at subsequent time points after the stroke event. |
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): https://www.cdc.gov/nchs/icd/icd10cm.htm | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Prior Functional Status | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C18820 | Developmental and academic history other text | DevelopmentalAcademicHistOTH | The free-text field related to 'Developmental and academic history type' specifying other text. Specific aspects of the participant's/subject's pre-morbid developmental status and academic function | The free-text field related to 'Developmental and academic history type' specifying other text. Specific aspects of the participant's/subject's pre-morbid developmental status and academic function | Other, specify | Alphanumeric |
For each history type indicate whether or not the participant/subject has a history |
International Pediatric Stroke Study (IPSS) | Pediatric | Supplemental | 3.00 | 2013-07-10 11:37:29.993 | Prior Functional Status | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C18821 | School placement other text | SchoolPlacementOTH | The free-text field related to 'School placement type' specifying other text. The description of the type of education the participant/subject receives with details of being with or without assistance | The free-text field related to 'School placement type' specifying other text. The description of the type of education the participant/subject receives with details of being with or without assistanc | Other, specify | Alphanumeric |
This element can be collected to describe the participant/ subject prior to the stroke event and also to assess the participant/ subject at subsequent time points after the stroke event. |
No references available | Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Prior Functional Status | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C05130 | Therapy or rehabilitation type | TherpyRehabTyp | Type of therapy or rehabilitation services received by the participant/subject | Type of therapy or rehabilitation services received by the participant/subjec | Specialized therapies and services | Speech therapy;Occupational therapy;Physical therapy;Sensory integration therapy;Social skills training;Adaptive physical education;Behavior support plan;Crisis management plan;Other, specify | Speech therapy;Occupational therapy;Physical therapy;Sensory integration therapy;Social skills training;Adaptive physical education;Behavior support plan;Crisis management plan;Other, specify | Alphanumeric |
Choose all that apply. This element can be collected to describe the participant/ subject prior to the stroke event and also to assess the participant/ subject at subsequent time points after the stroke event. |
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): https://www.cdc.gov/nchs/icd/icd10cm.htm | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Prior Functional Status | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C06005 | Data collected date and time | DataCollDateTime | Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performed | Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performe | Date information collected | 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 | 2013-07-24 21:00:23.88 | Prior Functional Status | General Health History | Participant History and Family History |
Free-Form Entry |
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| C11084 | Developmental and academic history type | DevelopmentalAcademicHistTyp | Specific aspects of the participant's/subject's pre-morbid developmental status and academic function | Specific aspects of the participant's/subject's pre-morbid developmental status and academic function | Does/did the participant/ subject have any of the following | Attention Deficit Hyperactivity Disorder (ADHD);Attention Deficit Disorder (ADD);Delayed acquisition of motor milestones, diagnosed by a pediatrician or neurologist;Social delay;Hand preference before twelve months of age;Abnormality of gait noted by parent or physician at the time the child began walking;Received or receives special education;Other, specify;Delayed acquisition of language milestones, diagnosed by a health care provider or educator;Delayed acquisition of cognitive milestones, diagnosed by a health care provider or educator | Attention Deficit Hyperactivity Disorder (ADHD);Attention Deficit Disorder (ADD);Delayed acquisition of motor milestones, diagnosed by a pediatrician or neurologist;Social delay;Hand preference before twelve months of age;Abnormality of gait noted by parent or physician at the time the child began walking;Received or receives special education;Other, specify;Delayed acquisition of language milestones, diagnosed by a health care provider or educator;Delayed acquisition of cognitive milestones, diagnosed by a health care provider or educator | Alphanumeric |
For each history type indicate whether or not the participant/subject has a history |
International Pediatric Stroke Study (IPSS) | Pediatric | Supplemental | 3.00 | 2013-07-10 11:37:29.993 | Prior Functional Status | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C11085 | Developmental and academic history indicator | DevelopmentalAcacdemicHistInd | Whether the participant/subject has a history of the specific aspect of the pre-morbid developmental status or academic function | Whether the participant/subject has a history of the specific aspect of the pre-morbid developmental status or academic function | Does/did the participant/ subject have any of the following | Yes;No;Unknown | History reported and/or confirmed in medical record;History NOT reported and NOT confirmed in medical record;History reported as unknown or could not be collected | Alphanumeric |
For each history type indicate whether or not the participant/subject has a history. Choose one for each history type. |
International Pediatric Stroke Study (IPSS) | Pediatric | Supplemental | 3.00 | 2013-07-10 11:37:29.993 | Prior Functional Status | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
