CDE Detailed Report
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 18 of 18
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C14948 | Family history relative type no biological sample in repository count | FmlyHistRelTypNoBioSamRepCt | The number of family members that do not have samples in a repository | The number of family members that do not have samples in a repository | No | Numeric Values |
Specify number of family members if No is checked for Family history relative type biological sample in repository indicator. |
No references available | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C00720 | Family history medical condition type | FamHistMedclCondTyp | Type of medical condition or health related event for which the family history is taken | Type of medical condition or health related event for which the family history is taken | Diagnosis | HD diagnosed;CAG expansion but not diagnosed;Other neurological disorder, specify;No neurological diagnosis;Unknown | HD diagnosed;CAG expansion but not diagnosed;Other neurological disorder, (specify);No neurological diagnosis;Unknown | Alphanumeric |
Choose all that apply for all relatives identified Collected from the subject, without requiring supportive clinical data. HD is defined as a diagnosis of HD made by a health care professional. |
No references available | Adult;Pediatric | Supplemental | 4.00 | 2024-02-29 15:42:34.0 | Family History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
3165585 | |||||||
| C14949 | Family history relative type unknown biological sample in repository count | FmlyHistRelTypUnknwBioSamRepCt | The number of family members who are unsure if they have samples in a repository | The number of family members who are unsure if they have samples in a repository | Unknown | Numeric Values |
Specify number of family members if Unknown is checked for Family history relative type biological sample in repository indicator. |
No references available | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C00722 | Family history medical condition relative type | FamHistMedclCondReltvTyp | Relationship of the family member or ancestor with the medical condition or health related event to the participant | Relationship of the family member or ancestor with the medical condition or health related event to the participant | Relative | Mother;Father;Full sibling;Half sibling;Child;Maternal grandmother;Paternal grandmother;Maternal grandfather;Paternal grandfather;Maternal aunt;Paternal aunt;Maternal uncle;Paternal uncle;Maternal niece/nephew;Paternal niece/nephew;Grandchild;Other, specify;Maternal cousin;Paternal cousin;Great-grandchild | Mother;Father;Full sibling;Half sibling;Child;Maternal grandmother;Paternal grandmother;Maternal grandfather;Paternal grandfather;Maternal aunt;Paternal aunt;Maternal uncle;Paternal uncle;Maternal niece/nephew;Paternal niece/nephew;Grandchild;Other, specify;Maternal cousin;Paternal cousin;Great-grandchild | Alphanumeric |
If no first degree relatives have been diagnosed with HD, do not complete family history for second degree relatives. If either or both of the participant's/subject's parents have been diagnosed with HD, complete family history for second degree relatives by considering only the parent(s) diagnosed with HD to determine maternal/paternal relationship. |
Krassioukov A, Alexander MS, Karlsson AK, Donovan W, Mathias CJ, Biering-SØrensen F. International spinal cord injury cardiovascular function basic data set. Spinal Cord. 2010 Aug;48(8):586-90. | Adult;Pediatric | Supplemental | 4.00 | 2024-03-18 15:21:17.0 | Family History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
3165810 | |||||||
| C14950 | Family history relative order number | FmlyHistRelOrderNumber | A numerical number assigned to each relative, if more than one | A numerical number assigned to each relative, if more than one | Number | Numeric Values |
Answer for each family member with that relationship to the participant/subject, if more than 1. |
No references available | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C08000 | Family history relative type total membercount | FmlyHistRelTypeTotalMembrCt | Count of total family members and ancestors for the specified relative type | Count of total family members and ancestors for the specified relative type | Number of Family Members | Numeric Values |
Prepopulated values are provided when possible; data is solicited for those relatives that can have variable values. Some relative types are prefilled with the total number of possible family members (e.g., biological mother is 1) |
No references available | Adult | Supplemental | 4.00 | 2022-07-01 10:51:19.0 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 100 | ||||||||
| C17681 | Family history collection source | FamHxCollSource | The source of collected family history data | The source of collected family history data | From whom/what was the family history collected | Participant/subject;Informant;Medical records | Participant/subject;Informant;Medical records | Alphanumeric |
Choose all that apply |
No references available | Adult | Supplemental | 4.00 | 2024-02-29 15:42:31.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C08001 | Family history relative type biological sample in repository indicator | FmlyHistRelTypBioSampleRepInd | Indicator of whether the participant's family member has donated biological sample(s) to a repository | Indicator of whether the participant's family member has donated biological sample(s) to a repository | Family Members with Sample(s) in Repository | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
No additional instructions |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:54:21.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17682 | Family history collection source informant specify type | FamHxCollSrceInformSpcfyTyp | The type of informant the family history data was collected from | The type of informant the family history data was collected from | If informant, specify type | Spouse (including common law partner);Parent;Sibling;Child;Partner;Other relative;Friend;Other non-relative | Spouse (including common law partner);Parent;Sibling;Child;Partner;Other relative;Friend;Other non-relative | Alphanumeric | No references available | Adult | Supplemental | 3.00 | 2013-08-30 17:06:52.8 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10813 | Adopted indicator | AdoptedInd | Indicator of whether the participant was adopted | Indicator of whether the participant was adopted | Are you adopted | Yes;No | Yes;No | Alphanumeric |
If the participant/ subject reports they are adopted, then ask if they have information about their biological relatives. If yes, continue to complete the form. If no, end completion of form. |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:33.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C18678 | Family history medical condition type other text | FamHistMedclCondTypOTH | The free-text field related to 'Family history medical condition type', specifying other text. Type of medical condition or health related event for which the family history is taken | The free-text field related to 'Family history medical condition type', specifying other text. Type of medical condition or health related event for which the family history is taken | Other, specify | Alphanumeric |
Choose all that apply for all relatives identified Collected from the subject, without requiring supportive clinical data. HD is defined as a diagnosis of HD made by a health care professional. |
No references available | Adult;Pediatric | Supplemental | 1.10 | 2024-02-29 15:42:35.0 | Family History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3165585 | ||||||||
| C14943 | Family history relative deceased indicator | FamHxReltvDeceaseInd | Indicator of whether family member is deceased | Indicator of whether family member is deceased | Deceased? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Answer for each family member with that relationship to the participant/subject, if more than 1. |
No references available | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C18679 | Family history medical condition relative type other text | FamHistMedclCondReltvTypOTH | The free-text field related to 'Family history medical condition relative type', specifying other text. Relationship of the family member or ancestor with the medical condition or health related event to the participant | The free-text field related to 'Family history medical condition relative type', specifying other text. Relationship of the family member or ancestor with the medical condition or health related event to the participant | Other, specify | Alphanumeric |
If no first degree relatives have been diagnosed with HD, do not complete family history for second degree relatives. If either or both of the participant's/subject's parents have been diagnosed with HD, complete family history for second degree relatives by considering only the parent(s) diagnosed with HD to determine maternal/paternal relationship. |
Krassioukov A, Alexander MS, Karlsson AK, Donovan W, Mathias CJ, Biering-SØrensen F. International spinal cord injury cardiovascular function basic data set. Spinal Cord. 2010 Aug;48(8):586-90. | Adult;Pediatric | Supplemental | 1.10 | 2024-02-29 15:42:37.0 | Family History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3165810 | ||||||||
| C14944 | Family history relative age value | FmlyHistRelAgeVal | Value for participant's/subject's family member's current age | Value for participant's/subject's family member's current ag | Current Age | 19-44;45-64;65 years and over | 19-44;45-64;65 years and over | Numeric Values |
Answer for each family member with that relationship to the participant/subject, if more than 1. Answer in years for each family member. Only answer current age OR age at death (if applicable), not both. |
No references available | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C22864 | Diagnosis Huntingtons Disease parent suspect indicator | DiagHDParentSuspectInd | Indicate whether there is a possibility of an HD diagnosis for a parent | Indicate whether there is a possibility of an HD diagnosis for a parent | Suspect parent HD diagnosis | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-12-01 09:07:19.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C14945 | Family history relative death age value | FmlyHistRelDeathAgeVal | Value for participant's/subject's family member's age at death, if deceased | Value for participant's/subject's family member's age at death, if decease | Current Age | 19-44;45-64;65 years and over | 19-44;45-64;65 years and over | Numeric Values |
Answer for each family member with that relationship to the participant/subject, if more than 1. If the family member is deceased, record age at death. Only answer current age OR age at death (if applicable), not both. |
No references available | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C14946 | Family history medical condition relative count | FmlyHistMedclCondRelCt | Number of family members with medical condition | Number of family members with medical condition | Number of Family Members | Numeric Values |
Record the number of family members for each medical condition selected. |
No references available | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C14947 | Family history relative type biological sample in repository count | FmlyHistRelTypBioSamRepCt | The number of family members that have samples in a repository | The number of family members that have samples in a repository | Number of Family Members with Sample(s) in Repository | Numeric Values |
Specify number of family members if Yes is checked for Family history relative type biological sample in repository indicator. |
No references available | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
