CDE Detailed Report

Disease: content
Sub-Domain: General Health History
CRF: welcome

Displaying 1 - 18 of 18
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
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

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

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

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 3.00 2013-07-24 11:38:01.2 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

C00722 Family history medical condition relative type FamHistMedclCondReltvTy Relationship of the family member or ancestor with the medical condition or health related event to the participant/subject Relationship of the family member or ancestor with the medical condition or health related event to the participant/subject 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 3.00 2013-07-24 11:38:01.2 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

C08000 Family history relative type total member number FmlyHistRelTypeTotalMembrNum Number of total family relatives with a specific type of prior medical history. Number of total family relatives with a specific type of prior medical history. 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 3.00 2013-07-22 16:57:17.79 Family History General Health History Participant History and Family History

Free-Form Entry

0 100
C17681 Family history collection source FamHxCollSrce 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 3.00 2013-08-30 17:06:52.8 Family History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C08001 Family history relative type biological sample in repository indicator FmlyHistRelTypBioSampleRepInd Indicator of whether the participant's/subject's family member has donated biological sample(s) to a repository Indicator of whether the participant's/subject'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 3.00 2013-07-22 16:57:17.79 Family History General Health History Participant History and Family History

Single Pre-Defined Value Selected

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

C10813 Adopted indicator AdoptedInd Whether the subject/participant was adopted Whether the subject/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 3.00 2013-07-22 16:57:17.79 Family History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C18678 Family history medical condition other text FamHistMedclCondOTH 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 1.00 2014-05-27 13:34:46.0 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

C18679 Family history medical condition relative other text FamHistMedclCondReltvOTH 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/subject 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/subject 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 1.00 2014-05-27 13:34:46.0 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 age. 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

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

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 deceased. 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

CSV