CDE Detailed Report
Disease: Multiple Sclerosis
Subdomain Name: General Health History
CRF: History Data Source and Reliability
Displaying 1 - 5 of 5
Subdomain Name: General Health History
CRF: History Data Source and Reliability
Displaying 1 - 5 of 5
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
Choose all that apply If selected Family, use the "Other specify" option to specify relation. |
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 |
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| 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 |
Choose all that apply |
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 |
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| C08147 | Data source | DataSource | Source of the data provided on the case report form | Source of the data provided on the case report form | From whom/ what were the medical history data 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 |
Choose all that apply If selected Family, use the "Other specify" option to specify relation. |
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 |
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| 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 | Indicate the reason(s) why | Dementia;Aphasia;Not fluent in examiner's language;Other, specify;Other cognitive impairment;Poor historian | Dementia;Aphasia;Not fluent in examiner's language;Other, specify;Other cognitive impairment;Poor historian | Alphanumeric |
Choose all that apply |
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 |
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| 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 of the reliability of the medical history data obtained | Definitely reliable;Probably reliable;Not reliable | Definitely reliable;Probably reliable;Not reliable | Alphanumeric |
Choose one |
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 |
