CDE Detailed Report

Disease: Multiple Sclerosis
Sub-Domain: General Health History
CRF: History Data Source and Reliability

Displaying 1 - 5 of 5
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 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

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

C11134 History data reliability type MedHistInfoReliablGrade 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

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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

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

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

CSV