CDE Detailed Report

Disease: Myotonic Muscular Dystrophy
Sub-Domain: General Health History
CRF: Medical 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 / 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
C00312 Body system category BodySysCat Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems. Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems. Body System Constitutional symptoms (e.g., fever, weight loss);Eyes;Ears, Nose, Mouth, Throat;Cardiovascular;Respiratory;Gastrointestinal;Genitourinary;Musculoskeletal;Integumentary (skin and/or breast);Neurological;Psychiatric;Endocrine;Hematologic/Lymphatic;Allergic/Immunologic;Hepatobiliary Constitutional symptoms (e.g., fever, weight loss);Eyes;Ears, Nose, Mouth, Throat;Cardiovascular;Respiratory;Gastrointestinal;Genitourinary;Musculoskeletal;Integumentary (skin and/or breast);Neurological;Psychiatric;Endocrine;Hematologic/Lymphatic;Allergic/Immunologic;Hepatobiliary Alphanumeric

Record the code number associated with the appropriate body system for each line of medical history. The numeric codes are provided for studies that will record the data on paper CRFs. In a database the body system can be used without the numeric codes.
Text term to identify a Review of Systems (ROS) component that consists of one or all members of an organ system, and/or additional medical questions.

Review of Symptoms from Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

2002895
C19520 Subject affected indicator SubjectAffectedInd Indicator for the subject's being affected Indicator for the subject's being affected Subject Affected? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2014-07-11 09:17:35.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C00314 Medical history taken date and time MedclHistTakenDateTime Date (and time, if applicable and known) the participant/subject's medical history was taken Date (and time, if applicable and known) the participant/subject's medical history was taken Date Medical History Taken 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 2013-07-25 08:54:08.2 Medical History General Health History Participant History and Family History

Free-Form Entry

2179659
C19521 Thyroid condition type ThyroidConditionTyp Type of thyroid condition Type of thyroid condition Type Hypothyroidism;Hyperthyroidism;Hashimoto's Hypothyroidism;Hyperthyroidism;Hashimoto's Alphanumeric

Indicate the type of thyroid condition

Adult;Pediatric Supplemental 1.00 2014-07-11 09:23:34.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C00315 Medical history global assessment indicator MedclHistGlobalAssmtInd Indicator of whether the participant/subject has a history of any medical problems/conditions Indicator of whether the participant/subject has a history of any medical problems/conditions Does the participant/subject have a history of any medical problems/conditions in the following body systems? Yes;No Yes;No Alphanumeric

If this question is answered NO then the rest of the form is blank. If the question is answered YES then the medical history for at least one body system should be recorded.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

3145578
C19522 Muscle disease hereditary type specify text MusclDiseasHerditryTypSpcfyTxt Specify text for type of hereditary muscle disease Specify text for type of hereditary muscle disease Type Alphanumeric

Hereditary, specify

Adult;Pediatric Supplemental 1.00 2014-07-11 09:59:25.0 Medical History General Health History Participant History and Family History 4000

Free-Form Entry

C00316 Medical history condition end date and time MedclHistCondEndDateTime Date (and time, if applicable and known) for the end of an event in the participant's/subject's medical history Date (and time, if applicable and known) for the end of an event in the participant's/subject's medical history End Date 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 2013-07-25 08:54:08.2 Medical History General Health History Participant History and Family History

Free-Form Entry

3145557
C19523 Muscle disease inflammatory type specify text MusclDiseasInflmtryTypSpcfyTxt Specify text for type of inflammatory muscle disease Specify text for type of inflammatory muscle disease Type Alphanumeric

Inflammatory, specify

Adult;Pediatric Supplemental 1.00 2014-07-11 09:59:25.0 Medical History General Health History Participant History and Family History 4000

Free-Form Entry

C00317 Medical history condition start date and time MedclHistCondStrtDateTime Date (and time, if applicable and known) for the start of an event in the participant's/subject's medical history Date (and time, if applicable and known) for the start of an event in the participant's/subject's medical history Start Date 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 2013-07-25 08:54:08.2 Medical History General Health History Participant History and Family History

Free-Form Entry

2543596
C19524 Diagnosis date DiagnosisDate Date of diagnosis Date of diagnosis Diagnosis Date Date or Date & Time Adult;Pediatric Supplemental 1.00 2014-07-11 10:02:43.0 Medical History General Health History Participant History and Family History

Free-Form Entry

C00319 Medical history condition ongoing indicator MedclHistCondOngoingInd Indicator of whether a medical condition/disease experienced by the participant/subject is ongoing Indicator of whether a medical condition/disease experienced by the participant/subject is ongoing Ongoing? Yes;No Yes;No Alphanumeric

Check Yes or No to indicate if the medical condition/disease is still present.

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

2736881
C19676 Muscle disease hereditary type MuscDisHeredTyp Specify if muscle disease type is hereditary Specify if muscle disease type is hereditary Type Hereditary, specify Hereditary, specify Alphanumeric

Indicate type of muscle disease

Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C00322 Medical history condition text MedclHistCondTxt Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history Medical History Term Alphanumeric

Record one Medical History term per line. Surgeries in the medical history should also be recorded under this CDE. See the data dictionary for additional information on coding the condition using SNOMED CT.
Text term to identify a Review of Systems (ROS) component that consists of one or all members of an organ system, and/or additional medical questions.

SNOMED CT Codes (http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html) Adult;Pediatric Core 3.00 2013-07-25 08:54:08.2 Medical History General Health History Participant History and Family History 4000

Free-Form Entry

2003874
C19677 Muscle disease inflammatory type MuscDisInflammTyp Specify if muscle disease type is inflammatory Specify if muscle disease type is inflammatory Type Inflammatory, specify Inflammatory, specify Alphanumeric

Indicate type of muscle disease

Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C06358 Diabetes mellitus type DiabetesMellitusTyp Type of diabetes mellitus Type of diabetes mellitus Type Type 1;Type 2 Type 1;Type 2 Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 21:00:23.88 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17461 Cancer history type text CancerHistTypTxt Text description of the type of cancer the participant/subject was or is diagnosed with Text description of the type of cancer the participant/subject was or is diagnosed with. Type Alphanumeric

Type of cancer:

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History General Health History Participant History and Family History 255

Free-Form Entry

C18793 Medical history condition other text MedHistCondOTH The free-text field related to 'Medical history condition type' specifying other text. Pre-specified medical condition/disease asked about when collecting the medical history from the participant/subject or found documented in the medical record. The free-text field related to 'Medical history condition type' specifying other text. Pre-specified medical condition/disease asked about when collecting the medical history from the participant/subject or found documented in the medical record. Other disease/condition, specify: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-17 09:26:36.973 Medical History General Health History Participant History and Family History 4000

Free-Form Entry

C19519 Disease condition associated name DiseaseConditionAssociatedName Name of associated disease/condition Name of associated disease/condition Associated Disease/Condition Thyroid condition;Diabetes mellitus;Rheumatoid arthritis;Systemic lupus erythematosus (SLE);Muscle disease;Epilepsy/Seizures;Cancer;Other disease/condition, specify Thyroid condition;Diabetes mellitus;Rheumatoid arthritis;Systemic lupus erythematosus (SLE);Muscle disease;Epilepsy/Seizures;Cancer;Other disease/condition, specify Alphanumeric

The questions in the following table should be explicitly asked to ensure a complete medical history is documented for conditions associated with Myotonic Dystrophy.

Adult;Pediatric Supplemental 1.00 2014-07-11 08:54:47.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

CSV