CDE Detailed Report
Subdomain Name: General Health History
CRF: welcome
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 |
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C00313 | Medical history condition SNOMED CT code | MedclHistCondSNOMEDCTCode | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | SNOMED CT code | Alphanumeric |
Code each of the medical history conditions using SNOMED CT |
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 | 255 |
Free-Form Entry |
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C18243 | Symptom first appear age type | SymptmFrstApprAgTyp | Type of age of the participant/subject at first symptom appearance | Type of age of the participant/subject at first symptom appearance | Age at first symptom | years;Months;Weeks;Days;Hours | years;Months;Weeks;Days;Hours | Alphanumeric |
Choose only one |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-21 12:11:21.037 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C00314 | Medical history taken date and time | MedclHistTakenDateTime | Date (and time, if applicable and known) the participant's medical history was taken | Date (and time, if applicable and known) the participant '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 | 3.20 | 2024-02-29 15:42:39.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
2179659 | |||||||||
C18254 | Medical history assessment indicator | MedclHistAssmtInd | Whether the participant/subject has a history of any medical problems/conditions | Whether the participant/subject has a history of any medical problems/conditions | History of any medical problems or conditions? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-21 12:11:21.037 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3145578 | ||||||||
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 medical history | Date (and time, if applicable and known) for the end of an event in the participant's medical history | End Date | Date or Date & Time |
Record the date the medical condition/disease ended. 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.) and in the format acceptable to the study database. |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:44.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
3145557 | |||||||||
C19519 | Disease condition associated name | DiseaseConditionAssociatedName | Name of associated disease/condition | Name of associated disease/condition | Associated Disease/Condition | Hearing Loss;Retinal vascular disease;Coats' disease;Restrictive Lung Disease;Epilepsy/Seizures;Developmental Cognitive Impairment;Other disease/condition, specify | Hearing Loss;Retinal vascular disease;Coats' disease;Restrictive Lung Disease;Epilepsy/Seizures;Developmental Cognitive Impairment;Other disease/condition, specify | Alphanumeric | 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 |
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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 medical history | Date (and time, if applicable and known) for the start of an event in the participant's medical history | Start Date | Date or Date & Time |
Record the date the medical condition/disease started. 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.) and in the format acceptable to the study database. |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:43.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
2543596 | |||||||||
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 |
This question is asked to ensure a complete medical history is documented for conditions commonly associated with Facioscapulohumeral muscular dystrophy. |
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 |
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C00319 | Medical history condition ongoing indicator | MedclHistCondOngoingInd | Indicator of whether a medical condition/disease experienced by the participant is ongoing | Indicator of whether a medical condition/disease experienced by the participant is ongoing | Continuing? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Check Yes or No to indicate if the medical condition/disease is still present. |
No references available | Adult;Pediatric | Supplemental | 4.00 | 2024-02-29 15:42:44.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2736881 | |||||||
C19525 | Disease/condition associated other specify text | DiseasCondnAssocdOTHTxt | Free text field that specifies the associated disease or condition | Free text field that specifies the associated disease or condition | Other disease/condition, specify: | Alphanumeric |
This question is asked to ensure a complete medical history is documented for conditions commonly associated with Facioscapulohumeral muscular dystrophy. |
Adult;Pediatric | Supplemental | 1.00 | 2014-07-14 09:54:37.0 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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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 Condition | Alphanumeric | 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 | |||||||||
C19678 | Associated Disease Condition Type | AssoctdDzConditnType | Type of disease or medical condition that is commonly associated with the primary disease under investigation | Type of disease or medical condition that is commonly associated with the primary disease under investigatio | Type | Alphanumeric |
This question should be explicitly asked to ensure a complete medical history is documented for conditions commonly associated with Facioscapulohumeral muscular dystrophy. |
Adult;Pediatric | Supplemental | 1.00 | 2015-01-29 09:29:25.0 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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C08006 | Symptoms first appear date and time | SymptmFirstAppearDateTime | Date (and time if applicable and known) the symptoms for the disease or disorder first appeared as confirmed by the participant's/subject's medical history obtained by a physician | Date (and time if applicable and known) the symptoms for the disease or disorder first appeared as confirmed by the participant's/subject's medical history obtained by a physician | Date of first symptom | Date or Date & Time | Adult;Pediatric | Supplemental | 3.10 | 2022-06-01 10:41:43.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
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C08007 | Diagnosis first given date and time | DiagnosFirstGivnDateTime | Date (and time if applicable and known) the participant/subject was initially diagnosed with the disease or disorder | Date (and time if applicable and known) the participant/subject was initially diagnosed with the disease or disorder | Date at diagnosis | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
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C10501 | Diagnosis initial age value | DiagnosAgeVal | Age of the participant/subject when initially diagnosed with disease/disorder | Age of the participant/subject when initially diagnosed with disease/disorder | Age at diagnosis | Numeric Values |
Answer should be recorded in years. History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 16:29:10.887 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
year | |||||||||
C18241 | Diagnosis age value unit of measure | DiagnosAgeValUOM | Unit of measure for age value of the participant when initially diagnosed with disease/disorder | Unit of measure for age value of the participant when initially diagnosed with disease/disorder | Age at diagnosis | years;Months;Weeks;Days;Hours | years;Months;Weeks;Days;Hours | Alphanumeric |
Choose only one |
No references available | Adult;Pediatric | Supplemental | 4.00 | 2024-02-02 12:33:19.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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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 system | Body system category | Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: | Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: | Alphanumeric | 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 | ||||||||
C18242 | Symptoms first appeared age value | SymptmFrstApprAgVal | Value of the age at which the participant/subject first noted a neuromuscular symptom | Value of the age at which the participant/subject first noted a neuromuscular symptom | Age at first symptom | Numeric Values | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-21 12:11:21.037 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |