CDE Detailed Report
Subdomain Name: General Health History
CRF: Behavioral History
Displaying 1 - 32 of 32
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C19502 | Tobacco cigarettes smoke daily average value | TobccoCigrtSmkeDailyAvgVal | Tobacco cigarettes smoked daily average number | If participant is a former or current smoker, documents the average number of cigarettes he/she smokes or did smoke on a daily basis | During the time that you regularly smoked, on average, how much did you smoke per day? Number of cigarettes: | Numeric Values |
History can be obtained from participant/subject, family member, friend, or chart/medical record. |
PhenX Toolkit https://www.phenxtoolkit.org/index.php - Protocol 1 : Tobacco - 30-Day Quantity and Frequency (Adolescent Protocol) #030801 | Adult;Pediatric | Supplemental | 3.00 | 2013-07-17 09:26:36.973 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C55989 | Regular aerobic exercise indicator | RegularAerobicExerciseInd | Indicator related to whether or not the participant/subject participates in regular aerobic exercise | Indicator related to whether or not the participant/subject participates in regular aerobic exercise | Regular aerobic exercise | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Supplemental - Highly Recommended based on study type, disease stage and disease type |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2017-06-05 10:05:06.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00701 | Tobacco use stopped age value | TobcoUseStopAgeVal | Age in years when participant/subject stopped using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) | Age in years when participant/subject stopped using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) | Age stopped tobacco use (years): | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. The age in years should be collected or N/A (Not applicable if subject never smoked) should be selected. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | 2524471 | ||||||
| C00714 | Behavioral history assessment date and time | BehavrlHistAssmtDateTime | Date (and time, if applicable and known) the participant/subject behavioral history was taken | Date (and time, if applicable and known) the participant/subject behavioral history was take | Date behavioral 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 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
3170040 | |||||||||
| C55993 | Regular aerobic exercise days week number | RglrArbcExrcsDysWkNum | Number of days per typical week that the participant/subject engages in aerobic exercises | Number of days per typical week that the participant/subject engages in aerobic exercises | If yes, during a typical week how many days do you get regular aerobic exercise | 0;1-2;3-5;6-7 | 0;1-2;3-5;6-7 | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Supplemental - Highly Recommended based on study type, disease stage and disease type |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2017-06-05 10:17:15.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00702 | Alcohol use started age value | AlcUseStrtAgeVal | Age in years when participant/subject started ingesting alcoholic beverages, including social drinking | Age in years when participant/subject started ingesting alcoholic beverages, including social drinking | Age started drinking (years): | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. The age in years should be collected or N/A (Not applicable if subject never smoked) should be selected. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | 2008447 | ||||||
| C00730 | Alcohol use frequency | AlcUseFreq | The frequency of consumption of alcohol by the participant | The frequency of consumption of alcohol by the participan | How often do you have a drink containing alcohol? | Monthly or less;2 to 4 times a month;2 to 3 times a week;4 or more times a week;Never | Monthly or less;2 to 4 times a month;2 to 3 times a week;4 or more times a week;Never | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Supplemental - Highly Recommended based on study type, disease stage and disease type |
Question is from the Alcohol Use Disorders Identification Test (AUDIT) - http://www.who.int/substance_abuse/activities/sbi/en/ | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 16:35:19.49 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171627 | |||||||
| C56008 | Perceived Stress Scale (PSS) - Unable control important thing life scale | PSSUnablCntrlImprtntThngLfScl | Scale of how often in the last month that the participant/subject has felt that he or she was unable to control the important things in his/her life | Scale of how often in the last month that the participant/subject has felt that he or she was unable to control the important things in his/her life | In the last month, how often have you felt that you were unable to control the important things in your life? | Never;Almost Never;Sometimes;Fairly Often;Very Often | Never;Almost Never;Sometimes;Fairly Often;Very Often | Alphanumeric |
The four questions listed were taken from the PSS-4 item questionnaire. The questions in this scale ask about the participant's feelings and thoughts during the last month. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2017-06-05 11:52:29.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00703 | Tobacco use started age value | TobcoUseStrtAgeVal | Age in years when participant/subject started using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) | Age in years when participant/subject started using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) | Age started tobacco use (years): | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. The age in years should be collected or N/A (Not applicable if subject never smoked) should be selected. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | 2178045 | ||||||
| C06108 | Tobacco smoke pack-year value | TobccoSmkePckYrVal | If participant is a former or current cigarette smoker, documents the number of pack-years of smoking [(average number smoked daily)/20] x (number of years smoked) = pack-years] | If participant is a former or current cigarette smoker, documents the number of pack-years of smoking [(average number smoked daily)/20] x (number of years smoked) = pack-years] | For former or current cigarette smokers only, indicate the number of pack-years of smoking: [(average number of cigarettes smoked daily)/20] x (number of years smoked: _____pack-years | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Supplemental - Highly Recommended based on study type, disease stage and disease type |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-17 09:26:36.973 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
pack-years | |||||||||
| C56009 | Perceived Stress Scale (PSS) - Confident handle personal problem scale | PSSCnfdntHndlPrsnlPrblmScl | Scale of how often in the last month that the participant/subject has felt confident in his or her ability to handle his or her personal problems | Scale of how often in the last month that the participant/subject has felt confident in his or her ability to handle his or her personal problems | In the last month, how often have you felt confident about your ability to handle your personal problems? | Never;Almost Never;Sometimes;Fairly Often;Very Often | Never;Almost Never;Sometimes;Fairly Often;Very Often | Alphanumeric |
The four questions listed were taken from the PSS-4 item questionnaire. The questions in this scale ask about the participant's feelings and thoughts during the last month. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2017-06-05 11:52:29.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00704 | Alcohol drinking day average drinks consumed range | AlcDrinkingDayAvgDrinksCnsmRng | The counted number of drinks containing alcohol consumed by the participant/subject on a typical day when he/she is drinking. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another, so the most common alcoholic beverages likely to be consumed will be defined as well as quantity of each that constitutes a drink (approximately 10 grams of pure ethanol). For example, one bottle of beer (330 ml at 5% ethanol), a glass of wine (140 ml at 12% ethanol), and a shot of spirits (40 ml at 40% ethanol) represent a standard drink of about 13 g of ethanol | The counted number of drinks containing alcohol consumed by the participant/subject on a typical day when he/she is drinking. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another | How many alcoholic drinks do you have on a typical day when you are drinking? | 1 or 2;3 or 4;5 or 6;7, 8, or 9;10 or more;Unknown | 1 or 2;3 or 4;5 or 6;7, 8, or 9;10 or more;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
Question is from the Alcohol Use Disorders Identification Test (AUDIT) - http://www.who.int/substance_abuse/activities/sbi/en/ | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 16:35:19.49 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171647 | |||||||
| C18670 | Subscribed drug or substance illicitly used category other text | SbscrbdDrgSubIllctUseCatOTH | The free-text field related to 'Subscribed drug or substance illicitly used category' specifying other text. Category of illegal drugs, prescription, or over-the-counter drugs the participant/subject used for purposes other than those for which they are meant to be used, or in large amounts | Subscribed drug substance illicitly used category specifying other text. Category of illegal drugs, prescription, or over-the-counter drugs the participant/subject used for purposes other than those for which they are meant to be used, or in large amounts | Other, specify (e.g., Methadone, Elavil, steroids, Thorazine, or Haldol) | Alphanumeric | Adult | Supplemental | 1.10 | 2022-06-24 11:33:13.0 | Behavioral History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3171797 | ||||||||||
| C56010 | Perceived Stress Scale (PSS) - Thing going your way scale | PSSThingGoingYourWayScl | Scale of how often in the last month that the participant/subject has felt that things were going his or her way | Scale of how often in the last month that the participant/subject has felt that things were going his or her way | In the last month, how often have you felt that things were going your way? | Never;Almost Never;Sometimes;Fairly Often;Very Often | Never;Almost Never;Sometimes;Fairly Often;Very Often | Alphanumeric |
The four questions listed were taken from the PSS-4 item questionnaire. The questions in this scale ask about the participant's feelings and thoughts during the last month. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2017-06-05 11:52:29.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00705 | Alcohol current use indicator | AlcCurntUseInd | Indicator of whether the participant/subject consumed at least one alcoholic drink within the past 12 months | Indicator of whether the participant/subject consumed at least one alcoholic drink within the past 12 months | Current drinker? (Consumed at least one drink within the past year) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. In the U.S., a single drink serving contains about 14 grams of ethanol or "pure" alcohol. Although the drinks below are different sizes, each one contains the same amount of pure alcohol and counts as a single drink: 12 oz. of beer (about %% alcohol) = 8-9 oz. of malt liquor (about 7% alcohol) = 5 oz. of wine (about 12% alcohol) = 1.5 oz. of hard liquor (about 40% alcohol) |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171540 | |||||||
| C20377 | Pittsburgh Sleep Quality Index (PSQI) - Past month bed time | PSQIPastMonthBedTime | The bed time (recorded as 24-hour clock or military time) for the majority of the nights in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) | The bed time (recorded as 24-hour clock or military time) for the majority of the nights in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI | In the last month, when have you gone to bed at night? | Date or Date & Time |
The first four questions were taken from the PSQI. The questions in this scale ask about the participant's sleep quality. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2015-03-11 11:17:32.0 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C56011 | Perceived Stress Scale (PSS) - Difficulty piling up unable overcome scale | PSSDffcltyPlngUpUnablOvrcmScl | Scale of how often in the last month that the participant/subject has felt that difficulties were piling up so high that he or she could not overcome them | Scale of how often in the last month that the participant/subject has felt that difficulties were piling up so high that he or she could not overcome them | In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? | Never;Almost Never;Sometimes;Fairly Often;Very Often | Never;Almost Never;Sometimes;Fairly Often;Very Often | Alphanumeric |
The four questions listed were taken from the PSS-4 item questionnaire. The questions in this scale ask about the participant's feelings and thoughts during the last month. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2017-06-05 11:52:29.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00706 | Alcohol prior use indicator | AlcPriorUseInd | Indicator of the participant's/subject's alcohol consumption prior to the past 12 months | Indicator of the participant's/subject's alcohol consumption prior to the past 12 months | Past drinker? (Consumed at least one drink prior to the past year) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171578 | |||||||
| C55907 | Nonsubscribed drug or substance illicitly used category | NonsbscrbdDrgSubIllctUseCat | Category of illegal drugs, prescription, or over-the-counter drugs unsubscribed by the participant/subject, and used for purposes other than those for which they are meant to be used, or in large amounts | Category of illegal drugs, prescription, or over-the-counter drugs unsubscribed by the participant/subject, and used for purposes other than those for which they are meant to be used, or in large amounts | If YES, specify type(s) used (select all that apply): | Sedatives (e.g., sleeping pills, barbiturates, Seconal, Quaaludes, or Chloral Hydrate);Tranquilizers or anti-anxiety drugs (e.g., Valium, Librium, muscle relaxants, or Xanax);Painkillers (e.g., Codeine, Darvon, Percodan, Dilaudid, or Demerol);Stimulants (e.g., Preludin, Benzedrine, Methadrine, uppers, or speed);Marijuana, hash, THC, or grass;Cocaine or crack;Hallucinogens (e.g., Ecstasy, LSD, mescaline, psilocybin, PCP, angel dust, or peyote);Inhalants or Solvents (e.g., amyl nitrate, nitrous oxide, glue, toluene, or gasoline;Heroin;Other, specify (e.g., Methadone, Elavil, steroids, Thorazine, or Haldol) | Sedatives (e.g., sleeping pills, barbiturates, Seconal, Quaaludes, or Chloral Hydrate);Tranquilizers or anti-anxiety drugs (e.g., Valium, Librium, muscle relaxants, or Xanax);Painkillers (e.g., Codeine, Darvon, Percodan, Dilaudid, or Demerol);Stimulants (e.g., Preludin, Benzedrine, Methadrine, uppers, or speed);Marijuana, hash, THC, or grass;Cocaine or crack;Hallucinogens (e.g., Ecstasy, LSD, mescaline, psilocybin, PCP, angel dust, or peyote);Inhalants or Solvents (e.g., amyl nitrate, nitrous oxide, glue, toluene, or gasoline;Heroin;Other, specify (e.g., Methadone, Elavil, steroids, Thorazine, or Haldol) | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
PhenX Toolkit - Substances - Lifetime Use Protocol #031100: https://www.phenxtoolkit.org/index.php | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | Behavioral History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
3171797 | |||||||
| C56029 | Pittsburgh Sleep Quality Index (PSQI) - Fall asleep past month length value | PSQIFallAsleepPastMnthLngthVal | The value of time (in minutes) it takes the subject to fall asleep the majority of the nights in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) | The value of time (in minutes) it takes the subject to fall asleep the majority of the nights in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI | In the last month, how long (in minutes) has it taken you to fall asleep each night? | Numeric Values |
The first four questions were taken from the PSQI. The questions in this scale ask about the participant's sleep quality. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2015-03-11 11:17:32.0 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
minutes | |||||||||
| C00707 | Alcohol consume six or more drinks frequency | AlcConsume6MoreDrinkFreq | The rate of occurrence for when the participant/subject consumes six or more drinks containing alcohol on one occasion. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another, so the most common alcoholic beverages likely to be consumed will be defined as well as quantity of each that constitutes a drink (approximately 10 grams of pure ethanol). For example, one bottle of beer (330 ml at 5% ethanol), a glass of wine (140 ml at 12% ethanol), and a shot of spirits (40 ml at 40% ethanol) represent a standard drink of about 13 g of ethanol | The rate of occurrence for when the participant/subject consumes six or more drinks containing alcohol on one occasion. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another | How often do you have six or more drinks on one occasion? | Never;Less than monthly;Monthly;Weekly;Daily or almost daily | Never;Less than monthly;Monthly;Weekly;Daily or almost daily | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
Question is from the Alcohol Use Disorders Identification Test (AUDIT) - http://www.who.int/substance_abuse/activities/sbi/en/ | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 16:35:19.49 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171659 | |||||||
| C55953 | Tobacco use stopped age not applicable status | TobcoUseStopAgeNoAplcblStat | Status indicating that age stopped tobacco use does not apply to the subject/participant as they are still using tobacco | Status indicating that age stopped tobacco use does not apply to the subject/participant as they are still using tobacc | N/A - still using tobacco | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Supplemental - Highly Recommended based on study type, disease stage and disease type |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
2524471 | ||||||||
| C56031 | Pittsburgh Sleep Quality Index (PSQI) - Get up morning past month time | PSQIGetupMorningPastMonthTime | The time at which the subject got up in the morning during the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) | The time at which the subject got up in the morning during the past month, as part of the Pittsburgh Sleep Quality Index (PSQI | During the past month, when have you usually gotten up in the morning? | Date or Date & Time |
The first four questions were taken from the PSQI. The questions in this scale ask about the participant's sleep quality. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2015-03-11 11:17:32.0 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C00708 | Alcohol use related to hospitalization indicator | AlcUseRelatedHospInd | Indicator of whether the participant/subject has been hospitalized for an alcohol-related problem (i.e., esophageal varices, delirium tremens (DTs), cirrhosis and others) | Indicator of whether the participant/subject has been hospitalized for an alcohol-related problem (i.e., esophageal varices, delirium tremens (DTs), cirrhosis and others) | Have you ever been hospitalized for an alcohol-related problem? (e.g., esophageal varices, delirium tremens (DTs), cirrhosis, etc.) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171677 | |||||||
| C55959 | Tobacco packs smoked daily average value | TobcoPackSmokedDlyAvgVal | Average number of packs of cigarettes the participant/subject smokes daily (On the days you smoked cigarettes during the past 30 days, how many cigarettes did you smoke per day, on average?) | Average number of packs of cigarettes the participant/subject smokes daily (On the days you smoked cigarettes during the past 30 days, how many cigarettes did you smoke per day, on average?) | During the time that you regularly smoked, on average, how much did you smoke per day? Number of Packs: | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Supplemental - Highly Recommended based on study type, disease stage and disease type |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
3170853 | ||||||||
| C56034 | Pittsburgh Sleep Quality Index (PSQI) - Asleep past month hour duration | PSQIAsleepPastMonthHourDur | The duration of time (in hours) the subject was asleep the majority of the nights in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) | The duration of time (in hours) the subject was asleep the majority of the nights in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI | In the last month, how many hours of actual sleep did you get at night? (This may e different than the number of hours you spent in bed) | Numeric Values |
The first four questions were taken from the PSQI. The questions in this scale ask about the participant's sleep quality. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2015-03-11 11:17:32.0 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 5000 | hours | |||||||
| C00710 | Tobacco current use indicator | TobcoUseCurntInd | Indicator for whether the participant/subject regularly uses tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) at the present time | Indicator for whether the participant/subject regularly uses tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) at the present tim | Current tobacco use? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3170060 | |||||||
| C55966 | Alcohol use stopped age not applicable status | AlcUseStopAgeNoAplcblStat | Status indicating that age quit drinking does not apply to the subject/participant, as they are still ingesting alcoholic beverages, including social drinking | Status indicating that age quit drinking does not apply to the subject/participant, as they are still ingesting alcoholic beverages, including social drinking | N/A -- still drinking alcohol | Alphanumeric |
Skip is Q7 and Q8 are both no |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2008448 | |||||||||
| C00711 | Tobacco prior use indicator | TobcoPriorUseInd | Indicator of the participant's/subject's past regular tobacco (e.g., cigarettes, cigars, chewing tobacco or pipe) use prior to the past 12 months | Indicator of the participant's/subject's past regular tobacco (e.g., cigarettes, cigars, chewing tobacco or pipe) use prior to the past 12 months | Past tobacco use? (Regular use of cigarettes, cigars, chewing tabacco or pipes prior ro the past year) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Supplemental - Highly Recommended based on study type, disease stage and disease type |
No references available | Adult;Pediatric | Supplemental | 3.00 | 7/20/2013 10:21:26 AM | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3170080 | |||||||
| C55977 | Overall diet health scale | OverallDietHealthScl | A general scale of how healthy the participant/subject's diet is | A general scale of how healthy the participant/subject's diet is | In general, how healthy is your overall diet? | Excellent;Good;Fair;Poor;Very good | Excellent;Good;Fair;Poor;Very good | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Supplemental - Highly Recommended based on study type, disease stage and disease type |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2017-06-05 09:36:12.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
||||||||
| C00700 | Alcohol use stopped age value | AlcUseStopAgeVal | Age in years when participant/subject stopped ingesting alcoholic beverages, including social drinking | Age in years when participant/subject stopped ingesting alcoholic beverages, including social drinking | Age quit drinking (years): | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. The age in years should be collected or N/A (Not applicable if subject never smoked) should be selected. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | 2008448 | ||||||
| C00713 | Drug or substance current illicit use indicator | DrgSubstCurrntIllicitUseInd | Indicator of participant's/subject's use of illegal drugs, prescription or over-the-counter drugs in the past year for purposes other than those for which they are meant to be used, or in large amounts | Indicator of participant's/subject's use of illegal drugs, prescription or over-the-counter drugs in the past year for purposes other than those for which they are meant to be used, or in large amounts | Current drug user? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Supplemental - Highly Recommended based on study type, disease stage and disease type |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171724 |
