This form structure is an organized set of data definitions for a copyrighted form

 General Details

Title:
CAGE Questionnaire
Short Name:
CAGE
Description:
CAGE Substance Abuse Screening Tool Questionnaire
Disease:
Traumatic Brain Injury
Organization:
CTDB - NICHD
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-02-11
Version:
1.0
Date Created:
2015-01-09
Owner:
Number of Data Elements:
14
eForms:
N

 Documentation


 Groups & Attached Data Elements

Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Visit date   Actual interview or visit date VisitDate Recommended CDE
5 Site name   The name of the site for the study SiteName Recommended CDE
6 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
7 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
8 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

CAGE Questions (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 CAGE Substance Abuse Screening Tool Questionnaire - Need decrease drinking indicator  The indicator related to feelings toward the need to cut down on the amount of alcohol consumed, as part of the CAGE Substance Abuse Screening Tool Questionnaire. CAGECutDownDrinkingInd Recommended CDE
2 CAGE Substance Abuse Screening Tool Questionnaire - Drinking associated criticism annoyance indicator  The indicator related to feeling annoyed due to others criticizing their alcohol consumption, as part of the CAGE Substance Abuse Screening Tool Questionnaire. CAGEAnnoyedCriticizeDrinkInd Recommended CDE
3 CAGE Substance Abuse Screening Tool Questionnaire - Drinking associated guilt indicator  The indicator related to feeling bad or guilt when drinking, as part of the CAGE Substance Abuse Screening Tool Questionnaire. CAGEGuiltyDrinkingInd Recommended CDE
4 CAGE Substance Abuse Screening Tool Questionnaire - Morning drinking indicator  The indicator related to having a drink in the morning to steady nerves or get rid of a hangover, as part of the CAGE Substance Abuse Screening Tool Questionnaire. CAGEDrinkMorningInd Recommended CDE
5 CAGE Substance Abuse Screening Tool Questionnaire - Total score  Total score of all questions in the CAGE Substance Abuse Screening Tool Questionnaire. CAGETotalScore Recommended CDE
6 CAGE Substance Abuse Screening Tool Questionnaire - Clinically significant indicator  The indicator of whether the total score for the CAGE Substance Abuse Screening Tool Questionnaire is clinically significant. CAGEClinicallySignificantInd Recommended CDE

 Change History

 Administrative Change History