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

 General Details

Title:
Orientation Log
Short Name:
OLOG_FITBIR
Description:
Orientation Log measures orientation to time, place, and circumstance.
Disease:
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-02-20
Version:
1.0
Date Created:
2015-01-29
Owner:
Number of Data Elements:
22
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.

O_Log (Appears Exactly 1 Time)

# Title Short Description Variable Name Required? Type
1 Orientation Log (O-LOG) - Current city name score  The score representing the participant's ability to name the current city, as part of the Orientation Log (O-LOG). OLOGCityNameScore Recommended CDE
2 Orientation Log (O-LOG) - Kind of place score  The score representing the participant's ability to name the kind of place they currently located, as part of the Orientation Log (O-LOG). OLOGPlaceScore Recommended CDE
3 Orientation Log (O-LOG) - Hospital name score  The score representing the participant's ability to name the hospital the are in, as part of the Orientation Log (O-LOG) OLOGHospitalNameScore Recommended CDE
4 Orientation Log (O-LOG) - Current month score  The score representing the participant's ability to name the current month, as part of the Orientation Log (O-LOG). OLOGMonthScore Recommended CDE
5 Orientation Log (O-LOG) - Today date score  The score representing the participant's ability to name today's date, as part of the Orientation Log (O-LOG). OLOGTodaysDateScore Recommended CDE
6 Orientation Log (O-LOG) - Current year score  The score representing the participant's ability to name the current year, as part of the Orientation Log (O-LOG). OLOGYearScore Recommended CDE
7 Orientation Log (O-LOG) - Day of the week score  The score representing the participant's ability to name the current day of the week, as part of the Orientation Log (O-LOG). OLOGDayWeekScore Recommended CDE
8 Orientation Log (O-LOG) - Current time score  The score representing the participant's ability to tell the current time, as part of the Orientation Log (O-LOG). OLOGTimeScore Recommended CDE
9 Orientation Log (O-LOG) - Etiology score  The score representing the participant's outward signs of mental disability, as part of the Orientation Log (O-LOG). OLOGEtiologyScore Recommended CDE
10 Orientation Log (O-LOG) - Pathology score  The score representing the participant's noted pathological problems related to accident, as part of the Orientation Log (O-LOG). OLOGPathlgyScore Recommended CDE
11 Orientation Log (O-LOG) - Place domain score  The score representing the total place domain score which is defined as: Place = City + Kind of Place + Name of Hospital, as part of the Orientation Log (O-LOG). OLOGPlaceDomainScore Recommended CDE
12 Orientation Log (O-LOG) - Situation domain score  The score representing the total situation domain score which is defined as: Situation = Etiology/Event + Pathology/Deficits, as part of the Orientation Log (O-LOG). OLOGSituationDomainScore Recommended CDE
13 Orientation Log (O-LOG) - Time domain score  The score representing the total time domain score which is defined as: Time = Month + Date +Year + Day of Week + Clock Time, as part of the Orientation Log (O-LOG). OLOGTimeDomainScore Recommended CDE
14 Orientation Log (O-LOG) - Total score  Total score of all elements, as part of the Orientation Log (O-LOG) OLOGTotalScore Recommended CDE

 Change History

 Administrative Change History