This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
PTSD Checklist - PCL Scoring
Short Name:
PCLScoring
Description:
PCL scoring to provide a presumptive diagnosis according to DSM-IV symptom criteria. Note: DO NOT PUBLISH YET. WORK IN PROGRESS
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-02-05
Owner:
Number of Data Elements:
18
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 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Recommended CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Recommended CDE
9 General notes text   General notes GeneralNotesTxt Recommended CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

PCL Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 PTSD Checklist Civilian (PCL - C) - Questions 1 to 5 ratings DSM & Critieria indicator  Indicates whether one or more of questiones 1 to 5 are endorsed with rating of 3 or higher PCLCQ1toQ5RatngBInd Recommended CDE
2 PTSD Checklist Civilian (PCL - C) - Questions 6 to 12 ratings DSM indicator  Indicates whether three or more of the questions 6 to 12 are endorsed with a rating of 3 or higher PCLCQ6toQ12RatngCInd Recommended CDE
3 PTSD Checklist Civilian (PCL - C) - Questions 13 to 17 ratings DSM indicator  Indicates whether two or more of the questions 13 to 17 are endorsed with a rating of 3 or higher PCLCQ13toQ17RatingDInd Recommended CDE

 Change History

 Administrative Change History