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

 General Details

Title:
Post Discharge/Outpatient Treatment
Short Name:
PostDischOutpatientTreat
Description:
The form structure contains data elements recommended by NINDS to capture the participant's/subject's course of treatment post-discharge. References: NINDS Traumatic Brain Injuryhttps://commondataelements.ninds.nih.gov/TBI.aspx#tab=Data_Standards
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2017-01-24
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 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 Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional 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

Post Discharge Outpatient Treatment (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Therapy or rehabilitation type  Type of therapy or rehabilitation services received by the participant/subject TherpyRehabTyp Optional CDE
2 Therapy rehabilitation ICD 9 CM code  ICD-9-CM code that describes the therapy or rehabilitation received by the participant/subject TherpyRehabICD9CMCd Optional CDE
3 Therapy or rehabilitation frequency  Identified describing the frequency the participant/subject received the therapy or rehabilitation TherpyRehabFreq Optional CDE
4 Therapy or rehabilitation session duration  Average duration of a therapy or rehabilitation session TherpyRehabSessnDur Optional CDE
5 Therapy rehabilitation start date time  Date (and time, if applicable and known) on which the therapy or rehabilitation started TherpyRehabStrtDateTime Optional CDE
6 Therapy rehabilitation end date time  Date (and time, if applicable and known) on which the therapy or rehabilitation ended TherpyRehabEndDateTime Optional CDE
7 Therapy rehabilitation ongoing indicator  Indicator of whether the therapy or rehabilitation is ongoing TherpyRehabOngngInd Optional CDE

 Change History

 Administrative Change History