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

 General Details

Title:
Test for Auditory Processing Disorders in Children-Revised (SCAN-C) screening
Short Name:
SCANCScreening
Description:
SCAN-C is used to detect auditory processing disorders in children. Keith, R. W. (2000). Development and standardization of SCAN-C test for auditory processing disorders in children. JOURNAL-AMERICAN ACADEMY OF AUDIOLOGY, 11(8), 438-445. Robert W. Keith; Copyright 2000 NCS Pearson, Inc. http://www.pearsonclinical.com
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-11-16
Owner:
Number of Data Elements:
19
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

Screening (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 A Test for Auditory Processing Disorders-English dominant indicator 

(Draft)

Indicates whether English is the subject's dominant language, as part of A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) and Test for Auditory Processing Disorders in Children-revised (SCAN-C) SCANEngDominantInd Recommended UDE
2 A Test for Auditory Processing Disorders- Behavioral observations text 

(Draft)

Description of behavioral observations, as part of A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) and Test for Auditory Processing Disorders in Children-revised (SCAN-C) SCANBehvrObsTxt Recommended UDE

Pure tone results (Appears Up To 2 Times)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Ear type  Type of ear being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTEarTyp Recommended CDE
2 A Test for Auditory Processing Disorders-Pure tone frequency 

(Draft)

Pure tone frequency in Hz, as part of A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) and Test for Auditory Processing Disorders in Children-revised (SCAN-C) SCANPureToneFreq Recommended UDE

 Change History

 Administrative Change History