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

 General Details

Title:
12-item Short Form Health Survey Version 2 (SF-12v2)
Short Name:
SF12
Description:
12-item Short Form Health Survey Version 2 (SF-12v2) . Uses SF-36 CDEs. Can be found in public domain. The FS does not contain scoring information, because scoring is vary. References: Eduardo Lacson, Jr.,corresponding author Jianglin Xu, Shu-Fang Lin, Sandie Guerra Dean, J. Michael Lazarus, and Raymond M. Hakim, A Comparison of SF-36 and SF-12 Composite Scores and Subsequent Hospitalization and Mortality Risks in Long-Term Dialysis Patients. Clin J Am Soc Nephrol. 2010 Feb; 5(2): 252–260. doi: 10.2215/CJN.07231009 PMCID: PMC2827595
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-03-31
Version:
1.3
Date Created:
2016-03-29
Owner:
Number of Data Elements:
25
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 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 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

SF-12 (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 36-item Short Form Health Survey (SF-36) - General health scaled score  Scaled score that reflects surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) SF36GenHlthScore Recommended CDE
2 36-item Short Form Health Survey (SF-36) - Health limited moderate activities scaled score  Scaled score that reflects surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) SF36HlthLmtModActScore Recommended CDE
3 36-item Short Form Health Survey (SF-36) - Health limited climbing several stairs scaled score  Scaled score that reflects surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) SF36HlthLmtClmbSvrlStairScore Recommended CDE
4 12-item Short Form Health Survey Version 2 (SF-12v2) - Less accomplished physical health scale  Score of surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) SF12LesAccompPhyHlthScale Recommended CDE
5 12-item Short Form Health Survey Version 2 (SF-12v2)- Limited work activities physical health scale  Scale for surveyee-reported limited work or activities as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) SF12LmtWrkActPhyHlthScale Recommended CDE
6 12-item Short Form Health Survey Version 2 (SF-12v2)- Less accomplished emotional problems scale  Scale for surveyee-reported less accomplishment as a result of emotional problems, as part of version2.0 of 12-item Short Form Health Survey (SF-12) SF12LesAccompEmotProbScale Recommended CDE
7 12-item Short Form Health Survey Version 2 (SF-12v2) - Work not carefully emotional problems indicator  Scale for surveyee-reported doing work or other activities not as carefully as usual as a result of emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) SF12WkNotCarefulEmotProbScale Recommended CDE
8 36-item Short Form Health Survey (SF-36) - Pain interfere work scaled score  Scaled score that reflects surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) SF36PainInterfWrkScore Recommended CDE
9 12-item Short Form Health Survey Version 2 (SF-12v2) - Times calm peaceful scale  Scale of times feeling calm and peaceful during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) SF12TimesCalmPcfulScale Recommended CDE
10 12-item Short Form Health Survey Version 2 (SF-12v2) - Times energy scale  Scale of times having a lot of energy during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) SF12TimesEnrgyScale Recommended CDE
11 12-item Short Form Health Survey Version 2 (SF-12v2) - Times downhearted depressed scale  Scale of times feeling downhearted and depressed during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) SF12TimesDownDepressedScale Recommended CDE
12 12-item Short Form Health Survey Version 2 (SF-12v2) - Interferingsocial activties physical emotional scale  Scale of interfered normal social activities due to physical and emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) SF12InterfSocPhyEmotScale Recommended CDE

 Change History

 Administrative Change History