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

 General Details

Title:
Screening for TBI in Military Personnel
Short Name:
ScreeningTBIMilitaryPersn
Description:
The Screening for TBI in Military Personnel consists of four questions that are designed to evaluate service members for possible traumatic brain injury.
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-10-07
Owner:
Number of Data Elements:
20
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 for TBI in Military Personnel (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Screening for TBI in Military Personnel (STBIMP) - military deployment event type  Type of event(s) the participant/subject experienced during the military deployment, as a part of Screening for TBI in Military Personnel (STBIMP). STBIMPMilDeplyEvntTyp Recommended CDE
2 Screening for TBI in Military Personnel (STBIMP) - military deployment event other text  Describe in text the event(s) ,other than those listed above, the participant/subject experienced during the military deployment, as a part of Screening for TBI in Military Personnel (STBIMP). STBIMPMilDeplyEvntOthrTxt Recommended CDE
3 Screening for TBI in Military Personnel (STBIMP) - military deployment event result  Result(s) happened to the participant/subject immediately after the above event(s) noted during the deployment in the military, as a part of Screening for TBI in Military Personnel (STBIMP). STBIMPMilDeplyEvntReslt Recommended CDE
4 Screening for TBI in Military Personnel (STBIMP) - military deployment post-event worse symptom type  Type of result that happened to the participant, or was told happened to the participant, immediately after any of those above events, as a part of Screening for TBI in Military Personnel (STBIMP). STBIMPMilDeplyPstEvtWrsSympTyp Recommended CDE
5 Screening for TBI in Military Personnel (STBIMP) - military deployment past week symptom type  Type of symptom that began or worsened after the events noted in question 9a, as a part of Screening for TBI in Military Personnel (STBIMP). STBIMPMilDeplymtPastWkSympTyp Recommended CDE

 Change History

 Administrative Change History