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

 General Details

Title:
Surgical and Therapeutic Procedures
Short Name:
SurgicalTherapticProc
Description:
Data elements pertaining to surgical and therapeutic procedures
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:
2016-10-06
Owner:
Number of Data Elements:
26
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
7 Assessment completion status  Status of completion of an assessment, such as a case report from (CRF), instrument, scale, computer assessment, etc. AssessmentCompletionStat Recommended CDE
8 Assessment completion status text  A free text related to "Assessment completion status" specifying completion details. This data element should be used along with AssessmenttCompletionStat to further describe the status of assessment completion AssessmentCompletionStatTxt Recommended CDE

Surgical and therapeutic procedures (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Surgical or therapeutic procedure type  Type of surgical or therapeutic procedure received by the participant/subject SurgTherapProcedurTyp Recommended CDE
2 Surgical or therapeutic procedure other text  The free-text field related to 'Surgical or therapeutic procedure type' specifying other text. Type of surgical or therapeutic procedure received by the participant/subject SurgTherapProcedurOTH Recommended CDE
3 Inpatient or outpatient status  Status describing whether the participant/subject was admitted to the hospital and stayed overnight InpatOutpatStatus Recommended CDE
4 Surgical or therapeutic procedure ICD-9-CM code  Code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for the selected surgical procedure SurgTherapuProcICD9CMCode Recommended CDE
5 Surgical or therapeutic procedure ICD-9-CM code other text  Surgical or therapeutic procedure ICD-9-CM code other text SurgTherapuProcICD9CMCodeOTH Recommended UDE
6 Surgical or therapeutic procedure ICD-10-CM code  Code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure SurgTherapuProcICD10CMCode Recommended CDE
7 Surgical or therapeutic procedure ICD-10-CM other text  The free-text field related to 'Surgical or therapeutic procedure ICD-10-CM code' specifying other text. Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure SurgTherapuProcICD10CMOTH Recommended CDE
8 Surgical or therapeutic procedure start date and time  Date (and time, if applicable and known) on which the surgical or therapeutic procedure started SurgTherapuProcStartDateTime Recommended CDE
9 Surgical or therapeutic procedure end date and time  Date on which the surgical or therapeutic procedure ended SurgTherapuProcEndDateTime Recommended CDE

 Change History

 Administrative Change History