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

 General Details

Title:
Wechsler Adult Intelligence Scale IV (WAIS-IV) Cancellation
Short Name:
WAISIV_Cancellation
Description:
The Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest measures processing speed. Copyright Pearson Inc. (2008), (http://www.pearsonclinical.com/content/ani/clinicalassessments/us/en.html). References: Wechsler D. Wechsler Adult Intelligence ScaleĀ–Fourth Edition. Pearson; San Antonio, TX: 2008.
Disease:
Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-08-12
Owner:
Number of Data Elements:
24
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

Cancellation-Item 1 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Completion time duration  Time interval required to complete Cancellation, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest WAISIVPSICATimeDur Recommended CDE
2 Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Number correct answers  Number of correct answers as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest WAISIVPSICACorrNum Recommended CDE
3 Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Number incorrect answers  Number of incorrect answers as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest WAISIVPSICAIncorrNum Recommended CDE
4 Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Item score  Item score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest WAISIVPSICAItemScore Recommended CDE

Cancellation-Item 2 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Completion time duration  Time interval required to complete Cancellation, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest WAISIVPSICATimeDur Recommended CDE
2 Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Number correct answers  Number of correct answers as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest WAISIVPSICACorrNum Recommended CDE
3 Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Number incorrect answers  Number of incorrect answers as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest WAISIVPSICAIncorrNum Recommended CDE
4 Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Item score  Item score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest WAISIVPSICAItemScore Recommended CDE

Cancellation-Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Total raw score  Total raw score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest WAISIVPSICARawScore Recommended CDE

 Change History

 Administrative Change History