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

 General Details

Title:
Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design
Short Name:
WASI_IBlockDesgn
Description:
The Wechsler Abbreviated Scale of Intelligence - First Edition (WASI-I) - Block Design subtest is used as part of assessment of human intelligence. It is thought to tap spatial visualization ability and motor skill. The test-taker uses hand movements to rearrange blocks that have various color patterns on different sides to match a pattern. The items in a block design test can be scored both by accuracy in matching the pattern and by speed in completing each item. http://www.pearsonassess.ca/en/programs/00/28/88/p002888.html
Disease:
General (For all diseases)
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-06-10
Version:
1.0
Date Created:
2016-04-12
Owner:
Number of Data Elements:
30
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 Group (Repeat Infinitely)

# 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

Design 1 to 4 (Appears Up To 4 Times)

# Title Short Description Variable Name Required? Type
1 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design number  Design number, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnNum Recommended CDE
2 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design indicator  Indicator of correct Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnCorrInd Recommended CDE
3 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Designs 1-4 score  Score for Designs 1-4, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgn1to4Score Recommended CDE
4 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design completion time  Time to complete Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnCompltTime Recommended CDE

Design 5 to 9 (Appears Up To 5 Times)

# Title Short Description Variable Name Required? Type
1 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design number  Design number, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnNum Recommended CDE
2 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design indicator  Indicator of correct Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnCorrInd Recommended CDE
3 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Designs 5-9 score  Score for Designs 5-9, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgn5to9Score Recommended CDE
4 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design completion time  Time to complete Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnCompltTime Recommended CDE

Design 10 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design number  Design number, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnNum Recommended CDE
2 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design indicator  Indicator of correct Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnCorrInd Recommended CDE
3 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design 10 score  Score for Design 10, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgn10Score Recommended CDE
4 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design completion time  Time to complete Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnCompltTime Recommended CDE

Design 11 to 13 (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design number  Design number, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnNum Recommended CDE
2 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design indicator  Indicator of correct Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnCorrInd Recommended CDE
3 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Designs 11-13 score  Score for Designs 11-13, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgn11to13Score Recommended CDE
4 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design completion time  Time to complete Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnCompltTime Recommended CDE

Total score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Total score  Total score, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section WASI_IBlockDesgnTotalScore Recommended CDE

 Change History

 Administrative Change History