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

 General Details

Title:
Wechsler Intelligence Scale for Children -Fourth edition (WISC-IV) Block design section
Short Name:
WISCIVBD
Description:
WISC-IV measures a child's intellectual ability. Block Design measures visual-motor coordination. Wechsler, D. (2003). Wechsler Intelligence Scale for Children–Fourth Edition: Technical and interpretive manual. San Antonio, TX: Psychological Corporation. Copyright 2003 by The Psychological Corporation, a Harcourt Assessment Company http://www.pearsonclinical.com/
Disease:
Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-30
Owner:
Number of Data Elements:
36
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

WISC-IV-Block Design 1 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Trial number (numeric)  The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. TrialNumber Recommended CDE
2 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator  Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCorrInd Recommended CDE
3 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Design 1 score  Score for Design 1, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgn1Score Recommended CDE
4 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time  Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCompltTime Recommended CDE

WISC-IV-Block Designs 2-3 (Appears Up To 2 Times)

# Title Short Description Variable Name Required? Type
1 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator  Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCorrInd Recommended CDE
2 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 2-3 score  Score for Designs 2-5, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgn2to3Score Recommended CDE
3 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time  Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCompltTime Recommended CDE

WISC-IV-Block Designs 4-5 (Appears Up To 2 Times)

# Title Short Description Variable Name Required? Type
1 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator  Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCorrInd Recommended CDE
2 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 4-5 score  Score for Designs 2-5, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgn4to5Score Recommended CDE
3 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time  Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCompltTime Recommended CDE

WISC-IV-Block Designs 6-8 (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator  Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCorrInd Recommended CDE
2 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 6-8 score  Score for Design 6-10, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgn6to8Score Recommended CDE
3 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time  Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCompltTime Recommended CDE

WISC-IV-Block Designs 9-10 (Appears Up To 2 Times)

# Title Short Description Variable Name Required? Type
1 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator  Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCorrInd Recommended CDE
2 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 9-10 score  Score for Design 6-10, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgn9to10Score Recommended CDE
3 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time  Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCompltTime Recommended CDE

WISC-IV-Block Designs 11-14 (Appears Up To 4 Times)

# Title Short Description Variable Name Required? Type
1 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator  Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCorrInd Recommended CDE
2 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 11-14 score  Score for Designs 11-14, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgn11to14Score Recommended CDE
3 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time  Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnCompltTime Recommended CDE

WISC-IV Block Design Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Total raw score  Total raw score, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBlockDesgnTotalRawScore Recommended CDE
2 Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Block Design No Time Bonus (BDN) raw score  Block Design No Time Bonus (BDN) raw score, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) WISCIVBDNRawScore Recommended CDE

 Change History

 Administrative Change History