Form Structure: Orientation Log
This form structure is an organized set of data definitions for a copyrighted form
Title:
Orientation Log
Short Name:
OLOG_FITBIR
Description:
Orientation Log measures orientation to time, place, and circumstance.
Disease:
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-02-20
Version:
1.0
Date Created:
2015-01-29
Owner:
Number of Data Elements:
22
eForms:
N
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 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 5 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 6 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 7 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 8 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
O_Log (Appears Exactly 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Orientation Log (O-LOG) - Current city name score | The score representing the participant's ability to name the current city, as part of the Orientation Log (O-LOG). | OLOGCityNameScore | Recommended | CDE |
| 2 | Orientation Log (O-LOG) - Kind of place score | The score representing the participant's ability to name the kind of place they currently located, as part of the Orientation Log (O-LOG). | OLOGPlaceScore | Recommended | CDE |
| 3 | Orientation Log (O-LOG) - Hospital name score | The score representing the participant's ability to name the hospital the are in, as part of the Orientation Log (O-LOG) | OLOGHospitalNameScore | Recommended | CDE |
| 4 | Orientation Log (O-LOG) - Current month score | The score representing the participant's ability to name the current month, as part of the Orientation Log (O-LOG). | OLOGMonthScore | Recommended | CDE |
| 5 | Orientation Log (O-LOG) - Today date score | The score representing the participant's ability to name today's date, as part of the Orientation Log (O-LOG). | OLOGTodaysDateScore | Recommended | CDE |
| 6 | Orientation Log (O-LOG) - Current year score | The score representing the participant's ability to name the current year, as part of the Orientation Log (O-LOG). | OLOGYearScore | Recommended | CDE |
| 7 | Orientation Log (O-LOG) - Day of the week score | The score representing the participant's ability to name the current day of the week, as part of the Orientation Log (O-LOG). | OLOGDayWeekScore | Recommended | CDE |
| 8 | Orientation Log (O-LOG) - Current time score | The score representing the participant's ability to tell the current time, as part of the Orientation Log (O-LOG). | OLOGTimeScore | Recommended | CDE |
| 9 | Orientation Log (O-LOG) - Etiology score | The score representing the participant's outward signs of mental disability, as part of the Orientation Log (O-LOG). | OLOGEtiologyScore | Recommended | CDE |
| 10 | Orientation Log (O-LOG) - Pathology score | The score representing the participant's noted pathological problems related to accident, as part of the Orientation Log (O-LOG). | OLOGPathlgyScore | Recommended | CDE |
| 11 | Orientation Log (O-LOG) - Place domain score | The score representing the total place domain score which is defined as: Place = City + Kind of Place + Name of Hospital, as part of the Orientation Log (O-LOG). | OLOGPlaceDomainScore | Recommended | CDE |
| 12 | Orientation Log (O-LOG) - Situation domain score | The score representing the total situation domain score which is defined as: Situation = Etiology/Event + Pathology/Deficits, as part of the Orientation Log (O-LOG). | OLOGSituationDomainScore | Recommended | CDE |
| 13 | Orientation Log (O-LOG) - Time domain score | The score representing the total time domain score which is defined as: Time = Month + Date +Year + Day of Week + Clock Time, as part of the Orientation Log (O-LOG). | OLOGTimeDomainScore | Recommended | CDE |
| 14 | Orientation Log (O-LOG) - Total score | Total score of all elements, as part of the Orientation Log (O-LOG) | OLOGTotalScore | Recommended | CDE |
Keywords
