Form Structure: Rancho Los Amigos Scale
This form structure is an organized set of data definitions for a copyrighted form
Title:
Rancho Los Amigos Scale
Short Name:
RanchoLosAmigos
Description:
This scale measures the level of awareness, cognition, behavior, and interaction with the environment.
Disease:
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-03-06
Version:
1.0
Date Created:
2015-02-06
Owner:
Number of Data Elements:
9
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.
Los Ranchos Amigos Score (Appears Exactly 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Rancho Los Amigos Level of Cognitive Functioning Scale (LCFS) version 1 - Score | Participant's score on the Rancho Los Amigos Level of Cognitive Functioning Scale (LCFS) version 1. | RanchoLosAmigosLCFS1Score | Recommended | UDE |
Keywords
