Form Structure: Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) screening
This form structure is an organized set of data definitions for a copyrighted form
Title:
Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) screening
Short Name:
SCAN3AScreening
Description:
SCAN-A is used to determine presence of auditory processing disorders. Age range: 12 through 50 years. References: Robert W. Keith, Development and Standardization of SCAN-A: Test of Auditory Processing Disorders in Adolescents and Adults, J Am Acad Audiol 6 : 286-292 (1995) Copyright 1994, 2009 NCS Pearson, Inc. http://www.pearsonclinical.com
Disease:
Traumatic Brain Injury
General (For all diseases)
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-11-16
Owner:
Number of Data Elements:
23
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 | 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 |
Screening (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 |
A Test for Auditory Processing Disorders-English dominant indicator
(Draft) |
Indicates whether English is the subject's dominant language, as part of A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) and Test for Auditory Processing Disorders in Children-revised (SCAN-C) | SCANEngDominantInd | Recommended | UDE |
2 |
A Test for Auditory Processing Disorders- Behavioral observations text
(Draft) |
Description of behavioral observations, as part of A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) and Test for Auditory Processing Disorders in Children-revised (SCAN-C) | SCANBehvrObsTxt | Recommended | UDE |
Pure tone results (Appears Up To 2 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Ear type | Type of ear being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTEarTyp | Recommended | CDE |
2 |
A Test for Auditory Processing Disorders-Pure tone frequency
(Draft) |
Pure tone frequency in Hz, as part of A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) and Test for Auditory Processing Disorders in Children-revised (SCAN-C) | SCANPureToneFreq | Recommended | UDE |
Tympanogram Results (Appears Up To 2 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Ear type | Type of ear being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTEarTyp | Recommended | CDE |
2 |
A Test for Auditory Processing Disorders-Tympanogram pressure value
(Draft) |
Tympanogram pressure in daPa, as part of A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) and Test for Auditory Processing Disorders in Children-revised (SCAN-C) | SCANTympanogramPressureVal | Recommended | UDE |
3 |
A Test for Auditory Processing Disorders-Tympanogram shape type
(Draft) |
Type of tympanogram shape, as part of A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) and Test for Auditory Processing Disorders in Children-revised (SCAN-C) | SCANTympanogramShapeTyp | Recommended | UDE |
4 |
A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A)-Tympanogram compliance value
(Draft) |
Tympanogram compliance reported in cc equivalent volume, as part of the A Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) | SCANATympanogramCmplanceVal | Recommended | UDE |
Keywords