Form Structure: Screening for TBI in Military Personnel
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Screening for TBI in Military Personnel
Short Name:
ScreeningTBIMilitaryPersn
Description:
The Screening for TBI in Military Personnel consists of four questions that are designed to evaluate service members for possible traumatic brain injury.
Disease:
Traumatic Brain Injury
General (For all diseases)
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-10-07
Owner:
Number of Data Elements:
20
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 for TBI in Military Personnel (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Screening for TBI in Military Personnel (STBIMP) - military deployment event type | Type of event(s) the participant/subject experienced during the military deployment, as a part of Screening for TBI in Military Personnel (STBIMP). | STBIMPMilDeplyEvntTyp | Recommended | CDE |
| 2 | Screening for TBI in Military Personnel (STBIMP) - military deployment event other text | Describe in text the event(s) ,other than those listed above, the participant/subject experienced during the military deployment, as a part of Screening for TBI in Military Personnel (STBIMP). | STBIMPMilDeplyEvntOthrTxt | Recommended | CDE |
| 3 | Screening for TBI in Military Personnel (STBIMP) - military deployment event result | Result(s) happened to the participant/subject immediately after the above event(s) noted during the deployment in the military, as a part of Screening for TBI in Military Personnel (STBIMP). | STBIMPMilDeplyEvntReslt | Recommended | CDE |
| 4 | Screening for TBI in Military Personnel (STBIMP) - military deployment post-event worse symptom type | Type of result that happened to the participant, or was told happened to the participant, immediately after any of those above events, as a part of Screening for TBI in Military Personnel (STBIMP). | STBIMPMilDeplyPstEvtWrsSympTyp | Recommended | CDE |
| 5 | Screening for TBI in Military Personnel (STBIMP) - military deployment past week symptom type | Type of symptom that began or worsened after the events noted in question 9a, as a part of Screening for TBI in Military Personnel (STBIMP). | STBIMPMilDeplymtPastWkSympTyp | Recommended | CDE |
Keywords
