Form Structure: Surgical and Therapeutic Procedures
This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
Surgical and Therapeutic Procedures
Short Name:
SurgicalTherapticProc
Description:
Data elements pertaining to surgical and therapeutic procedures
Disease:
General (For all diseases)
Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2020-07-27
Version:
1.0
Date Created:
2016-10-06
Owner:
Number of Data Elements:
26
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 |
| 7 | Assessment completion status | Status of completion of an assessment, such as a case report from (CRF), instrument, scale, computer assessment, etc. | AssessmentCompletionStat | Recommended | CDE |
| 8 | Assessment completion status text | A free text related to Assessment completion status specifying completion details. This data element should be used along with AssessmenttCompletionStat to further describe the status of assessment completion | AssessmentCompletionStatTxt | Recommended | CDE |
Surgical and therapeutic procedures (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Surgical or therapeutic procedure type | Type of surgical or therapeutic procedure received by the participant/subject | SurgTherapProcedurTyp | Recommended | CDE |
| 2 | Surgical or therapeutic procedure other text | The free-text field related to 'Surgical or therapeutic procedure type' specifying other text. Type of surgical or therapeutic procedure received by the participant/subject | SurgTherapProcedurOTH | Recommended | CDE |
| 3 | Inpatient or outpatient status | Status describing whether the participant/subject was admitted to the hospital and stayed overnight | InpatOutpatStatus | Recommended | CDE |
| 4 | Surgical or therapeutic procedure ICD-9-CM code | Code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for the selected surgical procedure | SurgTherapuProcICD9CMCode | Recommended | CDE |
| 5 | Surgical or therapeutic procedure ICD-9-CM code other text | Surgical or therapeutic procedure ICD-9-CM code other text | SurgTherapuProcICD9CMCodeOTH | Recommended | UDE |
| 6 | Surgical or therapeutic procedure ICD-10-CM code | Code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure | SurgTherapuProcICD10CMCode | Recommended | CDE |
| 7 | Surgical or therapeutic procedure ICD-10-CM other text | The free-text field related to 'Surgical or therapeutic procedure ICD-10-CM code' specifying other text. Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure | SurgTherapuProcICD10CMOTH | Recommended | CDE |
| 8 | Surgical or therapeutic procedure start date and time | Date (and time, if applicable and known) on which the surgical or therapeutic procedure started | SurgTherapuProcStartDateTime | Recommended | CDE |
| 9 | Surgical or therapeutic procedure end date and time | Date on which the surgical or therapeutic procedure ended | SurgTherapuProcEndDateTime | Recommended | CDE |
Keywords
