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Form Structure: Wechsler Adult Intelligence Scale IV (WAIS-IV) Arithmetic

This form structure is an organized set of data definitions for a copyrighted form
Title:
Wechsler Adult Intelligence Scale IV (WAIS-IV) Arithmetic
Short Name:
WAISIV_Arithmetic
Description:
Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Working Memory Index (WMI) Arithmetic sub-test measures mental manipulation, concentration, attention, short and long-term memory, and numerical reasoning. Copyright Pearson Inc. (2008), (http://www.pearsonclinical.com/content/ani/clinicalassessments/us/en.html). References: Wechsler D. Wechsler Adult Intelligence ScaleĀ–Fourth Edition. Pearson; San Antonio, TX: 2008.
Disease:
Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-08-12
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 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.

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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

Arithmetic-Sample (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wechsler Adult Intelligence Scale IV (WAIS-IV) Working Memory Index (WMI) Arithmetic - Item 1 completion time duration  Time interval (in seconds) required for Item 1, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Working Memory Index (WMI) Arithmetic subtest WAISIVWMIARItemTimeDur Recommended CDE
2 Wechsler Adult Intelligence Scale IV (WAIS-IV) Working Memory Index (WMI) Arithmetic - Item 1 response number  Number for response to Item 1, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Working Memory Index (WMI) Arithmetic subtest WAISIVWMIARItemRespNum Recommended CDE

Arithmetic (Appears Up To 22 Times)

# Title Short Description Variable Name Required? Type
1 Test item number (numeric)  The test (or assessment) item number representing the sequence for the items/questions of each test/assessmet/questionnaire being asked TestItemNum Recommended CDE
2 Wechsler Adult Intelligence Scale IV (WAIS-IV) Working Memory Index (WMI) Arithmetic - Item 1 completion time duration  Time interval (in seconds) required for Item 1, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Working Memory Index (WMI) Arithmetic subtest WAISIVWMIARItemTimeDur Recommended CDE
3 Wechsler Adult Intelligence Scale IV (WAIS-IV) Working Memory Index (WMI) Arithmetic - Item 1 response number  Number for response to Item 1, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Working Memory Index (WMI) Arithmetic subtest WAISIVWMIARItemRespNum Recommended CDE
4 Wechsler Adult Intelligence Scale IV (WAIS-IV) Working Memory Index (WMI) Arithmetic - Item 1 score  Item score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Working Memory Index (WMI) Arithmetic subtest WAISIVWMIARItemScore Recommended CDE

Arithmetic-Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wechsler Adult Intelligence Scale IV (WAIS-IV) Working Memory Index (WMI) Arithmetic - Total raw score  Total raw score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Working Memory Index (WMI) Arithmetic subtest WAISIVWMIARTtlRawScore Recommended CDE
Keywords

Change History