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

This form structure is an organized set of data definitions for a copyrighted form
Title:
Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design
Short Name:
WAISIV_Block_Design
Description:
The Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Perceptual Reasoning Index (PRI) Block Design subtest measures ability to analyze and synthesize abstract visual stimuli. 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:
32
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

WAIS-IV-Block Design Sample (Appears Up To 2 Times)

# Title Short Description Variable Name Required? Type
1 Trial number (numeric)  The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. TrialNumber Recommended CDE
2 Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Completion time duration  Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDTimeDur Recommended CDE

WAIS-IV-Block Designs 1-4 (Appears Up To 8 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 Trial number (numeric)  The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. TrialNumber Recommended CDE
3 Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Completion time duration  Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDTimeDur Recommended CDE
4 Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Items 1-4 score  Score for Items 1-4, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDItem1to4Score Recommended CDE

WAIS-IV-Block Designs 5-8 (Appears Up To 4 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) Block Design - Completion time duration  Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDTimeDur Recommended CDE
3 Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Items 5-8 score  Score for Items 5-8, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDItem5to8Score Recommended CDE

WAIS-IV-Block Designs 9-10 (Appears Up To 2 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) Block Design - Completion time duration  Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDTimeDur Recommended CDE
3 Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Items 9-10 score  Score for Items 9-10, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDItem9to10Score Recommended CDE

WAIS-IV-Block Designs 11-14 (Appears Up To 4 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) Block Design - Completion time duration  Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDTimeDur Recommended CDE
3 Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Items 11-14 score  Score for Items 11-14, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDItem11to14Score Recommended CDE

WAIS-IV Block Design-Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - No time bonus total raw score  Total raw score with no time bonus, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDNRawScore Recommended CDE
2 Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Total raw score  Total raw score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest WAISIVBDRawScore Recommended CDE
Keywords

Change History