Form Structure: Wechsler Adult Intelligence Scale IV (WAIS-IV) Cancellation
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Wechsler Adult Intelligence Scale IV (WAIS-IV) Cancellation
Short Name:
WAISIV_Cancellation
Description:
The Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest measures processing speed. Copyright Pearson Inc. (2008), (http://www.pearsonclinical.com/content/ani/clinicalassessments/us/en.html). References: Wechsler D. Wechsler Adult Intelligence Scale?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:
24
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 |
Cancellation-Item 1 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Completion time duration | Time interval required to complete Cancellation, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest | WAISIVPSICATimeDur | Recommended | CDE |
| 2 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Number correct answers | Number of correct answers as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest | WAISIVPSICACorrNum | Recommended | CDE |
| 3 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Number incorrect answers | Number of incorrect answers as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest | WAISIVPSICAIncorrNum | Recommended | CDE |
| 4 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Item score | Item score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest | WAISIVPSICAItemScore | Recommended | CDE |
Cancellation-Item 2 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Completion time duration | Time interval required to complete Cancellation, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest | WAISIVPSICATimeDur | Recommended | CDE |
| 2 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Number correct answers | Number of correct answers as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest | WAISIVPSICACorrNum | Recommended | CDE |
| 3 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Number incorrect answers | Number of incorrect answers as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest | WAISIVPSICAIncorrNum | Recommended | CDE |
| 4 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Item score | Item score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest | WAISIVPSICAItemScore | Recommended | CDE |
Cancellation-Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Processing Speed Index (PSI) Cancellation - Total raw score | Total raw score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Processing Speed Index (PSI) Cancellation subtest | WAISIVPSICARawScore | Recommended | CDE |
Keywords
