Data Dictionary for roscevfu

Number of Blaise fields: 614

Seq # Var Question Data Type/Coding
1 projid ROS FOLLOW-UP Clinical Evaluation (Version: 12/29/2020) Enter project ID number. String[8]
2 visit Enter curent visit code from face sheet: CODE F/U Year CODE F/U Year CODE F/U Year CODE F/U Year 00 = Baseline 08 = 8th F/U 16 = 16th F/U 24 = 24th F/U 01 = 1st F/U 09 = 9th F/U 17 = 17th F/U 25 = 25th F/U 02 = 2nd F/U 10 = 10th F/U 18 = 18th F/U 26 = 26th F/U 03 = 3rd F/U 11 = 11th F/U 19 = 19th F/U 27 = 27th F/U 04 = 4th F/U 12 = 12th F/U 20 = 20th F/U 28 = 28th F/U 05 = 5th F/U 13 = 13th F/U 21 = 21th F/U 29 = 29th F/U 06 = 6th F/U 14 = 14th F/U 22 = 22th F/U 30 = 30th F/U 07 = 7th F/U 15 = 15th F/U 23 = 23th F/U String[2]
3 dateint Date of interview Date type
4 baseyear Enter year of baseline from face sheet: 1993 .. 2025
5 formno Form Number String[8]
6 version Version Number String[4]
7 autodate Automatic Date. Date type
8 autotime Automatic Time. TimeType
9 autolog Automatic Logged Date. Date type
10 intid INTERVIEWER ID 100 .. 997
11 compid Laptop ID String[20]
12 datlas Date of last clinical evaluation Date type
13 sex Subject's sex. 1= Male 2= Female
14 autotm [COMPUTER CLOCK TIME] String[8]
15 phone Was this interview completed over the telephone or in person? 1= In-person 2= Telephone
16 q1drg Now I would like to ask you about medicines. 1. During the past two weeks, HAVE YOU TAKEN ANY MEDICINE PRESCRIBED by a doctor? 1= Yes 2= No
17 q2drg 2. Now, about supplements not usually prescribed by a doctor such as vitamin preparations including multivitamins, vitamin C, vitamin A, vitamin D, or vitamin E . . . During the past two weeks have you taken any of these or any other vitamin preparations? 1= Yes 2= No
18 q3drg 3. We are also interested in other medicines or supplements not prescribed by a doctor such as aspirin, Tylenol, Bufferin, Anacin, headache pills or pain killers, laxatives or bowel medicines, cold medicines, cough medicines, sleep medicines, antacids or stomach medicines, ointments or salves . . . During the past two weeks have you taken any of these or any other medicines from the drug store? 1= Yes 2= No
19 q4drg 4. May I please see all these medicines for the past two weeks? [INTERVIEWER RECORD ALL MEDICINES TAKEN WITHIN THE PAST 2 WEEKS WHETHER AVAILABLE FOR INSPECTION OR NOT] [ENTER TOTAL NUMBER OF MEDICINES TO BE RECORDED] 0 .. 50
20 name00 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
21 stren00 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
22 drgnm00 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
23 seen00 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
24 dosage00 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
25 recd00 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
26 name01 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
27 stren01 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
28 drgnm01 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
29 seen01 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
30 dosage01 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
31 recd01 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
32 name02 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
33 stren02 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
34 drgnm02 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
35 seen02 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
36 dosage02 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
37 recd02 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
38 name03 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
39 stren03 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
40 drgnm03 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
41 seen03 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
42 dosage03 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
43 recd03 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
44 name04 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
45 stren04 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
46 drgnm04 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
47 seen04 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
48 dosage04 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
49 recd04 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
50 name05 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
51 stren05 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
52 drgnm05 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
53 seen05 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
54 dosage05 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
55 recd05 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
56 name06 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
57 stren06 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
58 drgnm06 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
59 seen06 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
60 dosage06 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
61 recd06 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
62 name07 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
63 stren07 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
64 drgnm07 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
65 seen07 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
66 dosage07 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
67 recd07 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
68 name08 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
69 stren08 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
70 drgnm08 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
71 seen08 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
72 dosage08 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
73 recd08 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
74 name09 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
75 stren09 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
76 drgnm09 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
77 seen09 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
78 dosage09 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
79 recd09 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
80 name10 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
81 stren10 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
82 drgnm10 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
83 seen10 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
84 dosage10 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
85 recd10 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
86 name11 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
87 stren11 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
88 drgnm11 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
89 seen11 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
90 dosage11 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
91 recd11 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
92 name12 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
93 stren12 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
94 drgnm12 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
95 seen12 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
96 dosage12 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
97 recd12 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
98 name13 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
99 stren13 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
100 drgnm13 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
101 seen13 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
102 dosage13 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
103 recd13 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
104 name14 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
105 stren14 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
106 drgnm14 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
107 seen14 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
108 dosage14 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
109 recd14 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
110 name15 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
111 stren15 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
112 drgnm15 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
113 seen15 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
114 dosage15 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
115 recd15 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
116 name16 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
117 stren16 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
118 drgnm16 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
119 seen16 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
120 dosage16 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
121 recd16 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
122 name17 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
123 stren17 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
124 drgnm17 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
125 seen17 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
126 dosage17 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
127 recd17 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
128 name18 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
129 stren18 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
130 drgnm18 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
131 seen18 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
132 dosage18 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
133 recd18 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
134 name19 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
135 stren19 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
136 drgnm19 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
137 seen19 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
138 dosage19 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
139 recd19 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
140 name20 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
141 stren20 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
142 drgnm20 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
143 seen20 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
144 dosage20 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
145 recd20 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
146 name21 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
147 stren21 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
148 drgnm21 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
149 seen21 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
150 dosage21 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
151 recd21 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
152 name22 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
153 stren22 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
154 drgnm22 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
155 seen22 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
156 dosage22 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
157 recd22 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
158 name23 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
159 stren23 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
160 drgnm23 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
161 seen23 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
162 dosage23 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
163 recd23 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
164 name24 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
165 stren24 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
166 drgnm24 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
167 seen24 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
168 dosage24 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
169 recd24 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
170 name25 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
171 stren25 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
172 drgnm25 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
173 seen25 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
174 dosage25 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
175 recd25 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
176 name26 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
177 stren26 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
178 drgnm26 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
179 seen26 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
180 dosage26 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
181 recd26 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
182 name27 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
183 stren27 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
184 drgnm27 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
185 seen27 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
186 dosage27 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
187 recd27 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
188 name28 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
189 stren28 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
190 drgnm28 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
191 seen28 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
192 dosage28 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
193 recd28 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
194 name29 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
195 stren29 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
196 drgnm29 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
197 seen29 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
198 dosage29 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
199 recd29 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
200 name30 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
201 stren30 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
202 drgnm30 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
203 seen30 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
204 dosage30 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
205 recd30 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
206 name31 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
207 stren31 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
208 drgnm31 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
209 seen31 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
210 dosage31 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
211 recd31 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
212 name32 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
213 stren32 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
214 drgnm32 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
215 seen32 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
216 dosage32 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
217 recd32 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
218 name33 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
219 stren33 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
220 drgnm33 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
221 seen33 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
222 dosage33 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
223 recd33 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
224 name34 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
225 stren34 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
226 drgnm34 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
227 seen34 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
228 dosage34 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
229 recd34 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
230 name35 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
231 stren35 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
232 drgnm35 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
233 seen35 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
234 dosage35 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
235 recd35 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
236 name36 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
237 stren36 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
238 drgnm36 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
239 seen36 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
240 dosage36 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
241 recd36 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
242 name37 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
243 stren37 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
244 drgnm37 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
245 seen37 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
246 dosage37 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
247 recd37 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
248 name38 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
249 stren38 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
250 drgnm38 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
251 seen38 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
252 dosage38 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
253 recd38 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
254 name39 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
255 stren39 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
256 drgnm39 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
257 seen39 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
258 dosage39 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
259 recd39 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
260 name40 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
261 stren40 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
262 drgnm40 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
263 seen40 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
264 dosage40 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
265 recd40 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
266 name41 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
267 stren41 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
268 drgnm41 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
269 seen41 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
270 dosage41 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
271 recd41 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
272 name42 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
273 stren42 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
274 drgnm42 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
275 seen42 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
276 dosage42 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
277 recd42 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
278 name43 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
279 stren43 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
280 drgnm43 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
281 seen43 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
282 dosage43 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
283 recd43 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
284 name44 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
285 stren44 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
286 drgnm44 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
287 seen44 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
288 dosage44 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
289 recd44 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
290 name45 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
291 stren45 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
292 drgnm45 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
293 seen45 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
294 dosage45 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
295 recd45 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
296 name46 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
297 stren46 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
298 drgnm46 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
299 seen46 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
300 dosage46 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
301 recd46 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
302 name47 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
303 stren47 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
304 drgnm47 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
305 seen47 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
306 dosage47 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
307 recd47 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
308 name48 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
309 stren48 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
310 drgnm48 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
311 seen48 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
312 dosage48 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
313 recd48 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
314 name49 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
315 stren49 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
316 drgnm49 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
317 seen49 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
318 dosage49 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
319 recd49 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
320 q8atap FINGER TAPPING [TURN DIAL TO TAPPING TEST] 1. Right hand. 'I want to see how quickly you can tap this key. When I tell you to begin, tap this key as quickly as you can until I tell you to stop.' Record first trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 1 .. 97
321 q8ana Specify reason. String[40]
322 q8btap FINGER TAPPING [RESET TAPPER] Left hand. Record first trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 1 .. 97
323 q8bna Specify reason. String[40]
324 q8ctap FINGER TAPPING [RESET TAPPER] Right hand. Record second trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 1 .. 97
325 q8cna Specify reason. String[40]
326 q8dtap FINGER TAPPING [RESET TAPPER] Left hand. Record second trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 1 .. 97
327 q8dna Specify reason. String[40]
328 rhand1 HAND DYNAMOMETRY [SET RED NEEDLE TO 0.] 'I want to see how strongly you can squeeze this handle. When I say go, squeeze the handle as hard as you can until I tell you to stop.' Right Hand Trial 1 [RECORD IN POUNDS.] 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 777
329 rhand1na Specify reason. String[40]
330 lhand1 HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 1 [RECORED IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 777
331 lhand1na Specify reason. String[40]
332 rhand2 HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Right Hand Trial 2 [RECORD IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 777
333 rhand2na Specify reason. String[40]
334 lhand2 HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 2 [RECORD IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 777
335 lhand2na Specify reason. String[40]
336 rthand1 PINCH DYNAMOMETRY [SET RED NEEDLE TO 0.] 'I want to see how strongly you can pinch this plate. When I say go, squeeze the plate as hard as you can until I tell you to stop.' Right Hand Trial 1 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 77
337 rthand1n Specify reason. String[40]
338 lthand1 PINCH DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 1 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 77
339 lthand1n Specify reason. String[40]
340 rthand2 PINCH DYNAMOMETRY [RESET NEEDLE TO 0.] Right Hand Trial 2 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 77
341 rthand2n Specify reason. String[40]
342 lthand2 PINCH DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 2 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 77
343 lthand2n Specify reason. String[40]
344 strokefu MEDICAL HISTORY First I would like to ask you a few questions about specific medical conditions such as stroke and Parkinson's disease. STROKE 1. Since your evaluation on [last interview date], have you been told by a doctor, nurse or therapist that you had a STROKE, TRANSIENT ISCHEMIC ATTACK (TIA) or BRAIN HEMORRHAGE? 1= Yes 2= Suspect or possible 3= No
345 faint0fu At the time of this (last) event, did you you have . . . a. Fainting, blackout or loss of consciousness? 1= Yes 2= Suspect 3= No
346 dizzy0fu b. Dizzyness or lightheadedness? 1= Yes 2= Suspect 3= No
347 memor0fu c. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
348 speec0fu d. Language or speech change? 1= Yes 2= Suspect 3= No
349 visio0fu e. Loss of vision? 1= No 2= right only 3= left only 4= both
350 face0fu f. Weakness or paralysis of your face? 1= No 2= right only 3= left only 4= both
351 weakl0fu g. Weakness or paralysis of your arms or legs? 1= No 2= right only 3= left only 4= both
352 limse0fu h. Loss or change of sensation in your arms or legs? 1= No 2= right only 3= left only 4= both
353 symps0fu i. Specify any other signs or symptoms associated with this (last) event? String[40]
354 samet0fu j. Did the stroke occur around the same time as a SURGICAL OPERATION, HEART ATTACK, BREATHING DIFFICULTY, or ANOTHER SERIOUS MEDICAL PROBLEM? 1= Yes 2= Suspect 3= No
355 sames0fu Specify: String[60]
356 inhospfu 2. Since your evaluation on [last interview date], have you been HOSPITALIZED OVERNIGHT or longer because of a STROKE, a TIA or a BRAIN HEMORRHAGE? 1= Yes 2= Suspect 3= No
357 promp1fu 2a. Was this the same event we just spoke about? 1= Yes 2= No
358 hospnafu 2b. What was the name of the hospital? String[30]
359 faint1fu At the time of this (last) event, did you you have . . . a. Fainting, blackout or loss of consciousness? 1= Yes 2= Suspect 3= No
360 dizzy1fu b. Dizzyness or lightheadedness? 1= Yes 2= Suspect 3= No
361 memor1fu c. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
362 speec1fu d. Language or speech change? 1= Yes 2= Suspect 3= No
363 visio1fu e. Loss of vision? 1= No 2= right only 3= left only 4= both
364 face1fu f. Weakness or paralysis of your face? 1= No 2= right only 3= left only 4= both
365 weakl1fu g. Weakness or paralysis of your arms or legs? 1= No 2= right only 3= left only 4= both
366 limse1fu h. Loss or change of sensation in your arms or legs? 1= No 2= right only 3= left only 4= both
367 symps1fu i. Specify any other signs or symptoms associated with this (last) event? String[40]
368 samet1fu j. Did the stroke occur around the same time as a SURGICAL OPERATION, HEART ATTACK, BREATHING DIFFICULTY, or ANOTHER SERIOUS MEDICAL PROBLEM? 1= Yes 2= Suspect 3= No
369 sames1fu Specify: String[60]
370 stroksfu 3. Since [last interview date], have you had a CT, MRI or other type of brain scan because of a STROKE, a TIA or a BRAIN HEMORRHAGE? 1= Yes 2= Suspect 3= No
371 promp2fu 3a. Was this for ^event we just spoke about? 1= Yes 2= No
372 scanlofu 3b. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? String[30]
373 faint2fu At the time of this (last) event, did you you have . . . a. Fainting, blackout or loss of consciousness? 1= Yes 2= Suspect 3= No
374 dizzy2fu b. Dizzyness or lightheadedness? 1= Yes 2= Suspect 3= No
375 memor2fu c. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
376 speec2fu d. Language or speech change? 1= Yes 2= Suspect 3= No
377 visio2fu e. Loss of vision? 1= No 2= right only 3= left only 4= both
378 face2fu f. Weakness or paralysis of your face? 1= No 2= right only 3= left only 4= both
379 weakl2fu g. Weakness or paralysis of your arms or legs? 1= No 2= right only 3= left only 4= both
380 limse2fu h. Loss or change of sensation in your arms or legs? 1= No 2= right only 3= left only 4= both
381 symps2fu i. Specify any other signs or symptoms associated with this (last) event? String[40]
382 samet2fu j. Did the stroke occur around the same time as a SURGICAL OPERATION, HEART ATTACK, BREATHING DIFFICULTY, or ANOTHER SERIOUS MEDICAL PROBLEM? 1= Yes 2= Suspect 3= No
383 sames2fu Specify: String[60]
384 multipfu 4. Since your last evaluation on [last interview date], did you have only ONE STROKE, TIA or BRAIN HEMORRHAGE, or more than one? 1= Only one 2= More than one
385 leftspfu 5. Specify leftover troubles from your stroke(s)? String[60]
386 everscfu 6. Since [last interview date], have you had a CT, MRI or other type of brain scan? 1= Yes 2= Suspect 3= No
387 reasonfu 6c. Reason String[60]
388 escanlfu 6d. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? String[30]
389 parksfu 1. Since [last interview date], have you been told by a doctor, nurse or therapist that you had PARKINSONISM or PARKINSON'S DISEASE? 1= Yes 2= Suspect or possible 3= No
390 gaitfu With the parkinsonism, did you have . . . 2. Shuffling or unsteady gait, or loss of balance? 1= Yes 2= Suspect 3= No
391 writinfu 3. A change in your handwriting? 1= Yes 2= Suspect 3= No
392 stifffu 4. Stiffness or rigidity of your arms or legs? 1= No 2= right only 3= left only 4= both
393 slowmofu 5. Slowness of movement of your arms, hands or legs? 1= No 2= right only 3= left only 4= both
394 tremorfu 6. Tremor of your hands or feet? 1= No 2= right only 3= left only 4= both
395 medicafu 7. Are you currently taking any medication for your parkinsonism or Parkinson's disease (some examples are Sinemet, Symmetrel, Parlodel, Bromocriptine, etc.)? 1= Yes 2= Suspect or possible 3= No
396 medspefu 7a. Specify String[30]
397 admin NEUROLOGICAL EXAMINATION The neurologic examination should begin with both the subject and examiner comfortably seated facing one another. Right and left are always referenced to the subject. >>>>> PRESS ENTER FOR FIRST ITEM <<<<<
398 visual VISUAL FIELDS [EXAMINER: Test each quadrant separately by confrontation with both eyes open. Wiggle fingers in the middle of each quadrant for one second and ask the subject to look at the fingers. If the subject is unable to comply, note whether the subject attends the wiggling fingers.] >>>>> PRESS ENTER FOR FIRST ITEM <<<<<
399 speech3 SPEECH 1= Normal 2= Slight loss of expression, diction and/or volume which could be normal 3= Monotone, slurred but understandable, moderately impaired 4= Marked impairment, difficult to understand 5= Unintelligible
400 dentures Is the subject missing a substantial portion of his or her natural or prosthetic dentition? 1= Yes 2= No
401 facexp FACIAL EXPRESSION 1= Normal 2= Minimal hypomimia, could be normal `poker face' 3= Slight but definitely abnormal diminution of facial expression 4= Moderate hypomimia; lips parted some of the time 5= Masked or fixed facies with severe or complete loss of facial expression; lips parted 1/4 inch or more 7= Unable to test
402 nasorest FACIAL STRENGTH [EXAMINER: Observe facial symmetry at rest and with activation of facial muscle groups. Ask subject to raise eyebrows, close eyes, smile.] 1. Nasolabial fold at rest and or action 1= Symmetric 2= Right flatter than left 3= Left flatter than right 7= Unable to test
403 fissures 2. Palpebral fissures 1= Symmetric 2= Right wider than left 3= Left wider than right 7= Unable to test
404 eyebrows 3. Raise eyebrows 1= Symmetric 2= Right higher than left 3= Left higher than right 7= Unable to test
405 rightsup 1. Right superior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
406 rightinf 2. Right inferior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
407 leftsup 3. Left superior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
408 leftinf 4. Left inferior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
409 tongue TONGUE PROTRUSION [EXAMINER: Instruct the subject to open his or her mouth and stick out his or her tongue. Upper lip shuold not be in contact with tongue. The tongue will deviate to the weak side.] 1= Midline 2= Deviate right 3= Deviate left 7= Unable to test
410 rarmrest RESTING TREMOR [EXAMINER: Instruct the subject to sit completely relaxed and to count aloud backwards from 10. Observe the hands and feet for rhythmic tremor.] 1. Right arm rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
411 larmrest 2. Left arm rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
412 rlegrest 3. Right leg rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
413 llegrest 4. Left leg rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
414 chinjaw 5. Chin/jaw rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
415 rhanddys FINGER-TO-FINGER [EXAMINER: Instruct the subject to touch his or her index finger to your finger. The subject should extend the arm completely. Observe for dysmetria AND postural/action - NEXT Q.] 1. Right hand 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
416 lhanddys 2. Left hand 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
417 rhandact POSTURAL/ACTION TREMOR OF HANDS [EXAMINER: Instruct the subject to hold his or her arms perpendicular to body with the palms down and fingers spread apart for 10 seconds. Observe for postural or action tremor. Record most severe tremor.] 3. Right hand 1= Absent 2= Possible 3= Present 4= Unable to test due to weakness
418 rhamp 3a. Amplitude 1= Slight 2= Mild 3= Moderate 4= Marked
419 rhaorp 3b. Posture/Action 1= Action only 2= Posture only 3= Action AND posture
420 rhfreq 3c. Frequency 1= Slow [<7 Hz] 2= Moderate [7-10 Hz] 3= Fast [>10 Hz]
421 lhandact 4. Left hand 1= Absent 2= Possible 3= Present 4= Unable to test due to weakness
422 lhamp 4a. Amplitude 1= Slight 2= Mild 3= Moderate 4= Marked
423 lhaorp 4b. Posture/Action 1= Action only 2= Posture only 3= Action AND posture
424 lhfreq 4c. Frequency 1= Slow [<7 Hz] 2= Moderate [7-10 Hz] 3= Fast [>10 Hz]
425 scptrem 0 .. 8
426 scrtrem 0 .. 30
427 ilptrem String[6]
428 ilrtrem String[6]
429 mposttrm 0 .. 2
430 mresttrm 0 .. 5
431 admin2 BRADYKINESIA Finger taps [EXAMINER: Subject taps thumb with index finger in rapid succession with widest amplitude possible for 10 seconds. Observe amplitude and speed of movement.] >>>>> PRESS ENTER TO CONTINUE <<<<<
432 rfingtap 1. Right 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
433 lfingtap 2. Left 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
434 rfist Fist clench [EXAMINER: Subject opens and closes fist as widely and as rapidly as possible for 10 seconds. Observe for speed and amplitude of movement.] 3. Right 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
435 lfist 4. Left 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
436 rprosup Pronation-Supination [EXAMINER: Instruct subject to alternately tap the front and back of his or her hand on his or her knee for 10 seconds. Observe for speed, amplitude and rhythmicity of movement.] 5. Right 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
437 rdisdia 5a. Right disdiadochokinesia 1= Yes 2= Suspect 3= No
438 lprosup 6. Left 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
439 ldisdia 6a. Left disdiadochokinesia 1= Yes 2= Suspect 3= No
440 rheeltap Leg agility [EXAMINER: Subject taps heel on ground in rapid succession for 10 seconds. Picks up entire leg. Amplitude should be about three inches.] 7. Right heel tap 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
441 lheeltap 8. Left heel tap 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
442 scbrady 0 .. 70
443 ilbrady String[6]
444 mbrady 0 .. 8
445 admin3 STRENGTH [EXAMINER: When testing strength, push or pull for 2 seconds] Arm strength [EXAMINER: Instruct the subject to sit with both arms extended in front of the body with the palms facing upward and the fingers spread apart for 10 seconds. Observe for weakness and asymmetry.] >>>>> PRESS ENTER TO CONTINUE <<<<< String[1]
446 rarm 1. Right arm drift *******NOTE: BE SURE YOU ARE CODING EVERYTHING ACCORDING **** ******* TO THE >>SUBJECT'S<< RIGHT OR LEFT SIDE. ******* 1= No weakness 2= Possible weakness 3= Definite weakness, but elevates arm 10 seconds 4= Elevates arm less than 10 seconds 5= Unable to elevate arm 7= Unable to test
447 larm 2. Left arm drift 1= No weakness 2= Possible weakness 3= Definite weakness, but elevates arm 10 seconds 4= Elevates arm less than 10 seconds 5= Unable to elevate arm 7= Unable to test
448 armsym 3. Arm drift symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
449 rarmabd 4. Right arm abduction [deltoid] strength [EXAMINER: Stand in front of subject and instruct him or her to abduct his or her arms at the shoulders, and hold them up. Test both deltoid simultaneously] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
450 larmabd 5. Left arm abduction [deltoid] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
451 armadbsy 6. Arm abduction [deltoid] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
452 rflex 7. Right arm flexion [biceps] strength [EXAMINER: Stand in front of subject and instruct him or her to flex his or her supinated forearms, and hold them up. Test each arm separately.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
453 lflex 8. Left arm flexion [biceps] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
454 flexsym 9. Arm felxion [biceps] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
455 raext 10. Right arm extension [triceps] strength [EXAMINER: Stand in front of subject and instruct him or her to extend his or her supinated forearms at the elbow. Start with arm at 90 degree angle. Test each arm separately.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
456 laext 11. Left arm extension [triceps] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
457 extsym 12. Arm extension [triceps] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
458 rwrist 13. Right wrist extensor [extensor carpi radialis] strength [EXAMINER: Instruct subject to hold arms outstretched perpendicular to body, make a fist and `cock' his or her wrists back and hold them. Test each wrist separately.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
459 lwrist 14. Left wrist extensor [extensor carpi radialis] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
460 wristsym 15. Wrist extensor [extensor carpi radialis] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
461 rfinger 16. Right index finger strength (FDI). [EXAMINER: Instruct subject to place his or her palm and fingers flat on the table with fingers spread apart. Push on the first index finger joint. 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe
462 lfinger 17. Left index finger strength. 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe
463 rthumb 18. Right thumb strength (APB). [EXAMINER: Instruct subject to place the back of his or her hand on the table with the thumb pointed straight up. Push while subject abducts thumb toward other side of wrist. 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe
464 lthumb 19. Left thumb strength. 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe
465 rhip 20. Right hip flexion [iliopsoas] strength [EXAMINER: Stand in front of subject and instruct him or her to raise his or her leg off the chair. Test each leg separately.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
466 lhip 21. Left hip flexion [iliopsoas] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
467 hipsym 22. Hip felxion [iliopsoas] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
468 rleg Leg strength [EXAMINER: Instruct the subject to sit and extend both legs straight out for 10 seconds. Observe each leg in turn for weakness.] 23. Right leg strength *******NOTE: BE SURE YOU ARE CODING EVERYTHING ACCORDING **** ******* TO THE >>SUBJECT'S<< RIGHT OR LEFT SIDE. ******* 1= No weakness 2= Possible weakness 3= Definite weakness, but elevates leg 10 seconds 4= Elevates leg less than 10 seconds 5= Unable to elevate leg 7= Unable to test
469 lleg 24. Left leg strength 1= No weakness 2= Possible weakness 3= Definite weakness, but elevates leg 10 seconds 4= Elevates leg less than 10 seconds 5= Unable to elevate leg 7= Unable to test
470 legsym 25. Leg strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
471 rknee 26. Right knee extension strength [EXAMINER: Ask subject to straighten his or her leg; push down on ankle to check knee extension (quadriceps) strength. Test each leg separately] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
472 lknee 27. Left knee extension (quadriceps) strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
473 kneesym 28. Knee extension (quadriceps) strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
474 rankle 29. Right ankle dorsiflexion [tibialis anterior] strength [EXAMINER: Hold up subject's leg and ask subject to `cock' his or her foot back towards his or her face. Push on dorsum of foot.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
475 lankle 30. Left ankle dorsiflexion [tibialis anterior] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
476 anklesym 31. Ankle dorsiflexion [tibialis anterior] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
477 rfoot 32. Right foot plantar flexion [gastrocnemius] strength [EXAMINER: Stand in front of subject, straighten his or her legs, place your hand on ball of foot and instruct him or her to push his or her foot against your hand.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
478 lfoot 33. Left foot plantar flexion [gastrocnemius] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
479 footsym 34. Foot plantar flexion [gastrocnemius] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
480 neckrig HYPERTONICITY [EXAMINER: Judged on passive movement of the extremities with subject relaxed in a sitting position.] 1. Neck Rigidity 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
481 neckcog 1a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
482 rarmrig 2. Right arm rigidity present in flexors AND extensors 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
483 rarmcog 2a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
484 rarmgeg 2b. Rigidity in flexors and extensors increases as the examiner moves the extremity faster and harder. 1= Yes 2= Suspect 3= No 7= Unable to test
485 rarmspas 3. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
486 rarmflex 4. Flexion contracture present 1= Yes 2= Suspect 3= No 7= Unable to test
487 larmrig 5. Left arm rigidity present in flexors AND extensors 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
488 larmcog 5a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
489 larmgeg 5b. Rigidity in flexors and extensors increases as the examiner moves the extremity faster and harder. 1= Yes 2= Suspect 3= No 7= Unable to test
490 larmspas 6. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
491 larmflex 7. Flexion contracture present 1= Yes 2= Suspect 3= No 7= Unable to test
492 rlegrig 8. Right leg rigidity present in flexors AND extensors 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
493 rlegcog 8a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
494 rleggeg 8b. Rigidity in flexors and extensors increases as the examiner moves the extremity faster and harder. 1= Yes 2= Suspect 3= No 7= Unable to test
495 rlegspas 9. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
496 rlegflex 10. Flexion contracture present 1= Yes 2= Suspect 3= No 7= Unable to test
497 llegrig 11. Left leg rigidity present in flexors AND extensors 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
498 llegcog 11a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
499 lleggeg 11b. Rigidity in flexors and extensors increases as the examiner moves the extremity faster and harder. 1= Yes 2= Suspect 3= No 7= Unable to test
500 llegspas 12. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
501 llegflex 13. Flexion contracture present 1= Yes 2= Suspect 3= No 7= Unable to test
502 rlegatax HEEL-TO-SHIN TEST [EXAMINER: Lower extremity ataxia is checked by the heel-to-shin test. Instruct the subject to place the heel of one foot on the opposite knee, then to slide the heel down the shin in a straight line to the foot. Observe the accuracy of touching the knee with the heel and the smoothness of the movement down the shin.] 1. Right leg ataxia 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
503 llegatax Left leg ataxia 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
504 scrigid 0 .. 25
505 ilrigid String[6]
506 mrigid 0 .. 5
507 rbiceps DEEP TENDON REFLEXES 1. Right Biceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
508 lbiceps 2. Left Biceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
509 bicepsym 3. Biceps symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
510 rbrach 4. Right Brachioradialis 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
511 lbrach 5. Left Brachioradialis 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
512 brachsym 6. Brachioradialis symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
513 rtriceps 7. Right Triceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
514 ltriceps 8. Left Triceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
515 tricpsym 9. Triceps symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
516 rpatella 10. Right Patella 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
517 lpatella 11. Left Patella 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
518 patelsym 12. Patella symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
519 rachill 13. Right achilles 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
520 lachill 14. Left achilles 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
521 achilsym 15. Achilles symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
522 rbigtoe BABINSKI SIGN 1. Right big toe 1= Normal 2= Possible 3= Present 7= Unable to test
523 lbigtoe 2. Left big toe 1= Normal 2= Possible 3= Present 7= Unable to test
524 rtoevib SENSORY FUNCTION Vibratory sensation 1. Right big toe [EXAMINER: First, make sure that subject understands the sensation. Tap tuning fork in palm of hand and test for ability to perceive vibration on the top of the large toe of each foot.] 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 7= Unable to test
525 ltoevib Vibratory sensation 2. Left big toe 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 7= Unable to test
526 rlegvib Stocking pattern of vibratory loss 3. Right Leg. [EXAMINER: Determine whether there is a greater sensory loss in the toe vs. the ankle] 1= Yes 2= Possible 3= No
527 ltlegvib Stocking pattern of vibratory loss 4. Left leg. [EXAMINER: Determine whether there is a greater sensory loss in the toe vs. the ankle] 1= Yes 2= Possible 3= No
528 hpinsym Pin sensation 1. Back of index fingers symmetric 1= Yes 2= Right with less sensation than left 3= Left with less sensation than right 7= Unable to test
529 rhandpin Pin sensation 2. Right Index vs. Pinky [EXAMINER: Now instruct the subject that you will test the sensation of the index and pinky fingers. Ask the subject to tell you whether they feel the same; if they are different, where does he or she feel it more, the index finger or the small finger.] 1= Same 2= Index possible more than pinky 3= Index definitely more than pinky 4= Pinky possibly more than index 5= Pinky definitely more than index
530 lhandpin Pin sensation 3. Left Index vs. Pinky 1= Same 2= Index possible more than pinky 3= Index definitely more than pinky 4= Pinky possibly more than index 5= Pinky definitely more than index
531 fpinsym Pin sensation 4. Top of big toe symmetric 1= Yes 2= Right with less sensation than left 3= Left with less sensation than right 7= Unable to test
532 rlegpin Stocking pattern of pin loss 5. Right Leg. [EXAMINER: Tell the subject that he or she will feel the pin on the toe and ankle. Determine whether it is the same or different -- consistent with a stocking pattern of sensory loss.] 1= Yes 2= Possible 3= No
533 ltlegpin Stocking pattern of pin loss 6. Left leg. 1= Yes 2= Possible 3= No
534 chairup POSTURE/GAIT 1. Arising from a chair [EXAMINER: Seat the subject in a straight back chair with arms. Instruct him or her to cross his or her arms across his or her chest, and to stand from the chair. If he or she is unable to do this, he or she may stand using his or her hands.] 1= Normal 2= Slow, could be normal 3= Needs more than 1 attempt, but does not push with arms 4= Pushes self up from arms of chair 5= Using arms, tends to fall back or requires more than one attempt, but able to stand without help 6= Unable to arise without help 7= Unable to test
535 basegait Gait [EXAMINER: Ask the subject to walk as fast as possible (about 10 feet), turn around and walk back. Observe speed, associated movements and base.] 2. Base 1= Normal, medial malleoli within 3 inches 2= Slightly widened, medial malleoli 3-6 inches apart 3= Widened, medial melleoli > 6 inches apart 7= Unable to test
536 shufgait 3. Shuffling Gait [EXAMINER: Loss of heel-toe walk with low foot clearance.] 1= None 2= Walks slowly, may take short steps. Could be normal 3= Walks slowly, shuffles, no festination or propulsion 4= Walks with difficulty, shuffles, may festinate or propulse, requires no assistance 5= Severe disturbance of gait, shuffles, may festinate or propulse, unable to ambulate without assistance 6= Cannot walk at all due to shuffling gait, not even with assistance
537 armswing 3a. Reduced Armswing 1= Yes 2= Suspect 3= No 7= Unable to test
538 armside 3b. On which side is the armswing reduced? 1= Right 2= Left 3= Both
539 legcirc 4. Circumduction of Leg 1= Yes 2= Suspect 3= No 7= Unable to test
540 legside 4a. On which side is this? 1= Right 2= Left 3= Both
541 body 5. Body bradykinesia/hypokinesia [EXAMINER: This item represents a global view of the slowness and deliberateness of the subject's movements. During the examination, observe the rapidity of movements, also observe decrease in armswing and spontaneous movements.] 1= None 2= Minimal slowness, giving movement a deliberate character, possibly reduced amplitude 3= Mild degree of slowness and poverty of movement which is definitely abnormal, alternatively, some reduced amplitude 4= Moderate slowness, poverty or small amplitude of movement 5= Marked slowness, poverty or small amplitude of movement
542 turning 6. Turning 1= Pivots on narrow base 2= Hesitates or widens base, but steady 3= Turns slowly and awkwardly 4= Would likely fall without aid 5= Cannot turn 7= Unable to test
543 antspec Other gait abnormality: 7. Antalgic gait [EXAMINER: Limp, may be due to pain in back, hip(s), knee(s), ankle(s), foot/feet and/or toe(s).] 1= Yes 2= Suspect 3= No
544 ataxgait 8. Ataxic gait [EXAMINER: Disdiadochokinesia of gait, loss of gait rhythmicity.] 1= Yes 2= Suspect 3= No
545 neurgait 9. Neuropathic gait [EXAMINER: Steppage (equine) gait with high foot clearance.] 1= Yes 2= Suspect 3= No
546 gaitspec 10. Other gait abnormality String[40]
547 posture 1. Posture [EXAMINER: View the subject from the front and from the side.] 1= Normal erect 2= Slightly stooped posture, could be normal 3= Moderately stooped, can be leaning slightly to one side 4= Severely stooped with kyphosis, can be moderately leaning to one side 5= Marked flexion with extreme abnormality of posture 7= Unable to test
548 stblpost 2. Postural Stability [EXAMINER: Instruct the subject to stand with the feet about 6 inches apart. Instruct him or her that you will be pulling back on his or her shoulders and that he or she should `try not to fall.' Standing behind the subject, pull on the shoulders with increasing strength until the subject loses his or her balance. Note the number of steps and the strength of the pull.] 1= Normal, takes 1 step to correct balance 2= Possible retropulsion, takes 2 steps to correct balance 3= Definite retropulsion, takes 3 or more steps, but recovers unaided 4= Would fall if not caught 5= Unstable, tends to lose balance spontaneously 6= Unable to stand without assistance
549 numsteps 2a. NUMBER OF STEPS 3 .. 20
550 pull 2b. Strength of pull 1= Very light pull 2= Mild to moderate pull 3= Moderate to strong pull 4= Strong pull
551 myoclon MYOCLONUS [THIS SHOULD BE SCORED AS PRESENT ONLY IF ACTION OR RESTING MYOCLONUS IS ACTUALLY OBSERVED BY THE EXAMINER.] 1= Absent 2= Present during action or startle 3= Present at rest
552 chorea CHOREA [THIS SHOULD BE SCORED AS PRESENT ONLY IF ACTUALLY WITNESSED BY THE EXAMINER] 1= Absent 2= Possible chorea 3= Definite chorea
553 chorspec Specify: String[40]
554 screflex 0 .. 35
555 ilreflex String[6]
556 mreflex 0 .. 6
557 bedtime Sleep Questionnaire 1. During the past month, when have you usually gone to bed at night? Time (hh:mm) [INTERVIEWER If P responds with a range of time for bedtime, take the average. For example, if P indicates a bedtime between 10:30 pm-11:00 pm, enter 10:45 pm as the average bedtime. ] String[5]
558 bedtime_ 1. During the past month, when have you usually gone to bed at night? 1a. [am/pm] String[2]
559 min2slee 2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night? [Number of minutes] [INTERVIEWER If P responds with a range of minutes, take the average.] 0 .. 999
560 getuptim 3. During the past month, when have you usually gotten up in the morning? Time (hh:mm) [INTERVIEWER If P responds with a range of time for getting up time, take the average. ] String[5]
561 getupti2 3. During the past month, when have you usually gotten up in the morning? 3a. [am/pm] String[2]
562 sleephrs 4. During the past month, how many hours did you usually sleep at night? [hours] [INTERVIEWER If P responds with a range of time, take the average. ] 0 .. 23
563 sleephr2 4. During the past month, how many hours did you usually sleep at night? 4a. [minutes] 0 .. 59
564 trsleep_ 5. How often do you have trouble falling asleep? 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often
565 trsleep3 6. During the past month, how often did you have trouble falling asleep within 30 minutes? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
566 wakenigh 7. How often are you troubled by waking up during the night? 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often
567 wakenig2 8. During the past month, how often did you wake up in the middle of the night or early morning? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
568 rested_f 9. How often do you feel really rested when you wake up in the morning? 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often
569 tiredaft 10. During the past month, how often have you felt tired or fatigued after sleep? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
570 tiredwak 11. In the past month, during your waking time, how often have you felt tired, fatigued or not up to par? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
571 nap_freq 12. How often do you get so sleepy during the day or evening that you have to take a nap? 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often
572 sleepdri 13. Have you ever nodded off or fallen asleep while driving a vehicle? 0= No 1= Yes
573 sleepdr2 13a. Over the past month, how often has this occurred? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
574 psqi_med 14. Have you used sleeping medications in two weeks prior to this interview? 0= No 1= Yes
575 snore 15. Do you snore? 0= No 1= Yes 9= Don't know
576 snorebot 15a. Has your snoring ever bothered other people? 0= No 1= Yes 9= Don't know
577 snorerat 15b. If you snore, would you say your snoring is _____ ? 1= Slightly louder than breathing 2= As loud as talking 3= Louder than talking 4= Very loud - can be heard in adjacent rooms 99= DK
578 snore_fr 15c. Over the past month, how often have you been snoring? 1= NOT AT ALL 2= LESS THAN ONCE A WEEK 3= ONCE OR TWICE A WEEK 4= THREE OR MORE TIMES A WEEK 5= NEARLY EVERY DAY 99= DK
579 breathpa 16. During the past month, how often have others noticed that you quit breathing or have long pauses between breaths during sleep? 1= NOT AT ALL 2= LESS THAN ONCE A WEEK 3= ONCE OR TWICE A WEEK 4= THREE OR MORE TIMES A WEEK 5= NEARLY EVERY DAY 99= DK
580 sleepapn 17. Are you currently being treated for sleep apnea (e.g. CPAP)? 0= No 1= Yes
581 actdream Mayo Sleep Questionnaire ? Please mark ?Yes? if the described event has occurred at least 3 times. 18 . Have you ever been told that you appear to 'act out your dreams' while sleeping? (Punched or flailed arms in the air, shouted or screamed) 0= No 1= Yes
582 actdrea2 18a. How many months or years has this been going on? [Years] 0 .. 99
583 actdrea3 18a. How many months or years has this been going on? [Months] 18a-1. [Months] 0 .. 11
584 actdrea4 18b. Have you ever been injured from these behaviors (bruises, cuts, broken bones)? 0= No 1= Yes
585 actdrea5 18c. Has your bed-partner ever been injured from these behaviors (bruises, blows, pulled hair)? 0= No 1= Yes
586 dreamatt 18d. Have you ever had dreams about being attacked, or that involved defending yourself? 0= No 1= Yes
587 movdream 18e. Have you ever been told that the movements you made matched the details of your dream? 0= No 1= Yes
588 sleepwal 19. Have you ever been told that you walked around the bedroom or house while asleep? (please mark Yes if the described event has occurred at least 3 times) 0= No 1= Yes
589 sleepwa2 19a. If yes, how often does this occur? 0= Almost never 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
590 legtwitc 20. During the past month, how often have your legs repeatedly jerked or twitched during sleep (not just while falling asleep)? 1= NOT AT ALL 2= LESS THAN ONCE A WEEK 3= ONCE OR TWICE A WEEK 4= THREE OR MORE TIMES A WEEK 5= NEARLY EVERY DAY 99= DK
591 legdisru 21. During the past month, how often have you had a restless, nervous, tingly, or creepy-crawly feeling in your legs that disrupts your ability to fall or stay asleep? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
592 legdisr2 21a. Do these leg sensations decrease when you walk around? 0= No 1= Yes
593 legdisr3 21b. When do these sensations seem to be the worst? 1= Before 6pm 2= After 6pm
594 comm Comments. String[120]
595 autotm1 [COMPUTER CLOCK TIME] String[8]
596 report1 CLIN EVAL SUMMARY: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 1/10 AREA IMPAIRMENT LEVEL RANGE SCORE (Missing~) Bradykinesia ^VBrady 8-48 ^brady.ScBrady (^brady.mbrady of 8) Postural Reflex ^Vreflex 6-32 ^sensgait.Screflex^x1 (^sensgait.mreflex of 6) Rigidity ^Vrigid 5-25 ^hyper.ScRigid^x2 (^hyper.mrigid of 5) [~NOTE: If any data are missing, this will affect the computation of the impairment level.] >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
597 report2 CLIN EVAL SUMMARY: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 2/10 AREA IMPAIRMENT LEVEL RANGE SCORE (Missing~) Postural tremor ^Vptrem 0-8 ^tremor.Scptrem (^tremor.mposttrm of 2) Resting tremor ^Vrtrem 5-30 ^tremor.Scrtrem^x3 (^tremor.mresttrm of 5) Parkinsonism: ^Parkvar ^ps1^ps2^ps4^ps7^ps10 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
598 report3 HISTORY FROM CLIN EVAL: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 3/10 Stroke: ^strovar ^s1^s2^s3^s4^s6^s9^s12^s15^cervasc.symps0fu^s17 Current Drugs: ^drugvar^drugs.RXs.medicine[1].name00 ^drugs.RXs.medicine[2].name00 ^drugs.RXs.medicine[3].name00 ^drugs.RXs.medicine[4].name00 ^drugs.RXs.medicine[5].name00 ^drugs.RXs.medicine[6].name00 ^drugs.RXs.medicine[7].name00 ^drugs.RXs. medicine[8].name00 ^drugs.RXs.medicine[9].name00 ^drugs.RXs.medicine[10].name00 ^drugs.RXs.medicine[11].name00 ^drugs.RXs.medicine[12].name00 ^drugs.RXs.medicine[13].name00 ^drugs.RXs.medicine[14].name00 ^drugs.RXs.medicine[15].name00 ^drugs.RXs. medicine[16].name00 ^drugs.RXs.medicine[17].name00 ^drugs.RXs.medicine[18].name00 ^drugs.RXs.medicine[19].name00 ^drugs.RXs.medicine[20].name00 PRESS ENTER FOR NEXT SUMMARY SCREEN
599 report3a HISTORY FROM CLIN EVAL: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 3a/10 Stroke with hospitalization: ^strovar2 ^s201^s202^s203^s204^s205^s206^s208^s209^s211^s212^s214^s215 ^cervasc.symps1fu^s217 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
600 report3b HISTORY FROM CLIN EVAL: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 3b/10 Stroke with brain scan: ^strovar3 ^s301^s302^s303^s304^s305^s306^s308^s309^s311^s312^s314^s315 ^cervasc.symps2fu^s317 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
601 report4 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 4/10 CRANIAL NERVES ^normal^a5^a6^a7^a8 Brain scan: ^scanvar ^reason ^whyscan^cervasc.reasonfu PRESS ENTER FOR NEXT SUMMARY SCREEN
602 report5 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 5/10 Seventh Nerve: ^normal ^c1^d1^c2^d2^c3^d3^c4^d4 Tongue: ^c5^d5 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
603 report6 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 6/10 FOCAL SIGNS: ARM STRENGTH SYMMETRY ^normal2^e1^f1^e2^f2^e3^f3^e4^e5^e6^g1^g2^g3 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
604 report7 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 7/10 FOCAL SIGNS: LEG STRENGTH SYMMETRY ^normal2^e2^g4^h4^g5^h5^g6^h6^i4^i5^i6^j4^j5^j6^a5 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
605 report8 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 8/10 DEEP TENDON REFLEXES: ^normal2 ^g4^h4^g5^h5^g6^h6^g7^h7^g8^h8 BABINSKI SIGN: ^normal3 ^k1^k2 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
606 report9 NEURO EXAM-FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 9/10 SENSORY FUNCTION Pin Sensation: ^normal1 ^a1^b1^a2^b2 Vibratory Sensation: ^normal3^a6 ^a7 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
607 report10 NEURO EXAM-FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 10/10 CEREBELLAR FUNCTION FINGER-TO-FINGER: ^normal1 ^a1^a2 HEEL-TO-SHIN TEST: ^normal2 ^a3^a4 GAIT: ^normal3^a5 ^a6^a7 >>>>> END OF SUMMARY SECTION <<<<
608 formcode Please enter status code. 11 = COMPLETE 13 = COMPLETE, portion with proxy 12 = INCOMPLETE, refused 14 = INCOMPLETE, too impaired 21 = INCOMPLETE interim, complete later 73 = NOT TESTED, out of town 31 = NOT TESTED, moved 33 = NOT TESTED, refused 75 = NOT TESTED, hospitalized 76 = NOT TESTED, other 42 = DECEASED 43 = WITHDRAWN 44 = WITHDRAWN, Autopsy OK 11 .. 76
609 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
610 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
611 statid Please enter you staff id. 100 .. 997
612 formch Has the form been modified? 1= Yes 2= No
613 revidate Enter the date that the form was modified. Date type
614 revintd Enter your staff id number. 100 .. 997

Back to data dictionaries