Data Dictionary for radcmotce
Number of Blaise fields: 392
| Seq # | Var | Question | Data Type/Coding |
|---|---|---|---|
| 1 | versiondate | Version Date | |
| 1 | versiondate | Version Date | |
| 2 | formdescr | Form Description | |
| 2 | formdescr | Form Description | |
| 3 | formno | Form Number | String[10] |
| 3 | formno | Form Number | String[10] |
| 4 | version | Version Number | String[10] |
| 4 | version | Version Number | String[10] |
| 5 | spirobr | RADCMOT-CE Form 1. Spirometry 2. Finger Tap, Grip, Pinch 3. Pin Sensations 4. Rydel Tuning Fork Would you like to complete spirometry? | 1= Complete 2= Skip |
| 5 | spirobr | RADCMOT-CE Form 1. Spirometry 2. Finger Tap, Grip, Pinch 3. Pin Sensations 4. Rydel Tuning Fork Would you like to complete spirometry? | 1= Complete 2= Skip |
| 6 | fingtapbr | RADCMOT-CE Form 1. Spirometry 2. Finger Tap, Grip, Pinch 3. Pin Sensations 4. Rydel Tuning Fork Would you like to complete Finger Tap, Grip, Pinch? | 1= Complete 2= Skip |
| 6 | fingtapbr | RADCMOT-CE Form 1. Spirometry 2. Finger Tap, Grip, Pinch 3. Pin Sensations 4. Rydel Tuning Fork Would you like to complete Finger Tap, Grip, Pinch? | 1= Complete 2= Skip |
| 7 | pinbr | RADCMOT-CE Form 1. Spirometry 2. Finger Tap, Grip, Pinch 3. Pin Sensations 4. Rydel Tuning Fork Would you like to complete Pin Sensations? | 1= Complete 2= Skip |
| 7 | pinbr | RADCMOT-CE Form 1. Spirometry 2. Finger Tap, Grip, Pinch 3. Pin Sensations 4. Rydel Tuning Fork Would you like to complete Pin Sensations? | 1= Complete 2= Skip |
| 8 | tuningbr | RADCMOT-CE Form 1. Spirometry 2. Finger Tap, Grip, Pinch 3. Pin Sensations 4. Rydel Tuning Fork Would you like to complete Rydel Tuning Fork? | 1= Complete 2= Skip |
| 8 | tuningbr | RADCMOT-CE Form 1. Spirometry 2. Finger Tap, Grip, Pinch 3. Pin Sensations 4. Rydel Tuning Fork Would you like to complete Rydel Tuning Fork? | 1= Complete 2= Skip |
| 9 | projid | ^formdescr Form: ^formno Version: ^version (^versiondate) Enter project ID number. | String[8] |
| 9 | projid | ^formdescr Form: ^formno Version: ^version (^versiondate) Enter project ID number. | String[8] |
| 10 | 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] |
| 10 | 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] |
| 11 | baseyear | Enter year of baseline from face sheet: | 1993 .. 2025 |
| 11 | baseyear | Enter year of baseline from face sheet: | 1993 .. 2025 |
| 12 | autodate | Automatic Date. | Date type |
| 12 | autodate | Automatic Date. | Date type |
| 13 | autotime | Automatic Time. | TimeType |
| 13 | autotime | Automatic Time. | TimeType |
| 14 | autolog | Automatic Logged Date. | Date type |
| 14 | autolog | Automatic Logged Date. | Date type |
| 15 | intid | INTERVIEWER ID | 100 .. 997 |
| 15 | intid | INTERVIEWER ID | 100 .. 997 |
| 16 | compid | Laptop ID | String[20] |
| 16 | compid | Laptop ID | String[20] |
| 17 | dateint | Date of interview | Date type |
| 17 | dateint | Date of interview | Date type |
| 18 | educ | ^educ_question Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... | 0 .. 30 |
| 18 | educ | ^educ_question Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... | 0 .. 30 |
| 19 | formlang | What language will be used to administer this form? | 1= ENG 2= ESP |
| 19 | formlang | What language will be used to administer this form? | 1= English 2= Espa�ol |
| 20 | spiroqs | Will spirometry data be entered directly into Blaise form? | 1= Yes 2= No |
| 20 | spiroqs | Will spirometry data be entered directly into Blaise form? | 1= Yes 2= No |
| 21 | fev11 | Este pr�ximo test medir� c�mo de r�pido y cu�nto aire puede usted soplar. No hay resistencia. Ser� como soplar cien velas en un pastel de cumplea�os. Esto es lo que quiero que haga usted. Tome aire tan profundamente como pueda (llene sus pulmones con todo el aire que pueda), sujete, abra la boca, ponga sus labios firmemente en el tubo, luego sople tan fuerte y r�pido como usted pueda, como si usted estuviera soplando cien velas en un pastel de cumplea�os.(demostrar) �Preparado?...tome aire profundamente, sujete, abra bien, labios firmes, Sople!!! ... y pare (repetir para el Segundo intento) RESET Spirometry device FEV1 Trial 1 [Enter 95.5 for tried but unable.] _____ liters | 0.00 .. 95.50 |
| 21 | fev11 | RESET Spirometry device FEV1 Trial 1 [Enter 95.5 for tried but unable.] _____ liters | 0.00 .. 95.50 |
| 22 | pvc1 | PVC Trial 1 _____ liters | 0.00 .. 10.00 |
| 22 | pvc1 | PVC Trial 1 _____ liters | 0.00 .. 10.00 |
| 23 | fer1 | FER Trial 1 _____ percent | 0 .. 100 |
| 23 | fer1 | FER Trial 1 _____ percent | 0 .. 100 |
| 24 | pef1 | PEF Trial 1 _____ liters/minute [If greater than 999, enter 999.] | 0 .. 999 |
| 24 | pef1 | PEF Trial 1 _____ liters/minute [If greater than 999, enter 999.] | 0 .. 999 |
| 25 | fev12 | RESET Spirometry device FEV1 Trial 2 [Enter 95.5 for tried but unable.] _____ liters | 0.00 .. 95.50 |
| 25 | fev12 | RESET Spirometry device FEV1 Trial 2 [Enter 95.5 for tried but unable.] _____ liters | 0.00 .. 95.50 |
| 26 | pvc2 | PVC Trial 2 _____ liters | 0.00 .. 10.00 |
| 26 | pvc2 | PVC Trial 2 _____ liters | 0.00 .. 10.00 |
| 27 | fer2 | FER Trial 2 _____ percent | 0 .. 100 |
| 27 | fer2 | FER Trial 2 _____ percent | 0 .. 100 |
| 28 | pef2 | PEF Trial 2 _____ liters/minute [If greater than 999, enter 999.] | 0 .. 999 |
| 28 | pef2 | PEF Trial 2 _____ liters/minute [If greater than 999, enter 999.] | 0 .. 999 |
| 29 | spcom | Spirometry Enter any comment. [Press enter to continue if none.] | String[250] |
| 29 | spcom | Spirometry Enter any comment. [Press enter to continue if none.] | String[250] |
| 30 | q8atap | FINGER TAPPING [TURN DIAL TO TAPPING TEST] 1. Right hand. 'Quiero ver que tan r�pido usted puede presionar esta tecla. Ahora pruebe con su mano derecha. Cuando yo le diga que empiece, presione esta tecla de forma continua o repetida, lo m�s r�pido que pueda hasta que le diga que pare.' 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 |
| 30 | q8atap | FINGER TAPPING [DEPRESS BUTTON UNTIL '--' APPEARS.] 1. Right index finger. '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 |
| 31 | q8ana | Specify reason. | String[40] |
| 31 | q8ana | Specify reason. | String[40] |
| 32 | q8btap | FINGER TAPPING [RESET TAPPER] Left index finger. 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 |
| 32 | q8btap | FINGER TAPPING [RESET TAPPER] Left index finger. 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 |
| 33 | q8bna | Specify reason. | String[40] |
| 33 | q8bna | Specify reason. | String[40] |
| 34 | q8ctap | FINGER TAPPING [RESET TAPPER] Right index finger. 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 |
| 34 | q8ctap | FINGER TAPPING [RESET TAPPER] Right index finger. 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 |
| 35 | q8cna | Specify reason. | String[40] |
| 35 | q8cna | Specify reason. | String[40] |
| 36 | q8dtap | FINGER TAPPING [RESET TAPPER] Left index finger. 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 |
| 36 | q8dtap | FINGER TAPPING [RESET TAPPER] Left index finger. 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 |
| 37 | q8dna | Specify reason. | String[40] |
| 37 | q8dna | Specify reason. | String[40] |
| 38 | rhand1 | HAND DYNAMOMETRY [SET RED NEEDLE TO 0.] 'Quiero ver con cu�nta fuerza puede usted apretar este aparato manual. Cuando yo le diga que empiece, apriete con tanta fuerza como pueda hasta que yo le diga que pare.' 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 |
| 38 | 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 |
| 39 | rhand1na | Specify reason. | String[40] |
| 39 | rhand1na | Specify reason. | String[40] |
| 40 | lhand1 | HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 1 [RECORD IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 777 |
| 40 | lhand1 | HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 1 [RECORD IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 777 |
| 41 | lhand1na | Specify reason. | String[40] |
| 41 | lhand1na | Specify reason. | String[40] |
| 42 | 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 |
| 42 | 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 |
| 43 | rhand2na | Specify reason. | String[40] |
| 43 | rhand2na | Specify reason. | String[40] |
| 44 | 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 |
| 44 | 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 |
| 45 | lhand2na | Specify reason. | String[40] |
| 45 | lhand2na | Specify reason. | String[40] |
| 46 | rthand1 | PINCH DYNAMOMETRY [SET RED NEEDLE TO 0.] 'Quiero ver con cu�nta fuerza puede usted apretar este disco. Cuando yo le diga que empiece, apriete este disco con tanta fuerza como pueda hasta que yo le diga que pare.' 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 |
| 46 | 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 |
| 47 | rthand1n | Specify reason. | String[40] |
| 47 | rthand1n | Specify reason. | String[40] |
| 48 | 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 |
| 48 | 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 |
| 49 | lthand1n | Specify reason. | String[40] |
| 49 | lthand1n | Specify reason. | String[40] |
| 50 | 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 |
| 50 | 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 |
| 51 | rthand2n | Specify reason. | String[40] |
| 51 | rthand2n | Specify reason. | String[40] |
| 52 | 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 |
| 52 | 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 |
| 53 | lthand2n | Specify reason. | String[40] |
| 53 | lthand2n | Specify reason. | String[40] |
| 54 | hpinsym | Pin sensation 1. Back of index fingers symmetric | 1= Yes 2= rtless 3= ltless 7= notest |
| 54 | 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 |
| 55 | 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/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 |
| 55 | 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/she feel it more, the index finger or the small finger.] | 1= Same 2= possmore 3= defmore 4= Posspink 5= pinkydef |
| 56 | lhandpin | Pin sensation 3. Left Index vs. Pinky | 1= Same 2= possmore 3= defmore 4= Posspink 5= pinkydef |
| 56 | 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 |
| 57 | 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 |
| 57 | fpinsym | Pin sensation 4. Top of big toe symmetric | 1= Yes 2= rtless 3= ltless 7= notest |
| 58 | rlegpin | Stocking pattern of pin loss 5. Right Leg. [EXAMINER: Tell the subject that he/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 |
| 58 | rlegpin | Stocking pattern of pin loss 5. Right Leg. [EXAMINER: Tell the subject that he/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 |
| 59 | ltlegpin | Stocking pattern of pin loss 6. Left leg. | 1= Yes 2= Possible 3= No |
| 59 | ltlegpin | Stocking pattern of pin loss 6. Left leg. | 1= Yes 2= Possible 3= No |
| 60 | rtoe | Tuning Fork - Right toe [Enter 0 for absent] | 0 .. 100 |
| 60 | rtoe | Tuning Fork - Right toe [Enter 0 for absent] | 0 .. 100 |
| 61 | ltoe | Tuning Fork - Left toe [Enter 0 for absent] | 0 .. 100 |
| 61 | ltoe | Tuning Fork - Left toe [Enter 0 for absent] | 0 .. 100 |
| 62 | rankle | Tuning Fork - Right ankle [Enter 0 for absent] | 0 .. 100 |
| 62 | rankle | Tuning Fork - Right ankle [Enter 0 for absent] | 0 .. 100 |
| 63 | lankle | Tuning Fork - Left ankle [Enter 0 for absent] | 0 .. 100 |
| 63 | lankle | Tuning Fork - Left ankle [Enter 0 for absent] | 0 .. 100 |
| 64 | howwell | 1. INTERVIEWER OBSERVATIONS How well do you think the participant understood the questions? | 1= qw 2= fw 3= sw 4= vl 5= naa |
| 64 | howwell | 1. INTERVIEWER OBSERVATIONS How well do you think the participant understood the questions? | 1= Quite well 2= Fairly well 3= Somewhat 4= Very Little 5= Not at all |
| 65 | hearimp | 2. Does the participant have a SUBSTANTIAL hearing impairment? | 1= Yes 2= No |
| 65 | hearimp | 2. Does the participant have a SUBSTANTIAL hearing impairment? | 1= Yes 2= No |
| 66 | visimp | 3. Does the participant have a SUBSTANTIAL visual impariment? | 1= ycb 2= yvp 3= yp 4= nns |
| 66 | visimp | 3. Does the participant have a SUBSTANTIAL visual impariment? | 1= Yes, completely blind 2= Yes, very poor 3= Yes, poor 4= No, not substantial |
| 67 | phyeffrt | 4. How great an effort do you think the participant put into the physical function items? | 1= A great deal 2= A considerable amount 3= A moderate amount 4= A little bit 5= Hardly any |
| 67 | phyeffrt | 4. How great an effort do you think the participant put into the physical function items? | 1= agd 2= aca 3= ama 4= alb 5= ha |
| 68 | 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 |
| 68 | 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 |
| 69 | formpart | Was participant reluctant, and/or does participant have special needs? | 1= Yes 2= No |
| 69 | formpart | Was participant reluctant, and/or does participant have special needs? | 1= Yes 2= No |
| 70 | formcomm | Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] | String[120] |
| 70 | formcomm | Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] | String[120] |
| 71 | statid | Please enter you staff id. | 100 .. 997 |
| 71 | statid | Please enter you staff id. | 100 .. 997 |
| 72 | formch | Has the form been modified? | 1= Yes 2= No |
| 72 | formch | Has the form been modified? | 1= Yes 2= No |
| 73 | revidate | Enter the date that the form was modified. | Date type |
| 73 | revidate | Enter the date that the form was modified. | Date type |
| 74 | revintd | Enter your staff id number. | 100 .. 997 |
| 74 | revintd | Enter your staff id number. | 100 .. 997 |
| 75 | anydev | Are there any protocol deviations or missing data items to enter? | 1= Yes 2= No |
| 75 | anydev | Are there any protocol deviations or missing data items to enter? | 1= S� 2= No |
| 76 | numdev | How many total protocol deviations and tests with missing items to enter? | 1 .. 20 |
| 76 | numdev | How many total protocol deviations and tests with missing items to enter? | 1 .. 20 |
| 77 | reas00 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 77 | reas00 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 78 | test00 | Enter test or procedure. | String[15] |
| 78 | test00 | Enter test or procedure. | String[15] |
| 79 | item00 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 79 | item00 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 80 | code00 | Enter data code used. | 1= dont 2= ref 3= other |
| 80 | code00 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 81 | oth00 | Enter other code used. | String[20] |
| 81 | oth00 | Enter other code used. | String[20] |
| 82 | expl00 | Explain what happened | String[100] |
| 82 | expl00 | Explain what happened | String[100] |
| 83 | reas01 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 83 | reas01 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 84 | test01 | Enter test or procedure. | String[15] |
| 84 | test01 | Enter test or procedure. | String[15] |
| 85 | item01 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 85 | item01 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 86 | code01 | Enter data code used. | 1= dont 2= ref 3= other |
| 86 | code01 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 87 | oth01 | Enter other code used. | String[20] |
| 87 | oth01 | Enter other code used. | String[20] |
| 88 | expl01 | Explain what happened | String[100] |
| 88 | expl01 | Explain what happened | String[100] |
| 89 | reas02 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 89 | reas02 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 90 | test02 | Enter test or procedure. | String[15] |
| 90 | test02 | Enter test or procedure. | String[15] |
| 91 | item02 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 91 | item02 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 92 | code02 | Enter data code used. | 1= dont 2= ref 3= other |
| 92 | code02 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 93 | oth02 | Enter other code used. | String[20] |
| 93 | oth02 | Enter other code used. | String[20] |
| 94 | expl02 | Explain what happened | String[100] |
| 94 | expl02 | Explain what happened | String[100] |
| 95 | reas03 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 95 | reas03 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 96 | test03 | Enter test or procedure. | String[15] |
| 96 | test03 | Enter test or procedure. | String[15] |
| 97 | item03 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 97 | item03 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 98 | code03 | Enter data code used. | 1= dont 2= ref 3= other |
| 98 | code03 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 99 | oth03 | Enter other code used. | String[20] |
| 99 | oth03 | Enter other code used. | String[20] |
| 100 | expl03 | Explain what happened | String[100] |
| 100 | expl03 | Explain what happened | String[100] |
| 101 | reas04 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 101 | reas04 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 102 | test04 | Enter test or procedure. | String[15] |
| 102 | test04 | Enter test or procedure. | String[15] |
| 103 | item04 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 103 | item04 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 104 | code04 | Enter data code used. | 1= dont 2= ref 3= other |
| 104 | code04 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 105 | oth04 | Enter other code used. | String[20] |
| 105 | oth04 | Enter other code used. | String[20] |
| 106 | expl04 | Explain what happened | String[100] |
| 106 | expl04 | Explain what happened | String[100] |
| 107 | reas05 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 107 | reas05 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 108 | test05 | Enter test or procedure. | String[15] |
| 108 | test05 | Enter test or procedure. | String[15] |
| 109 | item05 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 109 | item05 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 110 | code05 | Enter data code used. | 1= dont 2= ref 3= other |
| 110 | code05 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 111 | oth05 | Enter other code used. | String[20] |
| 111 | oth05 | Enter other code used. | String[20] |
| 112 | expl05 | Explain what happened | String[100] |
| 112 | expl05 | Explain what happened | String[100] |
| 113 | reas06 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 113 | reas06 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 114 | test06 | Enter test or procedure. | String[15] |
| 114 | test06 | Enter test or procedure. | String[15] |
| 115 | item06 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 115 | item06 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 116 | code06 | Enter data code used. | 1= dont 2= ref 3= other |
| 116 | code06 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 117 | oth06 | Enter other code used. | String[20] |
| 117 | oth06 | Enter other code used. | String[20] |
| 118 | expl06 | Explain what happened | String[100] |
| 118 | expl06 | Explain what happened | String[100] |
| 119 | reas07 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 119 | reas07 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 120 | test07 | Enter test or procedure. | String[15] |
| 120 | test07 | Enter test or procedure. | String[15] |
| 121 | item07 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 121 | item07 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 122 | code07 | Enter data code used. | 1= dont 2= ref 3= other |
| 122 | code07 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 123 | oth07 | Enter other code used. | String[20] |
| 123 | oth07 | Enter other code used. | String[20] |
| 124 | expl07 | Explain what happened | String[100] |
| 124 | expl07 | Explain what happened | String[100] |
| 125 | reas08 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 125 | reas08 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 126 | test08 | Enter test or procedure. | String[15] |
| 126 | test08 | Enter test or procedure. | String[15] |
| 127 | item08 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 127 | item08 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 128 | code08 | Enter data code used. | 1= dont 2= ref 3= other |
| 128 | code08 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 129 | oth08 | Enter other code used. | String[20] |
| 129 | oth08 | Enter other code used. | String[20] |
| 130 | expl08 | Explain what happened | String[100] |
| 130 | expl08 | Explain what happened | String[100] |
| 131 | reas09 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 131 | reas09 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 132 | test09 | Enter test or procedure. | String[15] |
| 132 | test09 | Enter test or procedure. | String[15] |
| 133 | item09 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 133 | item09 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 134 | code09 | Enter data code used. | 1= dont 2= ref 3= other |
| 134 | code09 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 135 | oth09 | Enter other code used. | String[20] |
| 135 | oth09 | Enter other code used. | String[20] |
| 136 | expl09 | Explain what happened | String[100] |
| 136 | expl09 | Explain what happened | String[100] |
| 137 | reas10 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 137 | reas10 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 138 | test10 | Enter test or procedure. | String[15] |
| 138 | test10 | Enter test or procedure. | String[15] |
| 139 | item10 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 139 | item10 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 140 | code10 | Enter data code used. | 1= dont 2= ref 3= other |
| 140 | code10 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 141 | oth10 | Enter other code used. | String[20] |
| 141 | oth10 | Enter other code used. | String[20] |
| 142 | expl10 | Explain what happened | String[100] |
| 142 | expl10 | Explain what happened | String[100] |
| 143 | reas11 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 143 | reas11 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 144 | test11 | Enter test or procedure. | String[15] |
| 144 | test11 | Enter test or procedure. | String[15] |
| 145 | item11 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 145 | item11 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 146 | code11 | Enter data code used. | 1= dont 2= ref 3= other |
| 146 | code11 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 147 | oth11 | Enter other code used. | String[20] |
| 147 | oth11 | Enter other code used. | String[20] |
| 148 | expl11 | Explain what happened | String[100] |
| 148 | expl11 | Explain what happened | String[100] |
| 149 | reas12 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 149 | reas12 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 150 | test12 | Enter test or procedure. | String[15] |
| 150 | test12 | Enter test or procedure. | String[15] |
| 151 | item12 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 151 | item12 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 152 | code12 | Enter data code used. | 1= dont 2= ref 3= other |
| 152 | code12 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 153 | oth12 | Enter other code used. | String[20] |
| 153 | oth12 | Enter other code used. | String[20] |
| 154 | expl12 | Explain what happened | String[100] |
| 154 | expl12 | Explain what happened | String[100] |
| 155 | reas13 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 155 | reas13 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 156 | test13 | Enter test or procedure. | String[15] |
| 156 | test13 | Enter test or procedure. | String[15] |
| 157 | item13 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 157 | item13 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 158 | code13 | Enter data code used. | 1= dont 2= ref 3= other |
| 158 | code13 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 159 | oth13 | Enter other code used. | String[20] |
| 159 | oth13 | Enter other code used. | String[20] |
| 160 | expl13 | Explain what happened | String[100] |
| 160 | expl13 | Explain what happened | String[100] |
| 161 | reas14 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 161 | reas14 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 162 | test14 | Enter test or procedure. | String[15] |
| 162 | test14 | Enter test or procedure. | String[15] |
| 163 | item14 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 163 | item14 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 164 | code14 | Enter data code used. | 1= dont 2= ref 3= other |
| 164 | code14 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 165 | oth14 | Enter other code used. | String[20] |
| 165 | oth14 | Enter other code used. | String[20] |
| 166 | expl14 | Explain what happened | String[100] |
| 166 | expl14 | Explain what happened | String[100] |
| 167 | reas15 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 167 | reas15 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 168 | test15 | Enter test or procedure. | String[15] |
| 168 | test15 | Enter test or procedure. | String[15] |
| 169 | item15 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 169 | item15 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 170 | code15 | Enter data code used. | 1= dont 2= ref 3= other |
| 170 | code15 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 171 | oth15 | Enter other code used. | String[20] |
| 171 | oth15 | Enter other code used. | String[20] |
| 172 | expl15 | Explain what happened | String[100] |
| 172 | expl15 | Explain what happened | String[100] |
| 173 | reas16 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 173 | reas16 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 174 | test16 | Enter test or procedure. | String[15] |
| 174 | test16 | Enter test or procedure. | String[15] |
| 175 | item16 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 175 | item16 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 176 | code16 | Enter data code used. | 1= dont 2= ref 3= other |
| 176 | code16 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 177 | oth16 | Enter other code used. | String[20] |
| 177 | oth16 | Enter other code used. | String[20] |
| 178 | expl16 | Explain what happened | String[100] |
| 178 | expl16 | Explain what happened | String[100] |
| 179 | reas17 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 179 | reas17 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 180 | test17 | Enter test or procedure. | String[15] |
| 180 | test17 | Enter test or procedure. | String[15] |
| 181 | item17 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 181 | item17 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 182 | code17 | Enter data code used. | 1= dont 2= ref 3= other |
| 182 | code17 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 183 | oth17 | Enter other code used. | String[20] |
| 183 | oth17 | Enter other code used. | String[20] |
| 184 | expl17 | Explain what happened | String[100] |
| 184 | expl17 | Explain what happened | String[100] |
| 185 | reas18 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 185 | reas18 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 186 | test18 | Enter test or procedure. | String[15] |
| 186 | test18 | Enter test or procedure. | String[15] |
| 187 | item18 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 187 | item18 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 188 | code18 | Enter data code used. | 1= dont 2= ref 3= other |
| 188 | code18 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 189 | oth18 | Enter other code used. | String[20] |
| 189 | oth18 | Enter other code used. | String[20] |
| 190 | expl18 | Explain what happened | String[100] |
| 190 | expl18 | Explain what happened | String[100] |
| 191 | reas19 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 191 | reas19 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 192 | test19 | Enter test or procedure. | String[15] |
| 192 | test19 | Enter test or procedure. | String[15] |
| 193 | item19 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 193 | item19 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 194 | code19 | Enter data code used. | 1= dont 2= ref 3= other |
| 194 | code19 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 195 | oth19 | Enter other code used. | String[20] |
| 195 | oth19 | Enter other code used. | String[20] |
| 196 | expl19 | Explain what happened | String[100] |
| 196 | expl19 | Explain what happened | String[100] |