CDE Detailed Report
Disease: general-data-protection-regulation-gdpr
Sub-Domain: Additional Proposed Instruments
CRF:

Displaying 401 - 450 of 491
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type Source Form Set Form Field Domain CDASH Variable CDASH Definition CDASH Label Controlled Terminology Prompt Essentiality Question Text CDASH imp guidance SDTM IG target csDSR PhenX Data Type CRF Completion Inst SDTMIG Target Var SDTMIG Target Map Codelist Name PVs Pre Pop Value Query Display List Style
C10682 Imaging anatomic site ImgAntmicSite Type of body part or anatomy scanned in the imaging study Type of body part or anatomy scanned in the imaging study Brain;Cervical spine;Thoracic spine;Lumbar spine;Calf;Thigh;Other, specify;Brain;Cervical spine;Thoracic spine;Lumbar spine;Calf;Thigh;Other, specify Brain;Cervical spine;Thoracic spine;Lumbar spine;Calf;Thigh;Other, specify;Brain;Cervical spine;Thoracic spine;Lumbar spine;Calf;Thigh;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C21494 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span backward subtest trial number WAISIVDSBTrialNum Trial number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest Trial number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest 1;2 Trial 1;Trial 2 Alphanumeric Adult;Pediatric Supplemental 1.00 2015-07-22 11:32:44.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C14030 Vasospasm resistive index indicator VasospasmRestistIndexInd Indicates vasospasm resistive Index (RI) Indicates vasospasm resistive Index (RI) Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C00322 Medical history condition text MedclHistCondTxt Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

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2003874 DeBaun Forms
C18027 Comment text CmmntTxt Provide any additional information that pertains to the question. Provide any additional information that pertains to the question. Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

DeBaun Forms
C13927 Intima media thickness (IMT) B Mode guided M mode indicator IMTBModeGuidedMModeInd Indicates intima media thickness (IMT) B mode guided M mode Indicates intima media thickness (IMT) B mode guided M mode Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C12493 Imaging brainstem abnormality type ImgBrnstmAbnrmlyTyp The type of abnormality in the brainstem on the image The type of abnormality in the brainstem on the image Hypoplasia;Anterior concavity;Posterior concavity;Other, specify Hypoplasia;Anterior concavity;Posterior concavity;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C54689 PROMIS - Global Health physical health rate scale PROMISGlbHlthPhysHlthRtScl Scale related to an individual's rating of his/her physical health, as part of the PROMIS Global Health Scale related to an individual's rating of his/her physical health, as part of the PROMIS Global Health 1;2;3;4;5;1;2;3;4;5 Poor;Fair;Good;Very Good;Excellent;Poor;Fair;Good;Very Good;Excellent Numeric Values Adult;Pediatric Supplemental 1.00 2017-04-07 15:34:25.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C15565 Imaging angiography time of flight method duration ImgAngioTOFMethdDur Time of flight (TOF) method duration Time of flight (TOF) method duration Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

second
C02307 Adverse event verbatim term text AdvrsEvntVerbatimTermText Text that describes the adverse event word for word as described by the participant/subject Adverse event verbatim term text Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

2188132 DeBaun Forms
C18942 Cerebellar or coordination assessment abnormality present other text CerbllCoordAssmtAbnrmlyPrsOTH The free-text field related to 'Cerebellar or coordination assessment abnormality present status' specifying other text. Whether the cerebellar/coordination assessment found abnormalities The free-text field related to 'Cerebellar or coordination assessment abnormality present status' specifying other text. Whether the cerebellar/coordination assessment found abnormalities Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

DeBaun Forms
C13959 Microembolic signal measurement MicroembolSignalMeasr Indicates actual settings measurement for all categories (mm) Indicates actual settings measurement for all categories (mm) Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

millimeter
C13241 National Institutes of Health Stroke Scale (NIHSS) - Sensory score NIHSSSensoryScore Sensory abilities assessed using the NIH Stroke Scale (NIHSS) Sensory abilities assessed using the NIH Stroke Scale (NIHSS) 0;1;2;UN;0;1;2;UN Normal: no sensory loss.;Mild to moderate sensory loss: patient feels pinprick is less sharp or is dull on the affected side, or there is a loss of superficial pain with pinprick but patient is aware he/she is being touched.;Severe to total sensory loss: patient is not aware of being touched in the face, arm, and leg.;Unexaminable (intubated/paralyzed);Normal: no sensory loss.;Mild to moderate sensory loss: patient feels pinprick is less sharp or is dull on the affected side, or there is a loss of superficial pain with pinprick but patient is aware he/she is being touched.;Severe to total sensory loss: patient is not aware of being touched in the face, arm, and leg.;Unexaminable (intubated/paralyzed) Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C56406 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Block Design raw score WASIIIBDRawScore The raw score that the subject received on the Block Design subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) . The raw score that the subject received on the Block Design subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-12 11:23:35.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 71
C13906 Imaging B-mode artery name ImgBModArtName Indicates B-mode artery name Indicates B-mode artery name CCA;ICA;ECA;CCA;ICA;ECA Common carotid artery;Internal carotid artery;External carotid artery;Common carotid artery;Internal carotid artery;External carotid artery Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C12468 Imaging magnetic resonance imaging performed multiple count ImgMRIPerfMultiCt The count representing of the number of magnetic resonance imaging (MRI) sessions performed on the participant/subject The count representing of the number of magnetic resonance imaging (MRI) sessions performed on the participant/subject 2;3;4;5;6;>6;2;3;4;5;6;>6 2;3;4;5;6;>6;2;3;4;5;6;>6 Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C21505 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span sequencing subtest last trial correct digit score WAISIVLDSSScore Last digit correct, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest Last digit correct, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest Numeric Values Adult;Pediatric Supplemental 1.10 2018-07-30 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 9
C14056 Imaging depth measurement ImgDepthMeasr The depth measurement (mm) of imaging. The depth measurement (mm) of imaging. Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 999 millimeter
C01535 Respiratory rate RespRate Rate of the participant/subject's breathing (inhalation and exhalation). Rate of the participant/subject's breathing (inhalation and exhalation). Numeric Values Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 120 breaths per minute 2644399 DeBaun Forms
C18716 Imaging scanner manufacturer other text ImgScannerManufOTH The free-text field related to 'Imaging scanner manufacturer name' specifying other text. Name of manufacturer of imaging scanner The free-text field related to 'Imaging scanner manufacturer name' specifying other text. Name of manufacturer of imaging scanner Alphanumeric Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

C13938 Imaging minimum lumen diameter measurement ImgMinLumenDiameterMeasr Indicates minimum lumen diameter measurement (mm) Indicates minimum lumen diameter measurement (mm) Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

millimeter
C12504 Imaging gray matter hyperintensity T2 fluid attenuated inversion recovery site ImgGryMtrHyperT2FLAIRSiteTyp The type of anatomical site of the grey matter hyperintensity on T2/FLAIR (fluid attenuated inversion recovery) images The type of anatomical site of the grey matter hyperintensity on T2/FLAIR images Putamen;Caudate;Other, specify;Cerebellar nuclei;Colliculi;Floor of the fourth ventricle;Pallidum;Periaqueductal grey;Red nucleus;Substantia nigra;Mammillary body;Subthalmic nucleus;Thalamus Putamen;Caudate;Other, specify;Cerebellar nuclei;Colliculi;Floor of the fourth ventricle;Pallidum;Periaqueductal grey;Red nucleus;Substantia nigra;Mammillary body;Subthalmic nucleus;Thalamus Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C55777 Imaging inter peri ictal headache since end duration ImagInterPeriIctHeadSincEndDur The duration of time since the end of the subject's last inter-ictal or peri-ictal headahe. The duration of time since the end of the subject's last inter-ictal or peri-ictal headahe. Numeric Values Adult;Pediatric Supplemental 1.00 2017-05-31 12:23:34.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

C17494 Delay language cognitive milestone indicator DelayLangCogMilestoneInd Indicator as to whether the participant/subject has or had delayed acquisition of language or cognitive milestones, as diagnosed by a pediatrician or neurologist Indicator as to whether the participant/subject has or had delayed acquisition of language or cognitive milestones, as diagnosed by a pediatrician or neurologist Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C05408 Hospital admission date and time HospitlAdmissDateTime Date (and time, if applicable and known) the participant/subject was admitted to the hospital Date (and time, if applicable and known) the participant/subject was admitted to the hospital Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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DeBaun Forms
C19810 Medical history abdominal kidney problem indicator MedHistAbdmnlKdnyProbInd Indicator of history of kidney problem Indicator of history of kidney problem No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-05 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C14008 Imaging window quality category ImgWindowQualityCat Indicates window quality category Indicates window quality category Temporal;Posterior;Orbital Temporal;Posterior;Orbital Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C13459 Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - language deficit-production description text PSOMSNELangDefProdDescTxt Description of the language production deficits observed in the participant/subject based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). Description of the language production deficits observed in the participant/subject based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

Free-Form Entry

DeBaun Forms
C56418 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Examinee visual hearing aid type WASIIIExVisHearAidTyp The type of visual or hearing aid or aids that the examinee needed during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The type of visual or hearing aid or aids that the examinee needed during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Glasses;Assisted Listening Device;Other;Prescription Lenses Glasses;Assisted Listening Device;Other;Prescription Lenses Alphanumeric Adult;Pediatric Supplemental 1.00 2017-06-12 11:43:19.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C14020 Sickle cell disease vessel anatomic site SickleCellDisVesselAntmicSite Indicates sickle cell vessel Indicates sickle cell vessel ICA;MCA;ACA;Other, specify Internal carotid artery;Middle cerebral artery;Anterior carotid artery;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C13879 Imaging modality vessel imaging angiography type ImgModltyVesselImgAngioTyp Indicates imaging modality for vessel imaging angiography Indicates imaging modality for vessel imaging angiography DSA;MRA;CTA;CBCT Digital subtraction angiography;Magnetic resonance angiography;Computer tomography angiography;CBCT Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C56429 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Perceptual Reasoning IQ composite score WASIIIPercRsngIQCompScore The subject's Perceptual Reasoning IQ composite score, converted from his/her Perceptual Reasoning T score, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The subject's Perceptual Reasoning IQ composite score, converted from his/her Perceptual Reasoning T score, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-12 11:58:34.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

40 160
C56439 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Full Scale IQ 2 percentile rank value WASIIIFullScale2PrcntRankVal The percentile rank the subject placed in with respect to Full Scale IQ for two subtests (Vocabulary and Matrix Reasoning), as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The percentile rank the subject placed in with respect to Full Scale IQ for two subtests (Vocabulary and Matrix Reasoning), as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-12 13:04:39.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 100 percent
C13917 Imaging end diastolic velocity measurement ImgEndDiastVeloMears Indicates end diastolic velocity (cm/sec) Indicates end diastolic velocity (cm/sec) Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

centimeter per second
C12483 Imaging cortex-polymicrogyria indicator ImgCortexPolymicrogyriaInd Indicator of whether a developmental malformation of the human brain characterized by an excessive number of small convolutions (gyri) on the surface of the brain is present Indicator of whether a developmental malformation of the human brain characterized by an excessive number of small convolutions (gyri) on the surface of the brain is present Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C54607 Brief Test of Executive Function Second Edition (BRIEF 2) - Self monitor total raw scale score BRIEF2SlfMntrTtlRwSclScore Total score of the raw scale for the self monitor function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) Total score of the raw scale for the self monitor function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) Numeric Values Adult;Pediatric Supplemental 1.00 2017-03-22 09:57:02.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

C14681 Pediatric Migraine Disability Assessment (MIDAS) - headache cease home function day count PedMIDASHeadCeasHomFuncDayCt Count the days you were not able to do things at home (i.e., chores, homework, etc.) in the last 3 months due to a headache, as part of migraine disability assessment (MIDAS) questionnaire-pediatric form. Count the days you were not able to do things at home (i.e., chores, homework, etc.) in the last 3 months due to a headache, as part of migraine disability assessment (MIDAS) questionnaire-pediatric form. Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 92
C02006 Medication prior or concomitant dose MedctnPriorConcomDose Dose of prior/concomitant medication taken per administration. Dose of prior/concomitant medication taken per administration. Numeric Values Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

3162729 DeBaun Forms
C18859 Imaging cerebellum abnormality other text ImgCrblmAbnrmlyOTH The free-text field related to 'Imaging cerebellum abnormality type' specifying other text. The type of abnormality in the cerebellum on the image The free-text field related to 'Imaging cerebellum abnormality type' specifying other text. The type of abnormality in the cerebellum on the image Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

C13949 Imaging flow/probe direction type ImgFlowProbDireTyp Indicates flow/probe direction Indicates flow/probe direction Towards;Away from Towards;Away from Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C13199 Questionnaire for Verifying Stroke Free Status (QVSFS) - verbal status QVSFSVerbalStatus Have you ever suddenly lost the ability to express yourself verbally or in writing? Have you ever suddenly lost the ability to express yourself verbally or in writing? Questionnaire for Verifying Stroke Free Status (QVSFS) No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C56385 Conners Continuous Performance Test 3rd Edition (CPT3) - Inattentiveness variability value ConnersCPT3InaVarVal The variability of the subject's response speed consistency, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). The variability of the subject's response speed consistency, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-09 15:36:25.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

C13884 Imaging vessel angiography arterial anatomic site ImgVesselAngioArterAntmicSite Indicates vessel imaging angiography arterial findings location Indicates vessel imaging angiography arterial findings location CCA origin;CCA to bifurcation;ICA at origin;C1 cervical;C2 petrous;C3 lacerum;C4 cavernous;C5 clinoidal;C6 - ophthalmic to PCOM;C6 - PCOM to terminus;A1;A2;M1 proximal to striate;M1 distal to striate;M2 single;M2 multiple;M3 single;M3 multiple;M4 single;M4 multiple;Vertebral origin;Vertebral- cervical;Vertebral-intracranial proximal to PICA;Vertebral-distal to PICA;Basilar-distal to AICA;Basilar-mid;Basilar-proximal to AICA;PCOM;P1;P2;P3;SCA;AICA;PICA;CCA origin;CCA to bifurcation;ICA at origin;C1 cervical;C2 petrous;C3 lacerum;C4 cavernous;C5 clinoidal;C6 - ophthalmic to PCOM;C6 - PCOM to terminus;A1;A2;M1 proximal to striate;M1 distal to striate;M2 single;M2 multiple;M3 single;M3 multiple;M4 single;M4 multiple;Vertebral origin;Vertebral- cervical;Vertebral-intracranial proximal to PICA;Vertebral-distal to PICA;Basilar-distal to AICA;Basilar-mid;Basilar-proximal to AICA;PCOM;P1;P2;P3;SCA;AICA;PICA Common carotid artery origin;Common carotid artery to bifurcation;Internal carotid artery at origin;C1 cervical;C2 petrous;C3 lacerum;C4 cavernous;C5 clinoidal;C6 - ophthalmic to PCOM;C6 - PCOM to terminus;A1;A2;M1 proximal to striate;M1 distal to striate;M2 single;M2 multiple;M3 single;M3 multiple;M4 single;M4 multiple;Vertebral origin;Vertebral- cervical;Vertebral-intracranial proximal to PICA;Vertebral-distal to PICA;Basilar-distal to AICA;Basilar-mid;Basilar-proximal to AICA;PCOM;P1;P2;P3;SCA;AICA;PICA;Common carotid artery origin;Common carotid artery to bifurcation;Internal carotid artery at origin;C1 cervical;C2 petrous;C3 lacerum;C4 cavernous;C5 clinoidal;C6 - ophthalmic to PCOM;C6 - PCOM to terminus;A1;A2;M1 proximal to striate;M1 distal to striate;M2 single;M2 multiple;M3 single;M3 multiple;M4 single;M4 multiple;Vertebral origin;Vertebral- cervical;Vertebral-intracranial proximal to PICA;Vertebral-distal to PICA;Basilar-distal to AICA;Basilar-mid;Basilar-proximal to AICA;PCOM;P1;P2;P3;SCA;AICA;PICA Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C08242 Imaging acquisition duration ImgAcquisitionDur Duration of the imaging scan in minutes The duration of the imaging acquisition, in minutes Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

minute
C21484 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span forward subtest number series text WAISIVDSFNumTxt Series of numbers, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest Series of numbers, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest Numeric Values Adult;Pediatric Supplemental 1.00 2015-07-22 11:32:44.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

50
C13896 Imaging vessel angiography level of confidence status ImgVesselAngioLvlConfidTyp Indicates vessel angiography level of confidence Indicates vessel angiography level of confidence Low;Moderate;High Low;Moderate;High Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C10685 Imaging slice orientation type ImgSliceOrientTyp The slice orientation used in imaging acquisition The slice orientation used in imaging acquisition Axial;Coronal;Sagittal;Oblique;Transversal;Other, specify;Axial;Coronal;Sagittal;Oblique;Transversal;Other, specify Axial;Coronal;Sagittal;Oblique;Transversal;Other, specify;Axial;Coronal;Sagittal;Oblique;Transversal;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C21495 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span backward subtest trial score WAISIVDSBTrialScore Trial score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest Trial score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest 0;1;0;1;0;1 0;1;0;1;0;1 Alphanumeric Adult;Pediatric Supplemental 1.00 2015-07-22 11:32:44.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C14031 Vasospasm status VasospasmStatus Indicates vasospasm result Indicates vasospasm result Abnormal;Normal;Abnormal;Normal Abnormal;Normal;Abnormal;Normal Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C00720 Family history medical condition type FamHistMedclCondTyp Type of medical condition or health related event for which the family history is taken Type of medical condition or health related event for which the family history is taken Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

3165585 DeBaun Forms
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