CDE Detailed Report
Disease: sites
Sub-Domain: Additional Proposed Instruments
CRF: scdc

Displaying 1 - 50 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
C10568 Imaging radio frequency coil channel count ImgRFCoilChannelCt Number of the coil channels in the radio frequency (RF) coil used for the imaging scan Number of the coil channels in the radio frequency (RF) coil used for the imaging scan 1;8;12;16;24;32;Other, specify;1;8;12;16;24;32;Other, specify Single coil;8 channels;12 channels;16 channels;24 channels;32 channels;Other, specify;Single coil;8 channels;12 channels;16 channels;24 channels;32 channels;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

C13951 Imaging spectrum end diastolic ratio value ImgSpectrumEndDiastlRatioVal Indicates spectrum end diastolic ratio result Indicates spectrum end diastolic ratio result 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

C21500 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span sequencing subtest number series text WAISIVDSSNumTxt Series of numbers, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest Series of numbers, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing 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

0 50
C00035 Gender Type GenderTyp Self-reported gender of the participant/subject. Gender is the socially constructed identity of sex. Gender is equated with phenotypic sex. Gender may differ from the sex of an individual determined genetically. Self-reported gender of the participant/subject. Gender is the socially constructed identity of sex. Female;Male;Unknown;Unspecified;Not reported Female;Male;Unknown;Undifferentiated/Indeterminant/Intersex;Not reported Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

2200604 DeBaun Forms
C13886 Imaging vessel angiography cause type ImgVesselAngioCauseTyp Indicates vessel imaging angiography cause Indicates vessel imaging angiography cause Atherosclerotic;Embolic;Other;Unknown;Vasospasm Atherosclerotic;Embolic;Other;Unknown;Vasospasm 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

C18689 Imaging anatomic site other text ImgAntmicSitOTH The free-text field related to 'Imaging anatomic site' specifying other text. Type of body part or anatomy scanned in the imaging study The free-text field related to 'Imaging anatomic site' specifying other text. Type of body part or anatomy scanned in the imaging study 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

C12489 Imaging subcortical cysts site type ImgSubCorticalCystSiteTyp The anatomical site(s) of the subcortical cysts The anatomical site(s) of the subcortical cysts Temporal;Frontoparietal;Occipital Temporal;Frontoparietal;Occipital 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

C14022 Sickle cell disease criterion result text SickleCellCriterResltTxt Indicates sickle cell criterion result Indicates sickle cell criterion result 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
C54695 PROMIS - Global Health fatigue rate scale PROMISGlbHlthFtgRtScl Scale related to an individual's rating of his/her fatigue, as part of the PROMIS Global Health Scale related to an individual's rating of his/her fatigue, as part of the PROMIS Global Health 1;2;3;4;5;1;2;3;4;5 Excellent;Very good;Good;Fair;Poor;Excellent;Very good;Good;Fair;Poor Alphanumeric 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

C02209 Informed consent obtained indicator InfConsntObtInd Indicator of whether informed consent was obtained for the participant/subject to participate in the clinical research study. Indicator of whether informed consent was obtained for the participant/subject to participate in the clinical research study Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

2186028 DeBaun Forms
C13919 Imaging percent stenosis criterion type ImgPercentStenosisCriterionTyp The criteria used to find indicate stenosis. The criteria used to find indicate stenosis. PSV;PSV/EDV;Other, specify Peak systolic velocity;Peak systolic velocity/end diastolic velocity;Other, specify 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

C19358 Lab test type LabTstTyp Type of lab test performed on body fluid(s) and tissues. Test names are typically comprised of the analyte name, properties (%, Ratio, etc.), the type of body fluid tested, and any special instructions. Type of lab test performed on body fluid(s) and tissues. Test names are typically comprised of the analyte name, properties (%, Ratio, etc.), the type of body fluid tested, and any special instructions. Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

2003746 DeBaun Forms
C13237 National Institutes of Health Stroke Scale (NIHSS) - Facial palsy score NIHSSLvlConscFaclPlsyScore Facial palsy assessed using the NIH Stroke Scale (NIHSS) Facial palsy assessed using the NIH Stroke Scale (NIHSS) 0;1;2;3;UN;0;1;2;3;UN Normal symmetrical movement;Minor paralysis (flattened nasolabial fold, asymmetry on smiling);Partial paralysis (total or near total paralysis of lower face);Complete paralysis of one or both sides (absence of facial movement in the upper and lower face);Unexaminable (intubated/paralyzed);Normal symmetrical movement;Minor paralysis (flattened nasolabial fold, asymmetry on smiling);Partial paralysis (total or near total paralysis of lower face);Complete paralysis of one or both sides (absence of facial movement in the upper and lower face);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

C14683 Pediatric Migraine Disability Assessment (MIDAS) - headache decrease other activity function day count PedMIDASHeadDecOActFuncDayCt Count the days you participate in these activities, but functioned at less than half your ability, as part of migraine disability assessment (MIDAS) questionnaire-pediatric form. Count the days you participate in these activities, but functioned at less than half your ability, 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

C56412 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Matrix Reasoning T score WASIIIMRTScore The T score converted from the raw score that the subject received on the Matrix Reasoning subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) . The T score converted from the raw score that the subject received on the Matrix Reasoning 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

20 80
C16100 Symptoms new or worsening neurologic indicator SymptmNewWrseNeuroInd Indicates whether the participant/subject has new neurologic symptoms or an acute worsening of preexisting neurologic symptoms Indicates whether the participant/subject has new neurologic symptoms or an acute worsening of preexisting neurologic symptoms Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C56424 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Verbal Comprehension IQ composite score WASIIIVerbCompIQCompScore The subject's Verbal Comprehension IQ composite score, converted from his/her Verbal Comprehension T score, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The subject's Verbal Comprehension IQ composite score, converted from his/her Verbal Comprehension 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
C11026 Neuromuscular Exam Muscle weakness indicator NeuromuExmCranlMuscleWeaknInd Indicator whether there is muscle weakness in the muscle or muscle group examined Whether there is muscle weakness in the muscle or muscle group examined Yes;No;Not assessed;Unknown Yes;No;Not assessed;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C14000 Extracranial stenosis present indicator ExtracranStenPresInd Indicates presence of extracranial stenosis Indicates presence of extracranial stenosis 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

C54602 Behavior Rating Inventory of Executive Function 2nd Edition (BRIEF 2) - Form version name BRIEF2FormVersionName Name of the version of the form, as part of the Behavior Rating Inventory of Executive Function 2nd Edition (BRIEF 2) Name of the version of the form, as part of the Behavior Rating Inventory of Executive Function 2nd Edition (BRIEF 2) Parent form;Self form;Teacher form Parent form;Self form;Teacher form Alphanumeric Adult;Pediatric Supplemental 1.00 2017-03-20 15:13:56.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C01507 Blood pressure diastolic measurement BldPressrDiastlMeasr Measurement of pressure of the participant's/subject's blood against the artery walls during diastole (the relaxation phase) in millimeters of mercury (mmHg) Measurement of pressure of the participant's/subject's blood against the artery walls during diastole (the relaxation phase) in millimeters of mercury (mmHg) Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0 300 millimeter of mercury 2004291 DeBaun Forms
C13898 Imaging vessel angiography collateral grade ImgVesselAngioCollateralGrad Indicates vessel angiography collateral grade Indicates vessel angiography collateral grade Grade 0;Grade 1;Grade 2;Grade 3;Grade 4 No collaterals visible to the ischemic site;Slow collaterals to the periphery of the ischemic site with persistence of some of the defect;Rapid collaterals to the periphery of ischemic site with persistence of some of the defect and to only a portion of the ischemic territory;Collaterals with slow but complete angiographic blood flow of the ischemic bed by the late venous phase;Complete and rapid collateral blood flow to the vascular bed in the entire ischemic territory by retrograde perfusion. 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

C18854 Imaging other incidental finding other text ImgOthrIncidentalFindOTH The free-text field related to 'Imaging other incidental finding type' specifying other text. The type of other incidental findings found within the image studies The free-text field related to 'Imaging other incidental finding type' specifying other text. The type of other incidental findings found within the image studies 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

C12500 Imaging corpus callosum type indicator ImgCrpsClsmTypInd The condition of the corpus callosum fibers The condition of the corpus callosum fibers Involved;Spared Involved;Spared 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

C14033 Vasospasm vessel anatomic site VasospasmVesselAntmicSite Indicates vasospasm vessel(s) Indicates vasospasm vessel(s) ICA;Basilar;MCA;Other, specify;ACA;VA Internal carotid artery;Basilar;Middle cerebral artery;Other, specify;Anterior cerebral artery;Vertebral artery 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

C56378 Conners Continuous Performance Test 3rd Edition (CPT3) - Inattentiveness detectability score ConnersCPT3InaDetectScore Ability to discriminate between targets (non-X) and non-targets (X), as part of the Conners Continuous Performance Test 3rd Edition (CPT3). Ability to discriminate between targets (non-X) and non-targets (X), as part of the Conners Continuous Performance Test 3rd Edition (CPT3). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-09 15:27:57.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

C02495 Imaging scanner strength value ImgScannerStrgthVal Value, in Tesla (T), of the scanner's magnetic field strength used for the scan being reported Value, in Tesla (T), of the scanner's magnetic field strength used for the scan being reported 1.5T;3.0T;4.0T;7.0T;Other, specify;1.5T;3.0T;4.0T;7.0T;Other, specify 1.5T;3.0T;4.0T;7.0T;Other, specify;1.5T;3.0T;4.0T;7.0T;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

Tesla
C13930 Intima media thickness (IMT) timing type IMTTimingTyp Indicates intima media thickness (IMT) timing type Indicates intima media thickness (IMT) timing type ECG Gating;End Diastolic;Peak Systolic;ECG Gating;End Diastolic;Peak Systolic ECG Gating;End Diastolic;Peak Systolic;ECG Gating;End Diastolic;Peak Systolic 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

C20417 National Institutes of Health Stroke Scale (NIHSS) - Motor leg amputation text NIHSSMotLegAmpTxt The text field for explaining the amputation or joint fusion for question related to motor ability of the leg (both left and right) assessed using the NIH Stroke Scale (NIHSS). The text field for explaining the amputation or joint fusion for question related to motor ability of the leg (both left and right) assessed using the NIH Stroke Scale (NIHSS). Alphanumeric Adult;Pediatric Supplemental 4.00 2015-04-27 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

C13248 National Institutes of Health Stroke Scale (NIHSS) Supplemental - Limb sensory loss status NIHSSSupLimbSensoryLossStatus The indicator to determine if any limbs have sensory loss The indicator to determine if any limbs have sensory loss 0;1;2 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. 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

C13941 Imaging insonation plane type ImgInsonPlaneTyp Indicates insonation plane Indicates insonation plane Free;Coronal;Axial mesencephalic Free;Coronal;Axial mesencephalic 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

C21490 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span forward subtest total raw score WAISIVDSFTtlScore Total raw score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest Total raw score, 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

0 16
C13469 Stroke Adjudication Worksheet - neuroimaging indicator StrokeAdjudWksNeuroimagInd The indicator for whether neuro-imaging done for this stroke event. The indicator for whether neuro-imaging done for this stroke event. 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

DeBaun Forms
C17503 Hemoglobin electrophoresis type HemoglbnElectrophoresisType Type of hemoglobin that was identified by the electrophoresis test being reported Type of hemoglobin that was identified by the electrophoresis test being reported HbSS;HbSA;HBAA;HbFF;HbAF HbSS;HbSA;HBAA;HbFF;HbAF 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
C17798 Imaging contrast agent name ImgContrastAgentName Name of imaging contrast agent used Name of imaging contrast agent used Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

C12479 Imaging cortex-pachygyria site type ImgCortexPachygyriaSiteTyp The anatomical site(s) of the cortex-pachygyria The anatomical site(s) of the cortex-pachygyria Temporal;Frontoparietal;Occipital Temporal;Frontoparietal;Occipital 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

C14011 Intracranial stenosis present indicator IntracranStenosisPresentInd Indicates presence of intracranial stenosis Indicates presence of intracranial stenosis 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

C54613 Brief Test of Executive Function Second Edition (BRIEF 2) - Plan organize total raw scale score BRIEF2PlnOrgnzTtlRwSclScore Total score of the raw scale for the plan/organize function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) Total score of the raw scale for the plan/organize 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

C01702 Pregnancy test date and time PregTestDateTime The date (and time if applicable and known) when the pregnancy test was performed The date (and time if applicable and known) when the pregnancy test was performed 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

Free-Form Entry

DeBaun Forms
C56441 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Full Scale IQ 2 confidence interval upper bound value WASIIIFullSclIQ2ConfIntUppVal The upper bound of the subject's Full Scale IQ-2 confidence interval, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The upper bound of the subject's Full Scale IQ-2 confidence interval, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-12 13:06:29.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

C13909 Imaging plaque surface type ImgPlaqSurfaceTyp Indicates plaque surface type Indicates plaque surface type Irregular;Smooth Irregular;Smooth 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

C18900 Intracranial stenosis collateral vessel anatomic other text IntracrnStnoColltVsslAntmicOTH The free-text field related to 'Intracranial stenosis collateral vessel anatomic site' specifying other text. Indicates intracranial stenosis collateral vessel(s) The free-text field related to 'Intracranial stenosis collateral vessel anatomic site' specifying other text. Indicates intracranial stenosis collateral vessel(s) Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

C13195 Questionnaire for Verifying Stroke Free Status (QVSFS) - numbness status QVSFSNumbStatus Have you ever had sudden numbness or a dead feeling on one side of your body? Have you ever had sudden numbness or a dead feeling on one side of your body? 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
C14443 Muscle tone assessment anatomic site MuscToneAssmtAntmicSite Anatomic location of the muscle tone as part of the motor examination. Anatomic location of the muscle tone as part of the motor examination. Right upper extremity;Left upper extremity;Right lower extremity;Left lower extremity;Truncal tone Right upper extremity (RUE);Left upper extremity (LUE);Right lower extremity (RLE);Left lower extremity (LLE);Truncal tone Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C56394 Conners Continuous Performance Test 3rd Edition (CPT3) - Sustained attention commission block count ConnersCPT3SusAtnCommBlkCt The number of incorrect responses to non-targets by block, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). The number of incorrect responses to non-targets by block, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-09 15:44:12.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

0
C08238 Imaging repetition gap value ImgRepetitionGapVal Duration between successive pulse sequences, in milliseconds, applied to the same slice during imaging acquisition Duration between successive pulse sequences, in milliseconds, applied to the same slice during imaging acquisition Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

millisecond
C10570 Imaging contrast agent used indicator ImgContrastAgentUsedInd Indicator as to whether or not an imaging contrast agent was used for the scan as part of Diffusion Tensor Imaging (DTI). Indicator as to whether or not an imaging contrast agent was used for the scan. Yes;No;Unknown;Not applicable Yes;No;Unknown;Not applicable Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C13952 Consensus on Grading Intracranial Flow Obstruction (COGIF) - score COGIFScore The score related to the consensus on grading intracranial flow obstruction (COGIF) The score related to the consensus on grading intracranial flow obstruction (COGIF) No flow;Low flow/No diastolic flow;Low flow/diastolic flow;Established perfusion No flow;Low flow/No diastolic flow;Low flow/diastolic flow;Established perfusion 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

C21501 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span sequencing subtest item number WAISIVDSSItemNum Item number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest Item number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest 1;2;3;4;5;6;7;8 Item 1;Item 2;Item 3;Item 4;Item 5;Item 6;Item 7;Item 8 Numeric Values 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

C00312 Body system category BodySysCat Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems. Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems. Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify:;Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify:;Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

2002895 DeBaun Forms
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