CDE Detailed Report
Disease: cookie-policy
Sub-Domain: Participant Characteristics
CRF:

6 results.
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
C60139 Hospital admit date HospitalAdmitDate Date on which the subject/participant was admitted to a hospital. Date on which the subject/participant was admitted to a hospital. Date of Admission (yyyy/mm/dd) Date or Date & Time Adult;Pediatric Supplemental 1.00 2021-01-15 14:35:46.0 Hospitalization Form Participant Characteristics General Health History

Free-Form Entry

HO HOSPITAL_HOSTDAT

Healthcare Encounter Start Date

Admission Date

What was the hospital dmission date?

HOSTDTC Char Record the start date of the healthcare encounter (e.g., date of admission) using this format (DD-MON-YYYY).

HOSTDTC where HOTERM = HOSPITAL

Prompt
C60140 Hospital admit reason HospitalAdmitRsn Reason(s) for which the subject/participant was admitted to the hospital. Reason(s) for which the subject/participant was admitted to the hospital. Reason for admission Acute chest syndrome;Asthma;Congestive heart failure;Infection;Pain;Renal failure;Stroke;Surgery;Other, specify:;Transient red cell aplasia;Transfusion Reaction;Splenic sequestration;Skin ulcers;Priapism;Gall bladder and liver disease;Eye problems;Chelation therapy;Osteomyelitis or osteonecrosis Acute chest syndrome;Asthma;Congestive heart failure;Infection;Pain;Renal failure;Stroke;Surgery;Other, specify:;Transient red cell aplasia;Transfusion Reaction;Splenic sequestration;Skin ulcers;Priapism;Gall bladder and liver disease;Eye problems;Chelation therapy;Osteomyelitis or osteonecrosis Alphanumeric Adult;Pediatric Supplemental 1.00 2021-01-15 14:39:54.0 Hospitalization Form Participant Characteristics General Health History

Multiple Pre-Defined Values Selected

HO HOSPITAL_HOREAS

Reason for the Healthcare Encounter

Reason for the Hospital Admission

What was the reason for the hosptial admission?

SUPPHO.QVAL Char Provide the reason for the subject's hospital admission.

SUPPHO.QVAL where SUPPHO.QNAM = "HOREAS" and SUPPHO.QLABEL = "Reason for the Healthcare Encounter"

Prompt Radio
C60141 Hospital admit reason other text HospitalAdmitRsnOTH The free-text field related to "Hospital admit reason", specifying other text. The free-text field related to "Hospital admit reason", specifying other text. If Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2021-01-15 14:54:46.0 Hospitalization Form Participant Characteristics General Health History 4000

Free-Form Entry

HO HOSPITAL_HOREASO

Oth Reason for the Healthcare Encounter

Specify Other

If other is selected, specify?

SUPPHO.QVAL Char Provide the reason for the subject's hospital admission.

SUPPHO.QVAL where SUPPHO.QNAM = "HOREAS" and SUPPHO.QLABEL = "Reason for the Healthcare Encounter"

Question
C17409 Visit date VisitDate Date of interview or visit (actually the date when data in the form were captured) Date of interview or visit Visit Date (yyyy/mm/dd) Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Hospitalization Form Participant Characteristics General Health History

Free-Form Entry

DeBaun Forms LB VISDAT

Visit Date

Visit Date

What [is/was] the date of the visit?

N/A Char Record the [date/start date] of the visit using DD-MON-YYYY format. Prompt
C60137 Event ad hoc identification number text EventAdHocIDNumTxt Text field allowing for alphanumeric ad-hoc event identification numbers. Text field allowing for alphanumeric ad-hoc event identification numbers. Ad Hoc Event ID Alphanumeric Adult;Pediatric Supplemental 1.00 2021-01-15 14:28:33.0 Hospitalization Form Participant Characteristics General Health History 50

Free-Form Entry

HO HOSPID

HO Sponsor-Defined Identifier

Event ID

What was the event ID?

HOSPID Char If collected on the CRF, sponsor may insert instructions to ensure each record has a unique identifier. Prompt
C60138 Form data correction indicator FormDataCorrectionInd Indicator of whether the data collected on the form includes a correction of previously collected data. Indicator of whether the data collected on the form includes a correction of previously collected data. Correction No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2021-01-15 14:33:02.0 Hospitalization Form Participant Characteristics General Health History

Single Pre-Defined Value Selected

HO CORRECTED_HOYN

Any Corrections

Any Correction

Were any corrections made?

N/A Char Indicate whether any corrections were made to previously collected data. (NY)

Yes; No

Prompt Radio
6 results.
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