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CRF Continuous Documentation

1 forms  
Diseases
Description

Diseases

Alias
UMLS CUI-1
C0012634
Study-ID:
Description

study id

Data type

text

Alias
UMLS CUI [1]
C2826693
Does the participant have any pre-existing conditions or comorbidities?
Description

If 'yes' please fill-out the following table

Data type

boolean

Alias
UMLS CUI [1]
C0521987
UMLS CUI [2]
C0009488
Documentation of diseases
Description

Documentation of diseases

No.
Description

no of diagnosis

Data type

integer

Alias
UMLS CUI [1,1]
C0237753
UMLS CUI [1,2]
C0011900
Diagnosis
Description

Please regard the following diagnoses: Hypertension, diabetes mellitus, hypercholesterolemia, stroke, epilepsy, heart attack, recurrent depressive episode, neoplasms, thyroid disease, renal insufficiency. You can use the checklist pre-existing condition. In the database one can choose the ICD-Code after data entry.

Data type

text

Alias
UMLS CUI [1]
C0011900
Onset of disease
Description

onset of disease

Data type

date

Alias
UMLS CUI [1]
C0277793
End of disease
Description

end of disease

Data type

date

Alias
UMLS CUI [1]
C4019088
Disease enduring
Description

enduring

Data type

boolean

Alias
UMLS CUI [1]
C1314677
Checklist pre-existing conditions
Description

Checklist pre-existing conditions

No. 1 Hypertension
Description

hypertension diagnosed

Data type

text

Alias
UMLS CUI [1]
C0020538
Initial diagnosis
Description

date initial diagnosis hypertension

Data type

date

Alias
UMLS CUI [1,1]
C0020538
UMLS CUI [1,2]
C2316983
No.2 Hypercholesterolemia
Description

hypercholesterolemia

Data type

text

Alias
UMLS CUI [1]
C0020443
Initial diagnosis
Description

date initial diagnosis hypercholesterolemia

Data type

date

Alias
UMLS CUI [1,1]
C0020443
UMLS CUI [1,2]
C2316983
No.3 Hypertriglyceridemia
Description

hypertriglyceridemia

Data type

text

Alias
UMLS CUI [1]
C0020557
Initial diagnosis
Description

date initial diagnosis hypertriglyceridemia

Data type

date

Alias
UMLS CUI [1,1]
C0020557
UMLS CUI [1,2]
C2316983
No.4 Other hyperlipedimia or dyslipidemia
Description

hyperlipedimia or dyslipidemia

Data type

text

Alias
UMLS CUI [1]
C0020473
UMLS CUI [2]
C0242339
Initial diagnosis
Description

initial diagnosis of hyperlipedimia or dyslipedimia

Data type

date

Alias
UMLS CUI [1,1]
C0020473
UMLS CUI [1,2]
C2316983
UMLS CUI [2,1]
C0242339
UMLS CUI [2,2]
C2316983
No. 5 Diabetes mellitus type 1
Description

diabetes mellitus type 1

Data type

text

Alias
UMLS CUI [1]
C0011854
Initial diagnosis
Description

initial diagnosis of diabetes type 1

Data type

date

Alias
UMLS CUI [1,1]
C0011854
UMLS CUI [1,2]
C2316983
No. 6 Diabetes mellitus type 2
Description

diabetes mellitus type 2

Data type

text

Alias
UMLS CUI [1]
C0011860
Initial diagnosis
Description

initial diagnosis of diabetes type 2

Data type

date

Alias
UMLS CUI [1,1]
C0011860
UMLS CUI [1,2]
C2316983
No. 7 Diabetic polyneuropathy
Description

diabetic polyneuropathy

Data type

text

Alias
UMLS CUI [1]
C0271680
Initial diagnosis
Description

initial diagnosis of diabetic polyneuropathy

Data type

date

Alias
UMLS CUI [1,1]
C0271680
UMLS CUI [1,2]
C2316983
No. 8 Cardiac infarction
Description

cardiac infarction

Data type

text

Alias
UMLS CUI [1]
C0027051
Initial diagnosis
Description

date of initial diagnosis cardiac infarction

Data type

date

Alias
UMLS CUI [1,1]
C0027051
UMLS CUI [1,2]
C2316983
No.9 Transient ischemic attack (TIA)
Description

transient ischemic attack

Data type

text

Alias
UMLS CUI [1]
C0007787
Initial diagnosis
Description

date of initial diagnosis TIA

Data type

date

Alias
UMLS CUI [1,1]
C0007787
UMLS CUI [1,2]
C2316983
No. 10 Coronary heart disease
Description

coronary heart disease

Data type

text

Alias
UMLS CUI [1]
C0010068
Initial diagnosis
Description

date of initial diagnosis coronary heart disease

Data type

date

Alias
UMLS CUI [1,1]
C0010068
UMLS CUI [1,2]
C2316983
No. 11 Stroke (ischemic)
Description

stroke

Data type

text

Alias
UMLS CUI [1]
C0038454
Initial diagnosis
Description

date of initial diagnosis stroke

Data type

date

Alias
UMLS CUI [1,1]
C0038454
UMLS CUI [1,2]
C2316983
No. 12 Cerebral venous sinus thrombosis or cerebral thrombosis
Description

cerebral venous sinus thrombosis or cerebral thrombosis

Data type

text

Alias
UMLS CUI [1]
C0338573
UMLS CUI [2]
C0079102
Initial date
Description

date of initial diagnosis cerebral venous sinus thrombosis

Data type

date

Alias
UMLS CUI [1,1]
C0338573
UMLS CUI [1,2]
C2316983
UMLS CUI [2,1]
C0079102
UMLS CUI [2,2]
C2316983
No. 13 Subarachnoid hemorrhage
Description

subarachnoid hemorrhage

Data type

text

Alias
UMLS CUI [1]
C0038525
Initial diagnosis
Description

date of initial diagnosis SAB

Data type

date

Alias
UMLS CUI [1,1]
C0038525
UMLS CUI [1,2]
C2316983
No. 14 Intracerebral hemorrhage (ICH)
Description

ICH

Data type

text

Alias
UMLS CUI [1]
C2937358
Initial diagnosis
Description

date of initial diagnosis ICH

Data type

date

Alias
UMLS CUI [1,1]
C2937358
UMLS CUI [1,2]
C2316983
No. 15 Subdural hematoma
Description

subdural hematoma

Data type

text

Alias
UMLS CUI [1]
C0018946
Initial diagnosis
Description

date of initial diagnosis subdural hematoma

Data type

date

Alias
UMLS CUI [1,1]
C0018946
UMLS CUI [1,2]
C2316983
No. 16 Concussion
Description

concussion

Data type

text

Alias
UMLS CUI [1]
C0006107
Initial diagnosis
Description

date of initial diagnosis concussion

Data type

date

Alias
UMLS CUI [1,1]
C0006107
UMLS CUI [1,2]
C2316983
No. 17 Other pre-existing brain condition
Description

other pre-existing brain condition

Data type

text

Alias
UMLS CUI [1,1]
C0006111
UMLS CUI [1,2]
C2347662
UMLS CUI [1,3]
C0205394
Initial diagnosis
Description

date of initial diagnosis other pre-existing brain condition

Data type

date

Alias
UMLS CUI [1,1]
C0006111
UMLS CUI [1,2]
C2347662
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C2316983
No. 18 Peripheral arterial disease
Description

peripheral arterial disease

Data type

text

Alias
UMLS CUI [1]
C1704436
Initial diagnosis
Description

date of initial diagnosis PAD

Data type

date

Alias
UMLS CUI [1,1]
C1704436
UMLS CUI [1,2]
C2316983
No. 19 Atrial fibrillation
Description

atrial fibrillation

Data type

text

Alias
UMLS CUI [1]
C0004238
Initial diagnosis
Description

date of initial diagnosis atrial fillibration

Data type

date

Alias
UMLS CUI [1,1]
C0004238
UMLS CUI [1,2]
C2316983
No. 20 Hemophilia
Description

hemophilia

Data type

text

Alias
UMLS CUI [1]
C0684275
Initial diagnosis
Description

date of initial diagnosis hemophilia

Data type

date

Alias
UMLS CUI [1,1]
C0684275
UMLS CUI [1,2]
C2316983
No. 21 Parkinson's disease
Description

parkinsons disease

Data type

text

Alias
UMLS CUI [1]
C0030567
Initial diagnosis
Description

date of initial diagnosis PD

Data type

date

Alias
UMLS CUI [1,1]
C0030567
UMLS CUI [1,2]
C2316983
No. 22 Rheumatism or arthritis
Description

rheumatism or arthritis

Data type

text

Alias
UMLS CUI [1]
C0035435
UMLS CUI [2]
C0003864
Initial diagnosis
Description

date of initial diagnosis rheumatism or arthritis

Data type

date

Alias
UMLS CUI [1,1]
C0035435
UMLS CUI [1,2]
C2316983
UMLS CUI [2,1]
C0003864
UMLS CUI [2,2]
C2316983
No. 23 Hypersensitivity
Description

allergies

Data type

text

Alias
UMLS CUI [1]
C0020517
Initial diagnosis
Description

date of initial diagnosis hypersensitivity

Data type

date

Alias
UMLS CUI [1,1]
C0020517
UMLS CUI [1,2]
C2316983
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CRF Continuous Documentation

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Diseases
C0012634 (UMLS CUI-1)
study id
Item
Study-ID:
text
C2826693 (UMLS CUI [1])
pre-existing codition and comorbidities
Item
Does the participant have any pre-existing conditions or comorbidities?
boolean
C0521987 (UMLS CUI [1])
C0009488 (UMLS CUI [2])
Item Group
Documentation of diseases
no of diagnosis
Item
No.
integer
C0237753 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
diagnosis
Item
Diagnosis
text
C0011900 (UMLS CUI [1])
onset of disease
Item
Onset of disease
date
C0277793 (UMLS CUI [1])
end of disease
Item
End of disease
date
C4019088 (UMLS CUI [1])
enduring
Item
Disease enduring
boolean
C1314677 (UMLS CUI [1])
Item Group
Checklist pre-existing conditions
Item
No. 1 Hypertension
text
C0020538 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 1 Hypertension
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date initial diagnosis hypertension
Item
Initial diagnosis
date
C0020538 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No.2 Hypercholesterolemia
text
C0020443 (UMLS CUI [1])
hypertension diagnosed
Code List
No.2 Hypercholesterolemia
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date initial diagnosis hypercholesterolemia
Item
Initial diagnosis
date
C0020443 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No.3 Hypertriglyceridemia
text
C0020557 (UMLS CUI [1])
hypertension diagnosed
Code List
No.3 Hypertriglyceridemia
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date initial diagnosis hypertriglyceridemia
Item
Initial diagnosis
date
C0020557 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No.4 Other hyperlipedimia or dyslipidemia
text
C0020473 (UMLS CUI [1])
C0242339 (UMLS CUI [2])
hypertension diagnosed
Code List
No.4 Other hyperlipedimia or dyslipidemia
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
initial diagnosis of hyperlipedimia or dyslipedimia
Item
Initial diagnosis
date
C0020473 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
C0242339 (UMLS CUI [2,1])
C2316983 (UMLS CUI [2,2])
Item
No. 5 Diabetes mellitus type 1
text
C0011854 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 5 Diabetes mellitus type 1
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
initial diagnosis of diabetes type 1
Item
Initial diagnosis
date
C0011854 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 6 Diabetes mellitus type 2
text
C0011860 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 6 Diabetes mellitus type 2
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
initial diagnosis of diabetes type 2
Item
Initial diagnosis
date
C0011860 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 7 Diabetic polyneuropathy
text
C0271680 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 7 Diabetic polyneuropathy
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
initial diagnosis of diabetic polyneuropathy
Item
Initial diagnosis
date
C0271680 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 8 Cardiac infarction
text
C0027051 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 8 Cardiac infarction
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis cardiac infarction
Item
Initial diagnosis
date
C0027051 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No.9 Transient ischemic attack (TIA)
text
C0007787 (UMLS CUI [1])
hypertension diagnosed
Code List
No.9 Transient ischemic attack (TIA)
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis TIA
Item
Initial diagnosis
date
C0007787 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 10 Coronary heart disease
text
C0010068 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 10 Coronary heart disease
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis coronary heart disease
Item
Initial diagnosis
date
C0010068 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 11 Stroke (ischemic)
text
C0038454 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 11 Stroke (ischemic)
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis stroke
Item
Initial diagnosis
date
C0038454 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 12 Cerebral venous sinus thrombosis or cerebral thrombosis
text
C0338573 (UMLS CUI [1])
C0079102 (UMLS CUI [2])
hypertension diagnosed
Code List
No. 12 Cerebral venous sinus thrombosis or cerebral thrombosis
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis cerebral venous sinus thrombosis
Item
Initial date
date
C0338573 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
C0079102 (UMLS CUI [2,1])
C2316983 (UMLS CUI [2,2])
Item
No. 13 Subarachnoid hemorrhage
text
C0038525 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 13 Subarachnoid hemorrhage
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis SAB
Item
Initial diagnosis
date
C0038525 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 14 Intracerebral hemorrhage (ICH)
text
C2937358 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 14 Intracerebral hemorrhage (ICH)
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis ICH
Item
Initial diagnosis
date
C2937358 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 15 Subdural hematoma
text
C0018946 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 15 Subdural hematoma
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis subdural hematoma
Item
Initial diagnosis
date
C0018946 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 16 Concussion
text
C0006107 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 16 Concussion
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis concussion
Item
Initial diagnosis
date
C0006107 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 17 Other pre-existing brain condition
text
C0006111 (UMLS CUI [1,1])
C2347662 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
hypertension diagnosed
Code List
No. 17 Other pre-existing brain condition
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis other pre-existing brain condition
Item
Initial diagnosis
date
C0006111 (UMLS CUI [1,1])
C2347662 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2316983 (UMLS CUI [1,4])
Item
No. 18 Peripheral arterial disease
text
C1704436 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 18 Peripheral arterial disease
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis PAD
Item
Initial diagnosis
date
C1704436 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 19 Atrial fibrillation
text
C0004238 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 19 Atrial fibrillation
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis atrial fillibration
Item
Initial diagnosis
date
C0004238 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 20 Hemophilia
text
C0684275 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 20 Hemophilia
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis hemophilia
Item
Initial diagnosis
date
C0684275 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 21 Parkinson's disease
text
C0030567 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 21 Parkinson's disease
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis PD
Item
Initial diagnosis
date
C0030567 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 22 Rheumatism or arthritis
text
C0035435 (UMLS CUI [1])
C0003864 (UMLS CUI [2])
hypertension diagnosed
Code List
No. 22 Rheumatism or arthritis
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis rheumatism or arthritis
Item
Initial diagnosis
date
C0035435 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
C0003864 (UMLS CUI [2,1])
C2316983 (UMLS CUI [2,2])
Item
No. 23 Hypersensitivity
text
C0020517 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 23 Hypersensitivity
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis hypersensitivity
Item
Initial diagnosis
date
C0020517 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
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