Subject Number
Item
Subject Number:
text
C2348585 (UMLS CUI [1])
Subject Initials
Item
Subject Initials:
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Visit Date
Item
Visit Date:
date
C1320303 (UMLS CUI [1])
Test Date
Item
Test Date:
date
C2826247 (UMLS CUI [1])
Investigator name
Item
Examiner Name (print):
text
C2826892 (UMLS CUI [1])
Investigator Signature
Item
Examiner (signature):
text
C2346576 (UMLS CUI [1])
Item
Row
integer
C1552840 (UMLS CUI [1])
Item
Snellen Equivalent
text
C1827708 (UMLS CUI [1])
Code List
Snellen Equivalent
CL Item
20/12.5 (20/12.5)
Item
Chart 1 Letters
text
C0183370 (UMLS CUI [1])
Code List
Chart 1 Letters
CL Item
N C K Z O (N C K Z O)
CL Item
R H S D K (R H S D K)
CL Item
D O V H R (D O V H R)
CL Item
C Z R H S (C Z R H S)
CL Item
O N H R C (O N H R C)
CL Item
D K S N V (D K S N V)
CL Item
Z S O K N (Z S O K N)
CL Item
C K D N R (C K D N R)
CL Item
S R Z K D (S R Z K D)
CL Item
H Z O V C (H Z O V C)
CL Item
N V D O K (N V D O K)
CL Item
V H C N O (V H C N O)
CL Item
S V H C Z (S V H C Z)
CL Item
O Z D V K (O Z D V K)
number correct
Item
Number correct at 4 meters
integer
C0237753 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Total number correct
Item
Total number correct at 4 meters
integer
C4288115 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Item
Row
integer
C1552840 (UMLS CUI [1])
Item
Snellen Equivalent
text
C1827708 (UMLS CUI [1])
Code List
Snellen Equivalent
Item
Chart 1 Letters
text
C0183370 (UMLS CUI [1])
Code List
Chart 1 Letters
CL Item
N C K Z O (N C K Z O)
CL Item
R H S D K (R H S D K)
CL Item
D O V H R (D O V H R)
CL Item
C Z R H S (C Z R H S)
CL Item
O N H R C (O N H R C)
CL Item
D K S N V (D K S N V)
number correct
Item
Number correct at 1 meter
integer
C0237753 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Total number correct
Item
Total number correct at 1 meter
integer
C4288115 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Total number correct
Item
A. Total number correct at 4 meters: (SECTION I)
text
C4288115 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
score
Item
B. If A ≥ 4, write 30;otherwise, write zero
text
C0449820 (UMLS CUI [1])
Total number correct
Item
C. Total correct at 1 meter (SECTION II) (If not tested, write zero)
text
C4288115 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Visual Acuity Score
Item
A + B + C Visual Acuity Score: Right Eye =
integer
C0042812 (UMLS CUI [1,1])
C0449820 (UMLS CUI [1,2])
Snellen Equivalent
Item
SNELLEN EQUIVALENT Right Eye (Most difficult line with 1 or no errors)
text
C1827708 (UMLS CUI [1])
Snellen Equivalent
Item
OR Snellen Equivalent worse than 20/800
boolean
C1827708 (UMLS CUI [1])
Item
If visual acuity is not measurable, please test: Count fingers?
text
C0042793 (UMLS CUI [1,1])
C0449804 (UMLS CUI [1,2])
Code List
If visual acuity is not measurable, please test: Count fingers?
CL Item
Not Done (Not Done)
Item
If Yes, maximum distance:
text
C0042793 (UMLS CUI [1,1])
C0442747 (UMLS CUI [1,2])
Code List
If Yes, maximum distance:
Item
Hand movement?
text
C0042793 (UMLS CUI [1,1])
C0575809 (UMLS CUI [1,2])
CL Item
Not Done (Not Done)
Item
If Yes:
text
C0042793 (UMLS CUI [1,1])
C0449738 (UMLS CUI [1,2])
CL Item
With Direction (With Direction)
CL Item
Without Direction (Without Direction)
Item
Light Perception?
text
C0042793 (UMLS CUI [1,1])
C1154616 (UMLS CUI [1,2])
Code List
Light Perception?
CL Item
Not Done (Not Done)
Item
If Yes:
text
C0042793 (UMLS CUI [1,1])
C1154616 (UMLS CUI [1,2])
CL Item
With Projection (With Projection)
CL Item
Without Projection (Without Projection)