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Baseline - Parent-reported Form

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Indicate the patient's medical record number
Description

This number will not be shared with ICHOM. In the case patient-level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical RESPONSE OPTIONS: According to institution

Data type

text

Alias
UMLS CUI [1]
C1269815
Patient Demographic Factors
Description

Patient Demographic Factors

Alias
UMLS CUI-1
C1704791
Indicate the age at each clinical evaluation
Description

Inclusion Criteria: All patients Timing: On all forms Data Source: Clinical, parent-reported, or patient-reported Type: Single answer Response Options: Years and fractions

Data type

text

Measurement units
  • years
Alias
UMLS CUI [1]
C0001779
years
Indicate the patient’s sex at birth
Description

Inclusion Criteria: All patients Inclusion Criteria: All patients Timing: Baseline Data Source: Clinical, parent-reported, or patient-reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0079399
Please indicate the highest level of schooling completed by either parent (level of schooling defined in each country as per ISCED [International Standard Classification of Education]
Description

Inclusion Criteria: All patients Timing: Baseline Data Source: Parent-reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0030551
UMLS CUI [1,2]
C0013658
Indicate the patient’s insurance status
Description

Inclusion Criteria: All patients Timing: On all forms Data Source: Administrative data Type: Single answer

Data type

integer

Alias
UMLS CUI [1]
C1548070
Degree of Health
Description

Degree of Health

Alias
UMLS CUI-1
C0018759
Food falls out my child's mouth when they eat, more than I would expect for their age
Description

Inclusion Criteria: Age <8y Timing: Baseline, Pre-Intervention,Post-Intervention, 5 and 11 ages Follow-up, End of study Data Source: Parent-reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0332307
UMLS CUI [2,1]
C0008059
UMLS CUI [2,2]
C4062836
UMLS CUI [2,3]
C0439093
UMLS CUI [2,4]
C0679138
Liquid falls out of my child's mouth when they drink, more than I would expect for their age
Description

Inclusion Criteria: Age <8y Timing: Baseline, Pre-Intervention,Post-Intervention, 5 and 11 ages Follow-up, End of study Data Source: Parent-reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0332307
UMLS CUI [2,1]
C0008059
UMLS CUI [2,2]
C4062836
UMLS CUI [2,3]
C0302908
UMLS CUI [2,4]
C0439093
UMLS CUI [2,5]
C0679138
My child is has trouble chewing food
Description

Inclusion Criteria: Age <8y Timing: Baseline, Pre-Intervention,Post-Intervention, 5 and 11 ages Follow-up, End of study Data Source: Parent-reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0332307
UMLS CUI [2,1]
C0008059
UMLS CUI [2,2]
C1299586
UMLS CUI [2,3]
C0518499
My child bites their cheeks a lot
Description

Inclusion Criteria: Age <8y Timing: Baseline, Pre-Intervention,Post-Intervention, 5 and 11 ages Follow-up, End of study Data Source: Parent-reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0332307
UMLS CUI [2,1]
C0008059
UMLS CUI [2,2]
C0233625
UMLS CUI [2,3]
C0332183
PROMIS Paediatric Global Health
Description

As there is an official distribution site, the actual 7 questions of this questionnaire are not included in this version of the standard set. ICHOM's OIDs are: PROMIS-PPGH7_Q01 to PROMIS-PPGH7_Q07 Inclusion Criteria: Age 4-7 (if the patient is unable to respond to PROMIS CPGH7) Timing: Baseline, Pre-Intervention, Post-Intervention, 5 and 11 ages Follow-up , End of study Data Source: Parent-reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C3836333
UMLS CUI [1,2]
C0030755
UMLS CUI [1,3]
C2964552
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Similar models

Baseline - Parent-reported Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number
text
C1269815 (UMLS CUI [1])
Item Group
Patient Demographic Factors
C1704791 (UMLS CUI-1)
Age
Item
Indicate the age at each clinical evaluation
text
C0001779 (UMLS CUI [1])
Item
Indicate the patient’s sex at birth
integer
C0079399 (UMLS CUI [1])
Sex at birth
Code List
Indicate the patient’s sex at birth
CL Item
Male (1)
C1706180 (UMLS CUI-1)
(Comment:en)
CL Item
Female (2)
C0086287 (UMLS CUI-1)
(Comment:en)
CL Item
Undisclosed (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
Please indicate the highest level of schooling completed by either parent (level of schooling defined in each country as per ISCED [International Standard Classification of Education]
integer
C0030551 (UMLS CUI [1,1])
C0013658 (UMLS CUI [1,2])
Parent education
Code List
Please indicate the highest level of schooling completed by either parent (level of schooling defined in each country as per ISCED [International Standard Classification of Education]
CL Item
None (0)
C0549184 (UMLS CUI-1)
(Comment:en)
CL Item
Early Childhood Education (1)
C0681404 (UMLS CUI-1)
(Comment:en)
CL Item
Primary Education (2)
C0013658 (UMLS CUI-1)
C0033145 (UMLS CUI-2)
(Comment:en)
CL Item
Lower Secondary Education (3)
C0441994 (UMLS CUI-1)
C0557289 (UMLS CUI-2)
(Comment:en)
CL Item
Upper Secondary Education (4)
C0036530 (UMLS CUI-1)
(Comment:en)
CL Item
Short-Cycle Tertiary Education (5)
C0557291 (UMLS CUI-1)
(Comment:en)
CL Item
Bachelor's or Equivalent Level (6)
C1511035 (UMLS CUI-1)
C0205163 (UMLS CUI-2)
(Comment:en)
CL Item
Master's or Equivalent Level (7)
C1513010 (UMLS CUI-1)
C0205163 (UMLS CUI-2)
(Comment:en)
CL Item
Doctoral or Equivalent Level (8)
C1512027 (UMLS CUI-1)
C0205163 (UMLS CUI-2)
(Comment:en)
Item
Indicate the patient’s insurance status
integer
C1548070 (UMLS CUI [1])
Insurance status
Code List
Indicate the patient’s insurance status
CL Item
Uninsured (0)
C0087134 (UMLS CUI-1)
(Comment:en)
CL Item
Private insurance (1)
C3845555 (UMLS CUI-1)
(Comment:en)
CL Item
Governmental insurance (2)
C0021682 (UMLS CUI-1)
(Comment:en)
Item Group
Degree of Health
C0018759 (UMLS CUI-1)
Item
Food falls out my child's mouth when they eat, more than I would expect for their age
integer
C1457887 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0008059 (UMLS CUI [2,1])
C4062836 (UMLS CUI [2,2])
C0439093 (UMLS CUI [2,3])
C0679138 (UMLS CUI [2,4])
Oral symptoms question 1
Code List
Food falls out my child's mouth when they eat, more than I would expect for their age
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Liquid falls out of my child's mouth when they drink, more than I would expect for their age
integer
C1457887 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0008059 (UMLS CUI [2,1])
C4062836 (UMLS CUI [2,2])
C0302908 (UMLS CUI [2,3])
C0439093 (UMLS CUI [2,4])
C0679138 (UMLS CUI [2,5])
Oral symptoms question 1
Code List
Liquid falls out of my child's mouth when they drink, more than I would expect for their age
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
My child is has trouble chewing food
integer
C1457887 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0008059 (UMLS CUI [2,1])
C1299586 (UMLS CUI [2,2])
C0518499 (UMLS CUI [2,3])
Oral symptoms question 1
Code List
My child is has trouble chewing food
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
My child bites their cheeks a lot
integer
C1457887 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0008059 (UMLS CUI [2,1])
C0233625 (UMLS CUI [2,2])
C0332183 (UMLS CUI [2,3])
Oral symptoms question 1
Code List
My child bites their cheeks a lot
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
PROMIS Paediatric Global Health
Item
PROMIS Paediatric Global Health
integer
C3836333 (UMLS CUI [1,1])
C0030755 (UMLS CUI [1,2])
C2964552 (UMLS CUI [1,3])
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