Physical Examination
Item
Was the physical examination performed? Record any abnormal findings/conditions identified during the exam on the appropriate form.
boolean
C0031809 (UMLS CUI [1])
Assessment Date
Item
Assessment Date
date
C0031809 (UMLS CUI [1,1])
C2985720 (UMLS CUI [1,2])
Assessment
Item
Not Done:
boolean
C0518766 (UMLS CUI [1,1])
C1516048 (UMLS CUI [1,2])
Assessment Date
Item
Assessment Date
date
C0518766 (UMLS CUI [1,1])
C1516048 (UMLS CUI [1,2])
C2985720 (UMLS CUI [1,3])
Assessment Time
Item
Assessment Time
time
C0518766 (UMLS CUI [1,1])
C1516048 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Item
Vital Signs Position
integer
C0518766 (UMLS CUI [1,1])
C1262869 (UMLS CUI [1,2])
Code List
Vital Signs Position
Item
Location of blood pressure measurement
integer
C0005823 (UMLS CUI [1])
Code List
Location of blood pressure measurement
Systolic blood pressure
Item
Systolic blood pressure
text
C0871470 (UMLS CUI [1])
Diastolic Blood Pressure
Item
Diastolic Blood Pressure
text
C0428883 (UMLS CUI [1])
Pulse Rate
Item
Pulse Rate
text
C0232117 (UMLS CUI [1])
ECG Date
Item
Date ECG was performed
date
C0013798 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
ECG time
Item
ECG Time performed
time
C0013798 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Item
ECG Interpretation
integer
C1623258 (UMLS CUI [1,1])
C0459471 (UMLS CUI [1,2])
Code List
ECG Interpretation
CL Item
Abnormal - not clinically significant (1 )
CL Item
Abnormal - clinically significant (2 )
Assessment Date
Item
Assessment Date
date
C0005910 (UMLS CUI [1,1])
C2985720 (UMLS CUI [1,2])
Weight
Item
Body weight
float
C0005910 (UMLS CUI [1])
Item
Select "Not done" if urine sample was not taken.
integer
Code List
Select "Not done" if urine sample was not taken.
CL Item
Not done (Not done)
Pregnancy Test: Date
Item
Date of Sample Taken
date
C0032976 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Pregnancy test result
integer
C0427777 (UMLS CUI [1])
Code List
Pregnancy test result
Assessment Date
Item
Assessment Date
date
C2985720 (UMLS CUI [1])
Item
Over the past two weeks how bothered have you been by the amount of home monitoring (blood sugar testing) required as part of using your medication(s)?
integer
C3174324 (UMLS CUI [1,1])
C0005803 (UMLS CUI [1,2])
Code List
Over the past two weeks how bothered have you been by the amount of home monitoring (blood sugar testing) required as part of using your medication(s)?
CL Item
Not at all bothered (1)
C3828778 (UMLS CUI-1)
(Comment:en)
CL Item
Slightly bothered (2)
C3831310 (UMLS CUI-1)
(Comment:en)
CL Item
Somewhat bothered (3)
C3831293 (UMLS CUI-1)
(Comment:en)
CL Item
Very bothered (4)
C3831292 (UMLS CUI-1)
(Comment:en)
CL Item
Extremely bothered (5)
C3830278 (UMLS CUI-1)
(Comment:en)
Item
Over the past two weeks how bothered have you been by the number of times you need to take your medication(s) daily?
integer
C3174324 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Code List
Over the past two weeks how bothered have you been by the number of times you need to take your medication(s) daily?
CL Item
Not at all bothered (1)
C3828778 (UMLS CUI-1)
(Comment:en)
CL Item
Slightly bothered (2)
C3831310 (UMLS CUI-1)
(Comment:en)
CL Item
Somewhat bothered (3)
C3831293 (UMLS CUI-1)
(Comment:en)
CL Item
Very bothered (4)
C3831292 (UMLS CUI-1)
(Comment:en)
CL Item
Extremely bothered (5)
C3830278 (UMLS CUI-1)
(Comment:en)
Item
Over the past two weeks how bothered have you been by the need to adjust the dosing (amount) of your medication(s)?
integer
C3174324 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Code List
Over the past two weeks how bothered have you been by the need to adjust the dosing (amount) of your medication(s)?
CL Item
Not at all bothered (1)
C3828778 (UMLS CUI-1)
(Comment:en)
CL Item
Slightly bothered (2)
C3831310 (UMLS CUI-1)
(Comment:en)
CL Item
Somewhat bothered (3)
C3831293 (UMLS CUI-1)
(Comment:en)
CL Item
Very bothered (4)
C3831292 (UMLS CUI-1)
(Comment:en)
CL Item
Extremely bothered (5)
C3830278 (UMLS CUI-1)
(Comment:en)
Item
Over the past two weeks how bothered have you been by how your medication(s) interferes with your daily life?
integer
C3174324 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Code List
Over the past two weeks how bothered have you been by how your medication(s) interferes with your daily life?
CL Item
Not at all bothered (1)
C3828778 (UMLS CUI-1)
(Comment:en)
CL Item
Slightly bothered (2)
C3831310 (UMLS CUI-1)
(Comment:en)
CL Item
Somewhat bothered (3)
C3831293 (UMLS CUI-1)
(Comment:en)
CL Item
Very bothered (4)
C3831292 (UMLS CUI-1)
(Comment:en)
CL Item
Extremely bothered (5)
C3830278 (UMLS CUI-1)
(Comment:en)
Item
Over the past two weeks how bothered have you been by any of the following due to your diabetes medication(s)? Unwanted weight gain
integer
C0043094 (UMLS CUI [1,1])
C3174324 (UMLS CUI [1,2])
Code List
Over the past two weeks how bothered have you been by any of the following due to your diabetes medication(s)? Unwanted weight gain
CL Item
Not at all bothered (1)
C3828778 (UMLS CUI-1)
(Comment:en)
CL Item
Slightly bothered (2)
C3831310 (UMLS CUI-1)
(Comment:en)
CL Item
Somewhat bothered (3)
C3831293 (UMLS CUI-1)
(Comment:en)
CL Item
Very bothered (4)
C3831292 (UMLS CUI-1)
(Comment:en)
CL Item
Extremely bothered (5)
C3830278 (UMLS CUI-1)
(Comment:en)
Item
Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)? - Pain or discomfort
integer
C3639378 (UMLS CUI [1,1])
C3174324 (UMLS CUI [1,2])
Code List
Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)? - Pain or discomfort
CL Item
Not at all bothered (1)
C3828778 (UMLS CUI-1)
(Comment:en)
CL Item
Slightly bothered (2)
C3831310 (UMLS CUI-1)
(Comment:en)
CL Item
Somewhat bothered (3)
C3831293 (UMLS CUI-1)
(Comment:en)
CL Item
Very bothered (4)
C3831292 (UMLS CUI-1)
(Comment:en)
CL Item
Extremely bothered (5)
C3830278 (UMLS CUI-1)
(Comment:en)
Item
Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)? - Gas and bloating
integer
C0946092 (UMLS CUI [1,1])
C3174324 (UMLS CUI [1,2])
Code List
Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)? - Gas and bloating
CL Item
Not at all bothered (1)
C3828778 (UMLS CUI-1)
(Comment:en)
CL Item
Slightly bothered (2)
C3831310 (UMLS CUI-1)
(Comment:en)
CL Item
Somewhat bothered (3)
C3831293 (UMLS CUI-1)
(Comment:en)
CL Item
Very bothered (4)
C3831292 (UMLS CUI-1)
(Comment:en)
CL Item
Extremely bothered (5)
C3830278 (UMLS CUI-1)
(Comment:en)
Item
Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)? - Diarrhea
integer
C0011991 (UMLS CUI [1,1])
C3174324 (UMLS CUI [1,2])
Code List
Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)? - Diarrhea
CL Item
Not at all bothered (1)
C3828778 (UMLS CUI-1)
(Comment:en)
CL Item
Slightly bothered (2)
C3831310 (UMLS CUI-1)
(Comment:en)
CL Item
Somewhat bothered (3)
C3831293 (UMLS CUI-1)
(Comment:en)
CL Item
Very bothered (4)
C3831292 (UMLS CUI-1)
(Comment:en)
CL Item
Extremely bothered (5)
C3830278 (UMLS CUI-1)
(Comment:en)
Item
Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)? - Symptoms of low blood sugar (trembling, sweating, dizziness or blurred vision)
integer
C1457887 (UMLS CUI [1,1])
C0020615 (UMLS CUI [1,2])
C3174324 (UMLS CUI [1,3])
Code List
Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)? - Symptoms of low blood sugar (trembling, sweating, dizziness or blurred vision)
CL Item
Not at all bothered (1)
C3828778 (UMLS CUI-1)
(Comment:en)
CL Item
Slightly bothered (2)
C3831310 (UMLS CUI-1)
(Comment:en)
CL Item
Somewhat bothered (3)
C3831293 (UMLS CUI-1)
(Comment:en)
CL Item
Very bothered (4)
C3831292 (UMLS CUI-1)
(Comment:en)
CL Item
Extremely bothered (5)
C3830278 (UMLS CUI-1)
(Comment:en)
Item
Over the past two weeks, how DISSATISFIED or SATISFIED have you been with the ability of your diabetes medication(s) to ... keep your blood sugar levels stable (avoids highs and lows)?
integer
C0392201 (UMLS CUI [1,1])
C0205360 (UMLS CUI [1,2])
C0086715 (UMLS CUI [1,3])
C0242428 (UMLS CUI [1,4])
Code List
Over the past two weeks, how DISSATISFIED or SATISFIED have you been with the ability of your diabetes medication(s) to ... keep your blood sugar levels stable (avoids highs and lows)?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item
Over the past two weeks, how DISSATISFIED or SATISFIED have you been with the ability of your diabetes medication(s) to ... help you from feeling tired and lacking energy?
integer
C0015672 (UMLS CUI [1,1])
C0242428 (UMLS CUI [1,2])
Code List
Over the past two weeks, how DISSATISFIED or SATISFIED have you been with the ability of your diabetes medication(s) to ... help you from feeling tired and lacking energy?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item
Overall over the past two weeks, how DISSATISFIED or SATISFIED have you been with ... the ease and convenience of your diabetes medications
integer
C3831015 (UMLS CUI [1,1])
C0242428 (UMLS CUI [1,2])
Code List
Overall over the past two weeks, how DISSATISFIED or SATISFIED have you been with ... the ease and convenience of your diabetes medications
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item
Overall over the past two weeks, how DISSATISFIED or SATISFIED have you been with ... the impact of your diabetes medication(s) on your physical well being?
integer
C0018684 (UMLS CUI [1,1])
C0242428 (UMLS CUI [1,2])
Code List
Overall over the past two weeks, how DISSATISFIED or SATISFIED have you been with ... the impact of your diabetes medication(s) on your physical well being?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item
Overall over the past two weeks, how DISSATISFIED or SATISFIED have you been with ... the impact of your diabetes medication(s) on your emotional well being?
integer
C0025353 (UMLS CUI [1,1])
C0242428 (UMLS CUI [1,2])
Code List
Overall over the past two weeks, how DISSATISFIED or SATISFIED have you been with ... the impact of your diabetes medication(s) on your emotional well being?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item
Thinking about your diabetes medication(s) over the past two weeks ... how difficult has it been for your to plan your daily activities around your medication(s)?
integer
C0001288 (UMLS CUI [1,1])
C0013216 (UMLS CUI [1,2])
Code List
Thinking about your diabetes medication(s) over the past two weeks ... how difficult has it been for your to plan your daily activities around your medication(s)?
Item
Thinking about your diabetes medication(s) over the past two weeks ... how much burden has it been for you to take your medication(s) as prescribed?
integer
C2828008 (UMLS CUI [1,1])
C0013216 (UMLS CUI [1,2])
Code List
Thinking about your diabetes medication(s) over the past two weeks ... how much burden has it been for you to take your medication(s) as prescribed?
Item
Thinking about your diabetes medication(s) over the past two weeks ... how embarrassed or awkward have you felt of taking your medication(s) as prescribed?
integer
C3174033 (UMLS CUI [1,1])
C0013216 (UMLS CUI [1,2])
Code List
Thinking about your diabetes medication(s) over the past two weeks ... how embarrassed or awkward have you felt of taking your medication(s) as prescribed?
Item
Thinking about your diabetes medication(s) over the past two weeks ... how worries have you been that your medication(s) is not helping you to slow down or prevent long-term complications?
integer
C0850735 (UMLS CUI [1,1])
C0013216 (UMLS CUI [1,2])
Code List
Thinking about your diabetes medication(s) over the past two weeks ... how worries have you been that your medication(s) is not helping you to slow down or prevent long-term complications?
Item
Over the past two weeks, how often has taking your diabetes medication(s) as prescribed INTERFERED WITH your ability to... be flexible with planning meals (when you eat and what you are able to eat)?
integer
C0013216 (UMLS CUI [1,1])
C1998602 (UMLS CUI [1,2])
Code List
Over the past two weeks, how often has taking your diabetes medication(s) as prescribed INTERFERED WITH your ability to... be flexible with planning meals (when you eat and what you are able to eat)?
Item
Over the past two weeks, how often has taking your diabetes medication(s) as prescribed INTERFERED WITH your ability to... do your recommended physical activity or exercise?
integer
C0013216 (UMLS CUI [1,1])
C0015259 (UMLS CUI [1,2])
Code List
Over the past two weeks, how often has taking your diabetes medication(s) as prescribed INTERFERED WITH your ability to... do your recommended physical activity or exercise?
Item
Over the past two weeks, how often has taking your diabetes medication(s) as prescribed INTERFERED WITh your ability to... follow your recommended diet?
integer
C0013216 (UMLS CUI [1,1])
C0012155 (UMLS CUI [1,2])
Code List
Over the past two weeks, how often has taking your diabetes medication(s) as prescribed INTERFERED WITh your ability to... follow your recommended diet?
Item
Overall, thinking about each of the aspects of your diabetes medication(s) as mentioned above, how DISSATISFIED or SATISFIED have you been with your current diabetes medication(s)?
integer
C0242428 (UMLS CUI [1,1])
C0013216 (UMLS CUI [1,2])
Code List
Overall, thinking about each of the aspects of your diabetes medication(s) as mentioned above, how DISSATISFIED or SATISFIED have you been with your current diabetes medication(s)?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item
Overall, based on your current experiences with your diabetes medication(s), how INTERESTED would you be to change the type of medication(s) you take or the way you take it, if it was possible?
integer
C0013216 (UMLS CUI [1,1])
C0580105 (UMLS CUI [1,2])
Code List
Overall, based on your current experiences with your diabetes medication(s), how INTERESTED would you be to change the type of medication(s) you take or the way you take it, if it was possible?
CL Item
Not at all interested (1)
CL Item
Slightly interested (2)
CL Item
Somewhat interested (3)
CL Item
Very interested (4)
CL Item
Extremely interested (5)
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