Screening and Assessment Minimum Data Elements (MDEs)

Well-Integrated Screening and Evaluation for Women Across the Nation(WISEWOMAN) Reporting System

Attachment 3. ScreeningAssessmentMDE_v700

Screening and Assessment Minimum Data Elements (MDEs)

OMB: 0920-0612

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Screening and Assessment MDE
Field Descriptions





Data User’s Manual

Version 7.00

July 2008


Part A: Screening and Assessment MDE Field Descriptions


Name

Type

Location

0. MDE Version




a. MDE Version

MDEVer

Numeric

1-3

1. Screening Location




a. State/Tribal FIPS Code

StFIPS

Character

4-5

b. FIPS County Code (Provider)

HdFIPS

Character

6-8

c. Enrollment Site ID

EnrollSiteID

Character

9-13

d. Screening Site ID

ScreenSiteID

Character

14-18

2. Record Identification




a. Unique Screening Record ID Number

NRec

Numeric

19-24

b. Disposition Status

Disp

Numeric

25

3. Participant Information




a. Unique Participant ID Number

EncodeID

Character

26-40

b. County of Residence

CntyFIPS

Character

41-43

c. ZIP Code of Residence

ZIP

Character

44-48

d. Date of Birth

DOB

Numeric

49-56

e. Hispanic or Latino Origin

Latino

Numeric

57

f. First Race Listed

Race1

Numeric

58

g. Second Race Listed

Race2

Numeric

59

h. Third Race Listed

Race3

Numeric

60

i. Fourth Race Listed

Race4

Numeric

61

j. Fifth Race Listed

Race5

Numeric

62

k. Sixth Race Listed

Race6

Numeric

63

l. Education (highest grade completed)

Education

Numeric

64-65

4. Assessment Date




a. Assessment Date

AssessDate

Numeric

66-73

5. Assessment Information: Health History




a. Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?

SRHC

Numeric

74

b. Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?

SRHB

Numeric

75

c. Have you ever been told by a doctor, nurse, or other health professional that you have diabetes?

SRD

Numeric

76

d. Has a doctor, nurse, or other health professional ever told you that you had any of the following: heart attack (also called myocardial infarction), angina, coronary heart disease, or stroke?

SRHA

Numeric

77

6. Assessment Information: Family Health History



a. Has your father, brother, or son had a stroke or heart attack before age 55?

FAMHAM

Numeric

78

b. Has your mother, sister, or daughter had a stroke or heart attack before age 65?

FAMHAF

Numeric

79

c. Has either of your parents, your brother or sister, or your child ever been told by a doctor, nurse, or other health professional that he or she has diabetes?

FAMD

Numeric

80

7. Assessment Information: Medication Status




a. Are you currently taking medication for high cholesterol?

HCMeds

Numeric

81

b. Are you currently taking medication for high blood pressure?

HBPMeds

Numeric

82

c. Are you currently taking medication for diabetes?

DMeds

Numeric

83

8. Assessment Information: Smoking Status




a. Do you now smoke cigarettes?

Smoker

Numeric

84

9. Screening Information: Anthropometrics




a. Height and Weight Measurement Date

WeightDate

Numeric

85-92

b. Height

Height

Numeric

93-95

c. Height Unit

Hgt_Unit

Numeric

96

d. Weight

Weight

Numeric

97-99

e. Weight Unit

Wgt_Unit

Numeric

100

10. Screening Information: Blood Pressure




a. Blood Pressure Measurement Date

BPDate

Numeric

101-108

b. Systolic #1, mm Hg

SBP1

Numeric

109-111

c. Diastolic #1, mm Hg

DBP1

Numeric

112-114

d. Systolic #2, mm Hg

SBP2

Numeric

115-117

e. Diastolic #2, mm Hg

DBP2

Numeric

118-120

11. Screening Information: Blood Cholesterol




a. Cholesterol Measurement Date

TCDate

Numeric

121-128

b. Total Cholesterol (fasting or nonfasting), mg/dl

TotChol

Numeric

129-131

c. HDL Cholesterol (fasting or nonfasting), mg/dl

HDL

Numeric

132-134

d. LDL Cholesterol (fasting only), mg/dl

LDL

Numeric

135-137

e. Triglycerides (fasting only), mg/dl

Trigly

Numeric

138-141

f. Fasting Status for cholesterol measurement (at least 9 hours)

TCFast

Numeric

142

12. Screening Information: Blood Glucose




a. Glucose Measurement Date

BGDate

Numeric

143-150

b. Glucose (fasting or nonfasting), mg/dl

Glucose

Numeric

151-153

c. Fasting status for glucose (at least 8 hours)

BGFast

Numeric

154

d. A1C, %

A1C

Numeric

155-158

13. Workup: Alert Follow-up




a. If average SBP180 or DBP>110, what is the status of the workup?

BPAlert

Numeric

159

b. If average SBP180 or DBP>110, diagnostic exam date.

BPDiDate

Numeric

160-167

c. If average SBP180 or DBP>110, what type of treatment was prescribed?

BPTreat

Numeric

168

d. If TOTCHOL400, what is the status of the workup?

TCAlert

Numeric

169

e. If TOTCHOL400, diagnostic exam date.

TCDiDate

Numeric

170-177

f. If TOTCHOL400, what type of treatment was prescribed?

TCTreat

Numeric

178

g. If GLUCOSE375, what is the status of the workup?

BGAlert

Numeric

179

h. If GLUCOSE375, diagnostic exam date.

BGDiDate

Numeric

180-187

i. If GLUCOSE375, what type of treatment was prescribed?

BGTreat

Numeric

188


Part B: Screening and Assessment MDE Field Descriptions

Section 0: MDE Version

Item

0a: MDE Version

Purpose

To specify the version of the MDE that was used to construct the file.

Name

MDEVer

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

1

Edits

Cannot be blank.

Contents

700 Version 7.00

Explanation

Enter the version of the MDE that was used to construct the files.

Example

MDE version 7.00: 700

Section 1: Screening Location

Item

1a: State/Tribal FIPS Code (Provider)

Purpose

To specify the FIPS or Tribal Program code for the State or Tribe where screening occurred.

Name

StFIPS

Length

2

Type

Character

Justification

Left

Leading Zeros

Yes

Beginning Position

4

Edits

Valid FIPS State/Tribal code; cannot be blank.

Contents

06 California (CA)


09 Connecticut (CT)


17 Illinois (IL)


19 Iowa (IA)


25 Massachusetts (MA)


26 Michigan (MI)


27 Minnesota (MN)


29 Missouri (MO)


31 Nebraska (NE)


37 North Carolina (NC)


41 Oregon (OR)


42 Pennsylvania (PA)


45 South Carolina (SC)


46 South Dakota (SD)


49 Utah (UT)


50 Vermont (VT)


51 Virginia (VA)


54 West Virginia (WV)


55 Wisconsin (WI)


85 Southeast Alaska Region Health Consortium (SEARHC)


92 Southcentral Foundation (SCF)

Explanation

The State FIPS codes are the Federal Information Processing Standard codes developed by the National Bureau of Standards. The Tribal Program codes are codes assigned by CDC to be used by the Tribal Programs in lieu of FIPS.

Example

Connecticut: 09

Section 1: Screening Location

Item

1b: FIPS County Code (Provider)

Purpose

To specify the FIPS code for the county of the primary screening provider.

Name

HdFIPS

Length

3

Type

Character

Justification

Left

Leading Zeros

Yes

Beginning Position

6

Edits

Valid FIPS county code; cannot be blank (except for States without counties or Tribal Programs).

Contents

Explanation

This is the FIPS county code of the primary screening provider. The county FIPS codes are the Federal Information Processing Standard codes developed by the National Bureau of Standards. There are 3-digit codes for each county in a State. If you need a list of these codes for your State, CDC can supply it.



For States without counties and Tribal Programs, enter blank.

Example

Alameda County, CA: 001

Section 1: Screening Location

Item

1c: Enrollment Site ID

Purpose

To specify the point of enrollment into the program.

Name

EnrollSiteID

Length

5

Type

Character

Justification

Left

Leading Zeros

n/a

Beginning Position

9

Edits

Valid code for the enrollment site; cannot be blank.

Contents

Explanation

This is the point of enrollment of the participant to the program. The intent is to identify the center that is administratively responsible for the care and tracking of a participant.

Example

Cedar Clinic: 00025

Section 1: Screening Location

Item

1d: Screening Site ID

Purpose

To specify the site where the participant received her screening.

Name

ScreenSiteID

Length

5

Type

Character

Justification

Left

Leading Zeros

n/a

Beginning Position

14

Edits

Valid code for the screening site; cannot be blank.

Contents

Explanation

This is the site at which the participant is screened.

Example

Cedar Clinic: 00025

Section 2: Record Identification

Item

2a: Unique Screening Record ID Number

Purpose

To uniquely identify records within the file.

Name

NRec

Length

6

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

19

Edits

Cannot be blank.

Contents

Explanation

The record ID number is unique and is a sequence number from 1 to the number of records in the file.

Example

Sequence number: 254

Section 2: Record Identification

Item

2b: Disposition Status

Purpose

To indicate whether the record is complete and can be processed.

Name

Disp

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

25

Edits

Valid range; cannot be blank.

Contents

1 Open (additional data expected)


2 Closed (complete)

Explanation

Identifies partially complete records. Refers only to screening variables associated with the particular screening visit captured in the record. Only closed records (Disp=2) will be processed. Records from the last 6 months of the reporting period only can remain open (i.e., all records older than 6 months must be closed regardless of data completion).

Example

Closed: 2

Section 3: Participant Information

Item

3a: Unique Participant ID Number

Purpose

To uniquely identify a participant.

Name

EncodeID

Length

15

Type

Character

Justification

Left

Leading Zeros

n/a

Beginning Position

26

Edits

Cannot be blank.

Contents

Explanation

If Social Security number is used, encode it. One simple method is to rearrange the order of the 9 digits. The ID number is unique and constant for each participant in order to track the participant over time. WISEWOMAN uses the NBCCEDP ID number.

Example

ID: 1234567890

Section 3: Participant Information

Item

3b: County of Residence

Purpose

To specify the county of residence of the participant.

Name

CntyFIPS

Length

3

Type

Character

Justification

Left

Leading Zeros

Yes

Beginning Position

41

Edits

Valid county FIPS code; can be blank if ZIP code of residence is provided.

Contents

Explanation

If unknown, leave blank. Not required if ZIP code of residence is provided.

This field must be imported from the NBCCEDP data.

Example

Alameda County, CA: 001

Section 3: Participant Information

Item

3c: ZIP Code of Residence

Purpose

To specify the ZIP code of residence.

Name

ZIP

Length

5

Type

Character

Justification

Left

Leading Zeros

Yes

Beginning Position

44

Edits

Valid ZIP code, cannot be blank.

Contents

ZIP code

77777 Suppressed (ZIP code was provided but suppressed for the MDE submission because fewer than five WISEWOMAN participants live in the ZIP code).

99999 No ZIP code recorded

Explanation

Required even if county of residence is provided.


Zip codes with fewer than five participants may be collapsed with the neighboring ZIP codes or suppressed before submitting to RTI; however, collapsing or suppressing the codes is not required.

This field must be imported from the NBCCEDP data; missing values must be recoded using the values presented in the Contents.

Example

ZIP code: 27608

Section 3: Participant Information

Item

3d: Date of Birth

Purpose

To specify the date of birth of the participant.

Name

DOB

Length

8

Type

Numeric

Justification

Right

Leading Zeros

Yes

Beginning Position

49

Edits

Cannot be blank.

Contents

MMDDCCYY Date

Explanation

Age is computed using the date of birth and the screening date. A participant must be aged 40–64 at the time of the screening unless approval has been given by CDC to screen women younger than 40 years old. Refer to Attachment 6 for the verification procedure for participants who are 65 and older but are still eligible for the program.

This field must be imported from the NBCCEDP data.

Example

January 3, 1950: 01031950

Section 3: Participant Information

Item

3e: Hispanic or Latino Origin

Purpose

To indicate whether the participant is of Hispanic or Latino origin.

Name

Latino

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

57

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


7 Unknown

9 No answer recorded

Explanation

Indicate whether the participant is of Hispanic or Latino origin. This field must be imported from the NBCCEDP data; missing values must be recoded using the values presented in the Contents.

Example

Hispanic: 1

Section 3: Participant Information

Item

3f: First Race Listed

Purpose

To specify the race of the participant.

Name

Race1

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

58

Edits

Valid range, cannot be blank.

Contents

1 White


2 Black or African American


3 Asian


4 Native Hawaiian or Other Pacific Islander


5 American Indian or Alaska Native


7 Unknown


9 No answer recorded

Explanation

Race must be recorded. The First Race field must be populated first. If a participant self-identifies more than one race, then each race identified must be reported in a separate field.



This field must be imported from the NBCCEDP data; missing values must be recoded using the values presented in the Contents. If your NBCCEDP program collects ‘Other’ as a race category, it must be exported to ‘7 Unknown’ in the WISEWOMAN MDEs.


Example

White: 1

Section 3: Participant Information

Item

3g: Second Race Listed

Purpose

To specify the race of the participant.

Name

Race2

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

59

Edits

Valid range, cannot be blank.

Contents

1 White


2 Black or African American


3 Asian


4 Native Hawaiian or Other Pacific Islander


5 American Indian or Alaska Native


7 Unknown


9 No answer recorded

Explanation

This field must be coded as 9 (no answer recorded), unless participant reports more than one race.



This field must be imported from the NBCCEDP data; missing values must be recoded using the values presented in the Contents. If your NBCCEDP program collects ‘Other’ as a race category, it must be exported to ‘7 Unknown’ in the WISEWOMAN MDEs.

Example

Black: 2

Section 3: Participant Information

Item

3h: Third Race Listed

Purpose

To specify the race of the participant.

Name

Race3

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

60

Edits

Valid range, cannot be blank

Contents

1 White


2 Black or African American


3 Asian


4 Native Hawaiian or Other Pacific Islander


5 American Indian or Alaska Native


7 Unknown


9 No answer recorded

Explanation

This field must be coded as 9 (no answer recorded), unless participant reports more than two races.



This field must be imported from the NBCCEDP data; missing values must be recoded using the values presented in the Contents. If your NBCCEDP program collects ‘Other’ as a race category, it must be exported to ‘7 Unknown’ in the WISEWOMAN MDEs.

Example

Asian: 3

Section 3: Participant Information

Item

3i: Fourth Race Listed

Purpose

To specify the race of the participant.

Name

Race4

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

61

Edits

Valid range, cannot be blank

Contents

1 White


2 Black or African American


3 Asian


4 Native Hawaiian or Other Pacific Islander


5 American Indian or Alaska Native


7 Unknown


9 No answer recorded

Explanation

This field must be coded as 9 (no answer recorded), unless participant reports more than three races.



This field must be imported from the NBCCEDP data; missing values must be recoded using the values presented in the Contents. If your NBCCEDP program collects ‘Other’ as a race category, it must be exported to ‘7 Unknown’ in the WISEWOMAN MDEs.

Example

Native Hawaiian: 4

Section 3: Participant Information

Item

3j: Fifth Race Listed

Purpose

To specify the race of the participant.

Name

Race5

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

62

Edits

Valid range, cannot be blank.

Contents

1 White


2 Black or African American


3 Asian


4 Native Hawaiian or Other Pacific Islander


5 American Indian or Alaska Native


7 Unknown


9 No answer recorded

Explanation

This field must be coded as 9 (no answer recorded), unless participant reports more than four races.



This field must be imported from the NBCCEDP data; missing values must be recoded using the values presented in the Contents. If your NBCCEDP program collects ‘Other’ as a race category, it must be exported to ‘7 Unknown’ in the WISEWOMAN MDEs.

Example

American Indian: 5

Section 3: Participant Information

Item

3k: Sixth Race Listed

Purpose

To specify the race of the participant.

Name

Race6

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

63

Edits

Valid range, cannot be blank

Contents

1 White


2 Black or African American


3 Asian


4 Native Hawaiian or Other Pacific Islander


5 American Indian or Alaska Native


7 Unknown


9 No answer recorded

Explanation

This field must be coded as 9 (no answer recorded), unless participant reports more than five races.



This field must be imported from the NBCCEDP data; missing values must be recoded using the values presented in the Contents. If your NBCCEDP program collects ‘Other’ as a race category, it must be exported to ‘7 Unknown’ in the WISEWOMAN MDEs.

Example

No answer recorded: 9

Section 3: Participant Information

Item

3l: Education (highest grade completed)

Purpose

To specify the highest grade the participant completed.

Name

Education

Length

2

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

64

Edits

Valid range

Contents

1 < 9th


2 Some high school


3 High school graduate or equivalent


4 Some college or higher


7 Don’t know


8 Don’t want to answer


9 No answer recorded

Explanation

Record the code for the highest grade the participant completed.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Some college: 4

Section 4: Assessment Date

Item

4a: Assessment Date

Purpose

To specify the date that the assessment questions on health history, family health history, medication status, and smoking status were asked of the participant.

Name

AssessDate

Length

8

Type

Numeric

Justification

Right

Leading Zeros

Yes

Beginning Position

66

Edits

AssessDate=WeightDate=BPDate

AssessDate<=TCDate, BGDate

Must be blank if SRHC, SRHB, SRD, SRHA, FAMHAM, FAMHAF, FAMD, HCMeds, HBPMeds, DMeds, and Smoker = 9.


Contents

MMDDCCYY Date

Explanation

The assessment must be completed on the same date as the height/weight measurements and the blood pressure measurements. It must also be completed on the same date or before the cholesterol measurement date and the glucose measurement date.

Example

January 3, 2009: 01032009

Section 5: Assessment Information: Health History

Item

5a: Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?

Purpose

To determine whether the participant has been told she has high cholesterol.

Name

SRHC

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

74

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant has ever been told she has high blood cholesterol.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Has not been told: 2

Section 5: Assessment Information: Health History

Item

5b: Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?

Purpose

To determine whether the participant has been told she has high blood pressure.

Name

SRHB

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

75

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant has ever been told she has high blood pressure.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Does not know whether she has been told: 7

Section 5: Assessment Information: Health History

Item

5c: Have you ever been told by a doctor, nurse, or other health professional that you have diabetes?

Purpose

To determine whether the participant has been told she has diabetes.

Name

SRD

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

76

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant has ever been told she has diabetes.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Has been told: 1

Section 5: Assessment Information: Health History

Item

5d: Has a doctor, nurse, or other health professional ever told you that you had any of the following: heart attack (also called myocardial infarction), angina, coronary heart disease, or stroke?

Purpose

To determine whether the participant has been told she had a heart attack angina, coronary heart disease, or a stroke.

Name

SRHA

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

77

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant has ever been told she had a heart attack (also called myocardial infarction), angina, coronary heart disease, or a stroke.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Does not want to answer: 8

Section 6: Assessment Information: Family Health History

Item

6a: Has your father, brother, or son had a stroke or heart attack before age 55?

Purpose

To determine family history of stroke or heart attack.

Name

FAMHAM

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

78

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant’s father, brother, or son had a stroke or heart attack before age 55.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Father had a heart attack before 55: 1

Section 6: Assessment Information: Family Health History

Item

6b: Has your mother, sister, or daughter had a stroke or heart attack before age 65?

Purpose

To determine family history of stroke or heart attack.

Name

FAMHAF

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

79

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant’s mother, sister, or daughter had a stroke or heart attack before age 65.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

None of the listed relatives had a stroke or heart attack before 65: 2

Section 6: Assessment Information: Family Health History

Item

6c: Has either of your parents, your brother or sister, or your child ever been told by a doctor, nurse or other health professional that he or she has diabetes?

Purpose

To determine family history of diabetes.

Name

FAMD

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

80

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant’s parents, siblings, or children have been told that they have diabetes.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Does not know: 7

Section 7: Assessment Information: Medication Status

Item

7a: Are you currently taking medication for high cholesterol?

Purpose

To determine whether the participant is taking medication for high cholesterol.

Name

HCMeds

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

81

Edits

Valid range; cannot be blank.

Contents

1 Yes, as prescribed

2 Yes, but did not take today


3 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant is currently taking medication for high cholesterol.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Taking medication as prescribed: 1

Section 7: Assessment Information: Medication Status

Item

7b: Are you currently taking medication for high blood pressure?

Purpose

To determine whether the participant is taking medication for high blood pressure.

Name

HBPMeds

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

82

Edits

Valid range; cannot be blank.

Contents

1 Yes, as prescribed

2 Yes, but did not take today


3 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant is currently taking medication for high blood pressure.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Taking medication but skipped today’s dose: 2

Section 7: Assessment Information: Medication Status

Item

7c: Are you currently taking medication for diabetes?

Purpose

To determine whether the participant is taking medication for diabetes.

Name

DMeds

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

83

Edits

Valid range; cannot be blank.

Contents

1 Yes, as prescribed

2 Yes, but did not take today


3 No


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant is currently taking medication for diabetes.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Does not know: 7

Section 8: Assessment Information: Smoking Status

Item

8a: Do you now smoke cigarettes?

Purpose

To determine whether the participant smokes cigarettes.

Name

Smoker

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

84

Edits

Valid range; cannot be blank.

Contents

1 Every day


2 Some days


3 Not at all


7 Don’t know

8 Don’t want to answer

9 No answer recorded

Explanation

Indicate whether the participant is now smoking cigarettes.

Codes and response options highlighted in grey should not appear on the data collection form presented to the participant.

Example

Does not smoke cigarettes: 3

Section 9: Screening Information: Anthropometrics

Item

9a: Height and Weight Measurement Date

Purpose

To specify the date that the height and weight measurements were taken.

Name

WeightDate

Length

8

Type

Numeric

Justification

Right

Leading Zeros

Yes

Beginning Position

85

Edits

AssessDate=WeightDate=BPDate

Must be blank if Height and Weight =999

Contents

MMDDCCYY Date

Explanation

The height/weight measurements must be taken on the same date as the assessment.

Example

January 3, 2009: 01032009

Section 9: Screening Information: Anthropometrics

Item

9b: Height

Purpose

To specify the participant’s height.

Name

Height

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

93

Edits

041–092 inches, 104–234 centimeters; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

777 Unable to obtain

888 Client refused

999 No measurement recorded

Explanation

Record the height of the participant.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Height of 5 feet 6 inches: 66

Section 9: Screening Information: Anthropometrics

Item

9c: Height Unit

Purpose

To specify the unit used to report the participant’s height.

Name

Hgt_Unit

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

96

Edits

Valid range. Must be blank if height=777 or 888 or 999.

Contents

1 Inches


2 Centimeters

Explanation

Record the unit of measure used for height.

Example

Inches: 1

Section 9: Screening Information: Anthropometrics

Item

9d: Weight

Purpose

To specify the weight of the participant.

Name

Weight

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

97

Edits

065–460 pounds, 029–209 kilograms; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

777 Unable to obtain

888 Client refused

999 No measurement recorded

Explanation

Record the weight of the participant.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Weight in kilograms: 50

Section 9: Screening Information: Anthropometrics

Item

9e: Weight Unit

Purpose

To specify the unit used to report the participant’s weight.

Name

Wgt_Unit

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

100

Edits

Valid range. Must be blank if weight=777 or 888 or 999.

Contents

1 Pounds


2 Kilograms

Explanation

Record the unit of measure used for weight.

Example

Weight in kilograms: 2

Section 10: Screening Information: Blood Pressure

Item

10a: Blood Pressure Measurement Date

Purpose

To specify the date that the blood pressure measurements were taken.

Name

BPDate

Length

8

Type

Numeric

Justification

Right

Leading Zeros

Yes

Beginning Position

101

Edits

AssessDate=WeightDate=BPDate

Must be blank if SBP1, DBP1, SBP2, and DBP2 = 999

Contents

MMDDCCYY Date

Explanation

The blood pressure measurements must be taken on the same date as the assessment.

Example

January 3, 2009: 01032009

Section 10: Screening Information: Blood Pressure

Item

10b: Systolic #1, mm Hg

Purpose

To specify the participant’s first systolic blood pressure reading.

Name

SBP1

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

109

Edits

074–260; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

777 Unable to obtain

888 Client refused

999 No measurement recorded

Explanation

Record the first systolic blood pressure reading.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Systolic blood pressure: 90

Section 10: Screening Information: Blood Pressure

Item

10c: Diastolic #1, mm Hg

Purpose

To specify the participant’s first diastolic blood pressure reading.

Name

DBP1

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

112

Edits

002–156; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

777 Unable to obtain

888 Client refused

999 No measurement recorded

Explanation

Record the first diastolic blood pressure reading.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Diastolic blood pressure: 90

Section 10: Screening Information: Blood Pressure

Item

10d: Systolic #2, mm Hg

Purpose

To specify the participant’s second systolic blood pressure.

Name

SBP2

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

115

Edits

074–260, cannot be blank

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

777 Unable to obtain

888 Client refused

999 No measurement recorded

Explanation

Record the second systolic blood pressure reading.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Systolic blood pressure: 150

Section 10: Screening Information: Blood Pressure

Item

10e: Diastolic #2, mm Hg

Purpose

To specify the participant’s second diastolic blood pressure

Name

DBP2

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

118

Edits

002–156, cannot be blank

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

777 Unable to obtain

888 Client refused

999 No measurement recorded

Explanation

Record the second diastolic blood pressure reading.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Diastolic blood pressure: 80

Section 11: Screening Information: Blood Cholesterol

Item

11a: Cholesterol Measurement Date

Purpose

To specify the date that the blood cholesterol measurements were taken.

Name

TCDate

Length

8

Type

Numeric

Justification

Right

Leading Zeros

Yes

Beginning Position

121

Edits

AssessDate<=TCDate, BGDate

Must be blank if TotChol, HDL, and LDL=999 and Trigly=9999.

Contents

MMDDCCYY Date

Explanation

The blood cholesterol measurements must be taken on the same date as or after the assessment.

At minimum, every participant must have a total cholesterol and HDL cholesterol value recorded. If the participant was fasting and had a lipid panel completed at the baseline or rescreening visit, then LDL and triglyceride values must also be recorded in addition to total and HDL cholesterol. The date recorded in this field must be the date that the total and HDL cholesterol values were taken. If a lipid panel was completed as part of the baseline or rescreening visit, the date of the lipid panel must be recorded (as it would be the same as the date the total and HDL cholesterol were measured).

Example

January 3, 2009: 01032009

Section 11: Screening Information: Blood Cholesterol

Item

11b: Total Cholesterol (fasting or nonfasting), mg/dl

Purpose

To specify the participant’s total cholesterol.

Name

TotChol

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

129

Edits

059–702; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

777 Inadequate blood sample

888 Client refused

999 No measurement recorded

Explanation

Record the participant’s total cholesterol. Total cholesterol measurement may be taken as fasting or nonfasting. At minimum, every participant must have a total cholesterol and HDL cholesterol value recorded. If the participant was fasting and had a lipid panel completed at the baseline or rescreening visit, then LDL and triglyceride values must also be recorded in addition to total and HDL cholesterol.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Total cholesterol: 230

Section 11: Screening Information: Blood Cholesterol

Item

11c: HDL Cholesterol (nonfasting), mg/dl

Purpose

To specify the participant’s HDL cholesterol.

Name

HDL

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

132

Edits

008–196; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

777 Inadequate blood sample

888 Client refused

999 No measurement recorded

Explanation

Record the participant’s HDL cholesterol. HDL cholesterol measurement may be taken as fasting or nonfasting. At minimum, every participant must have a total cholesterol and HDL cholesterol value recorded. If the participant was fasting and had a lipid panel completed at the baseline or rescreening visit then LDL and triglyceride values must also be recorded in addition to total and HDL cholesterol.



Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.


Example

HDL cholesterol: 55

Section 11: Screening Information: Blood Cholesterol

Item

11d: LDL Cholesterol (fasting only), mg/dl

Purpose

To specify participant’s LDL cholesterol if a fasting LDL measurement was taken.

Name

LDL

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

135

Edits

20–380; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

777 Inadequate blood sample

888 Client refused

999 No measurement recorded

Explanation

If taken, record the participant’s LDL cholesterol reading. LDL cholesterol must be a fasting measurement. At minimum, every participant must have a total cholesterol and HDL cholesterol value recorded. If the participant was fasting and had a lipid panel completed at the baseline or rescreening visit, then LDL and triglyceride values must also be recorded in addition to total and HDL cholesterol.



Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

LDL cholesterol: 150

Section 11: Screening Information: Blood Cholesterol

Item

11e: Triglycerides (fasting only), mg/dl

Purpose

To specify participant’s triglycerides if a fasting triglycerides measurement was taken.

Name

Trigly

Length

4

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

138

Edits

13–3616; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

7777 Inadequate blood sample

8888 Client refused

9999 No measurement recorded

Explanation

If taken, record the participant’s triglycerides reading. Triglycerides must be a fasting measurement. At minimum, every participant must have a total cholesterol and HDL cholesterol value recorded. If the participant was fasting and had a lipid panel completed at the baseline or rescreening visit, then LDL and triglyceride values must also be recorded in addition to total and HDL cholesterol.



Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Triglycerides: 350

Section 11: Screening Information: Blood Cholesterol

Item

11f: Fasting status for cholesterol measurements (at least 9 hours)

Purpose

To indicate whether the participant fasted for at least 9 hours prior to having blood drawn for cholesterol measurements.

Name

TCFast

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

142

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


6 No cholesterol results available (inadequate blood sample, client refused, or no measurement recorded for total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides)


7 Don’t know

8 Client refused

9 No answer recorded

Explanation

Indicate whether the participant fasted for at least 9 hours prior to having blood drawn for cholesterol measurements.

At minimum, every participant must have a total cholesterol and HDL cholesterol value recorded. If the participant was fasting and had a lipid panel completed at the baseline or rescreening visit, then LDL and triglyceride values must also be recorded in addition to total and HDL cholesterol.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Fasted for at least 9 hours: 1

Section 12: Screening Information: Blood Glucose

Item

12a: Glucose Measurement Date

Purpose

To specify the date that the blood glucose measurement was taken.

Name

BGDate

Length

8

Type

Numeric

Justification

Right

Leading Zeros

Yes

Beginning Position

143

Edits

AssessDate<=TCDate, BGDate

Must be blank if Glucose=999 and A1C=9999

Contents

MMDDCCYY Date

Explanation

The blood glucose measurement must be taken on the same date or after the assessment.

If A1C was measured instead of glucose, the date of the A1C reading must be recorded in this field.

Example

January 3, 2009: 01032009

Section 12: Screening Information: Blood Glucose

Item

12b: Glucose (fasting or nonfasting), mg/dl

Purpose

To specify the participant’s glucose measurement.

Name

Glucose

Length

3

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

151

Edits

37–571; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

666 Participant has a previous diagnosis of diabetes (SRD=1 or DMEDS=1 or 2); glucose reading not necessary

777 Inadequate blood sample

888 Client refused

999 No measurement recorded

Explanation

Record the participant’s glucose reading. The glucose measurement may be fasting or nonfasting.

Participants previously diagnosed with diabetes (defined as SRD=1 or DMEDS=1 or 2) should receive an A1C test instead of the glucose.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Blood Glucose: 110

Section 12: Screening Information: Blood Glucose

Item

12c: Fasting status for glucose measurement (at least 8 hours)

Purpose

To indicate whether the participant fasted for at least 8 hours prior to having blood drawn for the glucose reading.

Name

BGFast

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

154

Edits

Valid range; cannot be blank.

Contents

1 Yes


2 No


6 No glucose results available (previously diagnosed diabetes, inadequate blood sample, client refused, or no measurement recorded for glucose)


7 Don’t know


8 Client refused


9 No answer recorded

Explanation

Indicate whether the participant fasted for at least 8 hours prior to having blood drawn for a glucose reading.

Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

Did not fast: 2

Section 12: Screening Information: Blood Glucose

Item

12d: A1C, %

Purpose

To specify A1C for participants who were previously diagnosed with diabetes.

Name

A1C

Length

4

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

155

Edits

2.8-16.2; cannot be blank.

Out-of-range values will be accepted as valid only if a program verifies that the values are valid. Refer to Attachment 6 for the validation procedure of out-of-range values.

Contents

6666 No previous diagnosis of diabetes (SRD^=1 & DMEDS^=1 or 2)

7777 Inadequate blood sample

8888 Client refused

9999 No measurement recorded

Explanation

Record the participant’s A1C reading if she was tested.



Participants previously diagnosed with diabetes (defined as SRD=1 or DMEDS=1 or 2) should receive an A1C test. This test must not be done for participants without a previous diagnosis of diabetes (use code 6666 for participants without a previous diagnosis of diabetes).



Codes and response options highlighted in grey should not appear on the data collection form completed by the provider.

Example

A1C : 6.5

Section 13: Workup Information: Alert Follow-up

Item

13a: If average SBP180 or average DBP>110, what is the status of the workup?

Purpose

To specify the status of the workup for a participant with an alert blood pressure reading

Name

BPAlert

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

159

Edits

Valid range, cannot be blank

Contents

1 Workup pending


2 Workup complete


3 Workup not medically indicated, client being treated


6 Not an alert reading (average SBP<=180 and average DBP<=110)

7 No blood pressure value recorded (SBP1 and DBP1=777, 888, or 999)

8 Client refused workup

9 Workup not completed, client lost to follow-up

Explanation

Indicate the status of the workup for participants with alert blood pressure. Two blood pressures must be averaged and rounded to determine if a participant has an alert value (average SBP>180 or average DBP>110). If second blood pressure was not taken, then the first reading must be used to determine if a participant has an alert value.

Example

Workup is pending: 1

Section 13: Workup Information: Alert Follow-up

Item

13b: If average SBP180 or average DBP>110, diagnostic exam date.

Purpose

To specify additional information about participants with alert blood pressure readings.

Name

BPDiDate

Length

8

Type

Numeric

Justification

Right

Leading Zeros

Yes

Beginning Position

160

Edits

BPDiDate>=BPDate, must be blank if blood pressure reading is not alert or was not recorded

Contents

MMDDCCYY Date

Explanation

Record the date of the diagnostic examination for alert blood pressure readings. Two blood pressures must be averaged and rounded to determine if a participant has an alert value (average SBP>180 or average DBP>110). If second blood pressure was not taken, then the first reading must be used to determine if a participant has an alert value.

Date of the diagnostic exam must be after or on the same date as the date of the blood pressure measurement.

Field must be left blank if the blood pressure reading was not alert or was not recorded.

Example

Diagnostic exam completed February 28, 2010: 02282010

Section 13: Workup Information: Alert Follow-up

Item

13c: If average SBP180 or average DBP>110, what type of treatment was prescribed?

Purpose

To specify additional information about participants with alert blood pressure readings.

Name

BPTreat

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

168

Edits

Valid range, cannot be blank

Contents

1 Medication


2 Therapeutic lifestyle changes (TLC) – this is NOT the same as the lifestyle intervention offered to WISEWOMAN participants


3 Both medication and TLC

4 Nothing prescribed


5 Already on meds

6 Not an alert reading (average SBP<=180 and average DBP<=110)

7 No blood pressure value recorded (SBP1 and DBP1=777, 888, or 999)

8 Client refused treatment

9 Lost to follow-up

Explanation

Indicate the type of treatment prescribed to a participant with an alert blood pressure reading. Two blood pressures must be averaged and rounded to determine if a participant has an alert value (average SBP>180 or average DBP>110). If second blood pressure was not taken, then the first reading must be used to determine if a participant has an alert value.

Example

Was prescribed medication: 1

Section 13: Workup Information: Alert Follow-up

Item

13d: If TOTCHOL400, what is the status of the workup?

Purpose

To specify the status of the workup for a participant with alert total cholesterol.

Name

TCAlert

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

169

Edits

Valid range.

Contents

1 Workup pending


2 Workup complete


3 Workup not medically indicated, client being treated


6 Not an alert reading (TOTCHOL<=400)

7 No total cholesterol value recorded (TOTCHOL=777, 888, or 999)

8 Client refused workup

9 Workup not completed, client lost to follow-up

Explanation

Indicate the status of the workup for participants with alert total cholesterol.

Example

Workup has been completed: 2

Section 13: Workup Information: Alert Follow-up

Item

13e: If TOTCHOL400, diagnostic exam date.

Purpose

To specify additional information about participants with an alert total cholesterol reading.

Name

TCDiDate

Length

8

Type

Numeric

Justification

Right

Leading Zeros

Yes

Beginning Position

170

Edits

TCDiDate>=TCDate, must be blank if total cholesterol is not alert or was not recorded.

Contents

MMDDCCYY Date

Explanation

Record the date of the diagnostic examination for alert total cholesterol.

Date of the diagnostic exam must be after or on the same date as the date of the cholesterol measurement.

Field must be left blank if total cholesterol is not alert or was not recorded.

Example

Diagnostic exam completed February 28, 2010: 02282010

Section 13: Workup Information: Alert Follow-up

Item

13f: If TOTCHOL400, what type of treatment was prescribed?

Purpose

To specify additional information about participants with an alert total cholesterol reading.

Name

TCTreat

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

178

Edits

Valid range

Contents

1 Medication


2 Therapeutic lifestyle changes (TLC) - this is NOT the same as the lifestyle intervention offered to WISEWOMAN participants


3 Both medication and TLC

4 Nothing prescribed


5 Already on meds

6 Not an alert reading (TOTCHOL<=400)

7 No total cholesterol value recorded (TOTCHOL=777, 888, or 999)

8 Client refused treatment

9 Lost to follow-up

Explanation

Indicate the type of treatment prescribed to a participant with alert total cholesterol.

Example

Is already taking meds: 5

Section 13: Workup Information: Alert Follow-up

Item

13g: If GLUCOSE375, what is the status of the workup?

Purpose

To specify the status of the workup for a participant with alert blood glucose.

Name

BGAlert

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

179

Edits

Valid range

Contents

1 Workup pending


2 Workup complete


3 Workup not medically indicated, client being treated


6 Not an alert reading (GLUCOSE<=375)

7 No blood glucose value recorded (GLUCOSE=666, 777, 888, or 999)

8 Client refused workup

9 Workup not completed, client lost to follow-up

Explanation

Indicate the status of the workup for participants with alert blood glucose.

Example

Workup refused: 8

Section 13: Workup Information: Alert Follow-up

Item

13h: If GLUCOSE375, diagnostic exam date.

Purpose

To specify additional information about participants with an alert blood glucose reading.

Name

BGDiDate

Length

8

Type

Numeric

Justification

Right

Leading Zeros

Yes

Beginning Position

180

Edits

BGDiDate>=BGDate, must be blank if blood glucose is not alert or was not recorded.

Contents

MMDDCCYY Date

Explanation

Record the date of the diagnostic examination for alert blood glucose reading.

Date of the diagnostic exam must be after or on the same date as the date of the glucose measurement.

Field must be left blank if blood glucose is not alert or was not recorded.

Example

Diagnostic exam completed February 28, 2010: 02282010

Section 13: Workup Information: Alert Follow-up

Item

13i: If GLUCOSE375, what type of treatment was prescribed?

Purpose

To specify additional information about participants with an alert blood glucose reading.

Name

BGTreat

Length

1

Type

Numeric

Justification

Right

Leading Zeros

No

Beginning Position

188

Edits

Valid range.

Contents

1 Medication


2 Therapeutic lifestyle changes (TLC) - this is NOT the same as the lifestyle intervention offered to WISEWOMAN participants


3 Both medication and TLC

4 Nothing prescribed


5 Already on meds

6 Not an alert reading (GLUCOSE<=375)

7 No blood glucose value recorded (GLUCOSE=666, 777, 888, or 999)

8 Client refused treatment

9 Lost to follow-up

Explanation

Indicate the type of treatment prescribed to a participant with alert blood glucose.

Example

Was not prescribed anything: 4




Version 7.00, July 2008

File Typeapplication/msword
File TitleAttachment 1:
AuthorOlga Khavjou
Last Modified Byarp5
File Modified2009-11-04
File Created2009-09-30

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