Page 1
Field Properties
Study # 1 (INSITE)
Plate # 1 (Eligibility, p1)
7 Number ID001[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials001[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date confrmdt[confrmdt] Consent Form Sig DateStyle: WIC DateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice inc1[inc1] Inc Crit #1Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
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Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: notEligInclusion()
11 Choice inc2[inc2] Inc Crit #2Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice inc3[inc3] Inc Crit #3Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice inc4[inc4] Inc Crit #4Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice inc5[inc5] Inc Crit #5Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
2
Page 3
Plate Exit:
15 Choice inc6[inc6] Inc Crit #6Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice inc7[inc7] Inc Crit #7Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice exc1[exc1] Excl Crit #1Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: notEligExclusion1()
18 Choice exc2[exc2] Excl Crit #2Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice exc3[exc3] Excl Crit #3Style: YN Check
3
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Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice exc4[exc4] Excl Crit #4Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice exc5[exc5] Excl Crit #5Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Choice exc6[exc6] Excl Crit #6Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Choice exc7[exc7] Excl Crit #7Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checked
4
Page 5
Box 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Choice exc8[exc8] Excl Crit #8Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Choice exc9[exc9] Excl Crit #9Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Choice exc10[exc10] Excl Crit #10Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 String LCUser001[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter:
5
Page 6
Field Enter: Field Exit: Plate Exit:
28 String LCDate001[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String LCTime001[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 2 (Eligibility, p2)
7 Number ID002[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials002[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
6
Page 7
Field Exit: ecGetInitials()Plate Exit:
9 Choice exc11[exc11] Excl Crit #11Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: notEligExclusion2()
10 Choice exc12[exc12] Excl Crit #12Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice exc13[exc13] Excl Crit #13Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice exc14[exc14] Excl Crit #14Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice exc15[exc15] Excl Crit #15
7
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Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice exc16[exc16] Excl Crit #16Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice exc17[exc17] Excl Crit #17Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice exc18[exc18] Excl Crit #18Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Date eligdt[eligdt] Eligibility DateStyle: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
8
Page 9
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Check invagree[invagree] Investigator Agrees EligibleStyle: SimpleCheckNeed: Required Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: ecChangeAccess()Field Enter:
Field Exit: Plate Exit:
19 String LCUser002[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 String LCDate002[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String LCTime002[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: None
9
Page 10
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 3 (SI Joint Injection)
7 Number ID003[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials003[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date sijinjdt[sijinjdt] SI Joint Injectino DateStyle: WIC Date HistNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/22-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 String sijphys[sijphys] SI Joint Inj Phys NameStyle: SimpleStringNeed: Required Hidden: No Reason level: 0Legal: Help:
Display: 25 Store: 25Format:
10
Page 11
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice bilatsij[bilatsij] Bilateral SI joint injection?Style: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice sijinjside[sijinjside] SIJ Injected SideStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice arthrosucc[arthrosucc] Arthrogram SuccessfulStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No, could not accessBox 3: 3 No, other reason
Skip: 1 fields if value equals 1-2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(3)
14 String arthroreas[arthroreas] Reason Arthrog Not SuccessfulStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 35Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter:
11
Page 12
Field Enter: Field Exit: Plate Exit:
15 Choice leakage[leakage] Leakage of ContrastStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 No leakageBox 2: 2 Minor leakageBox 3: 3 Major leakage
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Check aneslido[aneslido] Local Anesthetic (Lidocain)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Check anesbupi[anesbupi] Local Anesthetic (Bupivacaine)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Check anesother[anesother] Local Anesthetic (Other)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
19 String anesothersp[anesothersp] Other Anesthetic Used (Sp)Style: SimpleString
12
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Need: Optional Hidden: No Reason level: 0Legal: Help:
Display: 14 Store: 31Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Number amtlocal[amtlocal] Amount of Local Anesthetic UsedStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: 0-5.0Help:
Display: 4 Store: 4Format: n.nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice sterinj[sterinj] Steroid InjectedStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
22 String stermedname[stermedname] Steroid Med NameStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 20 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Number sterinjamt[sterinjamt] Steroid Injection AmountStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 4 Store: 4Format: n.nn
13
Page 14
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Number sterconc[sterconc] Steroid ConcentrationStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Number stertotal[stertotal] Steroid Total DoseStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Choice sijimg[sijimg] SIJ Images Forwarded to SponsorStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Number nrspriorsij[nrspriorsij] NRS Prior to SIJ InjectionStyle: NRSNeed: Required Hidden: No Reason level: 0Legal: 0-10Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 Number nrsposthalfsij[nrsposthalfsij] NRS 1/2 Hr After SIJ Injection
14
Page 15
Style: NRSNeed: Required Hidden: No Reason level: 0Legal: 0-10Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 Number nrspostonesij[nrspostonesij] NRS 1 Hr Post SIJ InjectionStyle: NRSNeed: Required Hidden: No Reason level: 0Legal: 0-10Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 Choice sijpred50[sijpred50] SIJ Pain Reduced 50%Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: notEligPain()
31 String LCUser003[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 String LCDate003[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
15
Page 16
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
33 String LCTime003[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 4 (Other Side SI Joint Injection)
7 Number ID004[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials004[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date sijinjdt[sijinjdt] SI Joint Injectino DateStyle: WIC Date HistNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/22-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: Inherit
16
Page 17
Impute: InheritMapping: To Upper
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 String sijphys[sijphys] SI Joint Inj Phys NameStyle: SimpleStringNeed: Required Hidden: No Reason level: 0Legal: Help:
Display: 25 Store: 25Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice sijinjside[sijinjside] SIJ Injected SideStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice arthrosucc[arthrosucc] Arthrogram SuccessfulStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No, could not accessBox 3: 3 No, other reason
Skip: 1 fields if value equals 1-2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(3)
13 String arthroreas[arthroreas] Reason Arthrog Not SuccessfulStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 35Format:
Mapping: NoneSkip: 0 fields if value equals
17
Page 18
Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice leakage[leakage] Leakage of ContrastStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 No leakageBox 2: 2 Minor leakageBox 3: 3 Major leakage
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Check aneslido[aneslido] Local Anesthetic (Lidocain)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Check anesbupi[anesbupi] Local Anesthetic (Bupivacaine)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Check anesother[anesother] Local Anesthetic (Other)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
18 String anesothersp[anesothersp] Other Anesthetic Used (Sp)
18
Page 19
Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 14 Store: 31Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Number amtlocal[amtlocal] Amount of Local Anesthetic UsedStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: Help:
Display: 4 Store: 4Format: n.nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice sterinj[sterinj] Steroid InjectedStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
21 String stermedname[stermedname] Steroid Med NameStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 20 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Number sterinjamt[sterinjamt] Steroid Injection AmountStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 4 Store: 4
19
Page 20
Format: n.nnSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Number sterconc[sterconc] Steroid ConcentrationStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Number stertotal[stertotal] Steroid Total DoseStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Choice sijimg[sijimg] SIJ Images Forwarded to SponsorStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Number nrspriorsij[nrspriorsij] NRS Prior to SIJ InjectionStyle: NRSNeed: Required Hidden: No Reason level: 0Legal: 0-10Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20
Page 21
27 Number nrsposthalfsij[nrsposthalfsij] NRS 1/2 Hr After SIJ InjectionStyle: NRSNeed: Required Hidden: No Reason level: 0Legal: 0-10Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 Number nrspostonesij[nrspostonesij] NRS 1 Hr Post SIJ InjectionStyle: NRSNeed: Required Hidden: No Reason level: 0Legal: 0-10Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 Choice sijpred50[sijpred50] SIJ Pain Reduced 50%Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: notEligPain()
30 String LCUser004[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 String LCDate004[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12
21
Page 22
Format: Mapping: None
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 String LCTime004[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 5 (Preop CT Scan)
7 Number ID005[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials005[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date cteligdt[cteligdt] CT Eligibility DateStyle: WIC Date HistNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/22-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
22
Page 23
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice cttype[cttype] CT Type (Res)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Standard resBox 2: 2 High res
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Check osteophytes[osteophytes] Osteophytes on CTStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Check asymmwid[asymmwid] Asymm Widening on CTStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Check sclerosis[sclerosis] Sclerosis on CTStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
23
Page 24
Plate Exit:
14 Check subchon[subchon] Subchondral Cyst on CTStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Check vacuum[vacuum] Vacuum on CTStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice undcond[undcond] Primary Underlying ConditionStyle: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 DegenerationBox 2: 2 Disruption
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice ctsubmit[ctsubmit] CT SubmittedStyle: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Date ctsubmitdt[ctsubmitdt] CT Submit DateStyle: WIC Date HistNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/22-today
24
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Help: Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 String ctnotsubwhy[ctnotsubwhy] Reason Why CT Not SubmittedStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 40 Store: 255Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Check ctnotdone[ctnotdone] CT Scan Not Done/RequiredStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String LCUser005[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 String LCDate005[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
25
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Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 String LCTime005[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 11 (Baseline, p1)
7 Number ID011[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials011[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date basevisdt[basevisdt] Baseline Visit DateStyle: VisitDateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/01-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: Inherit
26
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Impute: InheritMapping: To Upper
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Date dob[dob] Date of BirthStyle: WIC Date HistNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/22-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Date consdt[consdt] Consent DateStyle: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice gender[gender] GenderStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 MaleBox 2: 2 Female
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Number wtlbs[wtlbs] Weight (lbs)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 80-400Help:
Display: 3 Store: 3
27
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Format: Skip: 1 fields if value equals 1-1000
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecWeight()
14 Number wtkg[wtkg] Weight (kg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 40-200Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Number heightft[heightft] Height (feet)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 3-8Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecHeight()
16 Number heightin[heightin] Height (inches)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-11Help:
Display: 2 Store: 2Format:
Skip: 1 fields if value equals 0-11Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Number heightcm[heightcm] Height (cm)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 50-220Help: Height in cm
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice ethnic[ethnic] Ethnicity
28
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Style: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 HispanicBox 2: 2 Not Hispanic
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice race[race] RaceStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 WhiteBox 2: 2 Hawaiian / Pac IslBox 3: 3 BlackBox 4: 4 Amer IndianBox 5: 5 AsianBox 6: 6 Other
Skip: 1 fields if value equals 1-5,7Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(6)
20 String raceother[raceother] Race (Other)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 20 Store: 35Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Check painloc3[painloc3] Pain Loc (L1 spine)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Check painloc4[painloc4] Pain Loc (Left Lower Lumbar)Style: SimpleCheck
29
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Need: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Check painloc5[painloc5] Pain Loc (Right Lower Lumbar)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Check painloc6[painloc6] Pain Loc (L5 spine)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Check painloc7[painloc7] Pain Loc (Left PSIS)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Check painloc8[painloc8] Pain Loc (Right PSIS)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
30
Page 31
Field Exit: Plate Exit:
27 Check painloc11[painloc11] Pain Loc (Left Hip)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 Check painloc9[painloc9] Pain Loc (Left Buttock)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 Check painloc10[painloc10] Pain Loc (Right Buttock)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 Check painloc12[painloc12] Pain Loc (Right Hip)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 Check painloc13[painloc13] Pain Loc (Left Upper Leg Post)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
31
Page 32
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 Check painloc14[painloc14] Pain Loc (Right Upper Leg Post)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
33 Check painloc15[painloc15] Pain Loc (Left Lower Leg Post)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
34 Check painloc16[painloc16] Pain Loc (Right Lower Leg Post)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
35 Check painloc17[painloc17] Pain Loc (Left Post Knee)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
32
Page 33
36 Check painloc18[painloc18] Pain Loc (Right Post Knee)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
37 Check painloc20[painloc20] Pain Loc (Right ASIS)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
38 Check painloc21[painloc21] Pain Loc (Left ASIS)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
39 Check painloc22[painloc22] Pain Loc (Right Lower Groin)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
40 Check painloc23[painloc23] Pain Loc (Left Lower Groin)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals
33
Page 34
Plate Enter: Field Enter:
Field Exit: Plate Exit:
41 Check painloc24[painloc24] Pain Loc (Pubic Symphysis)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
42 Check painloc25[painloc25] Pain Loc (Right Upper Leg)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
43 Check painloc26[painloc26] Pain Loc (Left Upper Leg)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
44 Check painloc27[painloc27] Pain Loc (Right Lower Leg)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
45 Check painloc28[painloc28] Pain Loc (Left Lower Leg)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0
34
Page 35
Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
46 Check painloc29[painloc29] Pain Loc (Right Knee)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
47 Check painloc30[painloc30] Pain Loc (Left Knee)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
48 String LCUser011[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
49 String LCDate011[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter:
35
Page 36
Field Enter: Field Exit: Plate Exit:
50 String LCTime011[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 12 (Baseline, p2)
7 Number ID012[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials012[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Number painstartmo[painstartmo] Pain Start MonthStyle: Body SystemNeed: Required Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
36
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Plate Exit:
10 Number painstartyr[painstartyr] Pain Start YearStyle: YearNeed: Required Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice painperip[painperip] Pain Began PeripartumStyle: YN NANeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 NoBox 3: 3 NA
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice painradleg[painradleg] Pain Radiates LegStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice paingroin[paingroin] Pain in GroinStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice painsit[painsit] Pain Worse Sitt ingStyle: YN Check
37
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Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice painris[painris] Pain Worse RisingStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice painwalk[painwalk] Pain Worse WalkingStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice painclimb[painclimb] Pain Worse Climbing StairsStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice paindesc[paindesc] Pain Worse Descending StairsStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checked
38
Page 39
Box 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 String otherwors[otherwors] Other Activ That Worsen PainStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 40 Store: 255Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice conscare6[conscare6] Cons Care At Least 6 MoStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice priorpt[priorpt] Prior PT for SIJStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 1 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
22 Number numcourpt[numcourpt] Number of Courses of PT in 2 YrsStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-20Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
39
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Field Exit: Plate Exit:
23 Choice priorsterinj[priorsterinj] Prior Steroid InjectionStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 1 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
24 Number numsijinj[numsijinj] Number of SIJ Injections Past 5 YrStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-20Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Choice priorrfa[priorrfa] Prior RFAStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 1 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
26 Number numrfa[numrfa] Number of RFAs in 5 YrsStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-20Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Choice hofusion[hofusion] History of Prior FusionStyle: NY CheckNeed: Optional Hidden: No Reason level: 0
40
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Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 6 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
28 String fus1desc[fus1desc] Fusion 1 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
29 Number fus1mo[fus1mo] Prior Fusion Mo 1Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 Number fus1year[fus1year] Prior Fusion Year 1Style: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 String fus2desc[fus2desc] Fusion 2 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
41
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Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
32 Number fus2mo[fus2mo] Prior Fusion Mo 2Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
33 Number fus2year[fus2year] Prior Fusion Year 2Style: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
34 Choice priorstenosis[priorstenosis] History of Lumbar StenosisStyle: NY CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 6 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
35 String sten1desc[sten1desc] Stenosis 1 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
36 Number sten1mo[sten1mo] Prior Sten Mo 1
42
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Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
37 Number sten1year[sten1year] Prior Stenosis Year 1Style: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
38 String sten2desc[sten2desc] Stenosis 2 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
39 Number sten2mo[sten2mo] Prior Sten Mo 2Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
40 Number sten2year[sten2year] Prior Stenosis Year 2Style: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals
43
Page 44
Plate Enter: Field Enter:
Field Exit: Plate Exit:
41 Choice priorpiri[priorpiri] History of Piriformis SyndromeStyle: NY CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 6 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
42 String piri1desc[piri1desc] Pirif 1 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
43 Number piri1mo[piri1mo] Piri Treat Mo 1Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
44 Number piri1year[piri1year] Piri Treat Year 1Style: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
45 String piri2desc[piri2desc] Pirif 2 Desc
44
Page 45
Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
46 Number piri2mo[piri2mo] Piri Treat Mo 2Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
47 Number piri2year[piri2year] Piri Treat Year 2Style: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
48 String LCUser012[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
49 String LCDate012[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
45
Page 46
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
50 String LCTime012[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
51 Check holumbfusion[holumbfusion] History of Lumbar Fusion (MM)Style: SimpleCheckNeed: Optional Hidden: Yes Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 13 (Baseline, p3)
7 Number ID013[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials013[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
46
Page 47
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice hohip[hohip] History of Hip ProblemsStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 9 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
10 String hipdiag[hipdiag] Hip DiagnosesStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 24 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecHipDiag()
11 Check hipright[hipright] Hip Affected (R)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Check hipleft[hipleft] Hip Affected (L)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 String hip1desc[hip1desc] Hip 1 Desc
47
Page 48
Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
14 Number hip1mo[hip1mo] Hip Mo 1Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Number hip1year[hip1year] Hip 1 YrStyle: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 String hip2desc[hip2desc] Hip 2 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
17 Number hip2mo[hip2mo] Hip Mo 2Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
48
Page 49
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Number hip2year[hip2year] Hip 2 YrStyle: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice hosactra[hosactra] History of Sacral TraumaStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 7 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
20 String sactraum[sactraum] Sacral Trauma DescriptionStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 24 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String sitrau1desc[sitrau1desc] SI Trauma 1 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
49
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22 Number sitrau1mo[sitrau1mo] SI Trauma Mo 1Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Number sitrau1year[sitrau1year] SI Trauma 1 YrStyle: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 String sitrau2desc[sitrau2desc] SI Trauma 2 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
25 Number sitrau2mo[sitrau2mo] SI Trauma Mo 2Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Number sitrau2year[sitrau2year] SI Trauma 2 YrStyle: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4
50
Page 51
Format: Skip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Choice hosif[hosif] History of SI FractureStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 7 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
28 String sinsuffdesc[sinsuffdesc] Sac Insuf Fx DescriptionStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 24 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String sif1desc[sif1desc] Sac Insuff Fx 1 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
30 Number sif1mo[sif1mo] Sac Insuff Fx Mo 1Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
51
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Plate Exit:
31 Number sif1year[sif1year] Sac Insuff Fx Yr 1Style: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 String sif2desc[sif2desc] Sac Insuff Fx 2 DescStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 95Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecCheckDateDiag()
33 Number sif2mo[sif2mo] Sac Insuff Fx Mo 2Style: MonthNeed: Optional Hidden: No Reason level: 0Legal: 1-12Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
34 Number sif2year[sif2year] Sac Insuff Fx Yr 2Style: YearNeed: Optional Hidden: No Reason level: 0Legal: 1920-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
35 Choice ambstat[ambstat] Ambulatory Status (BL)Style: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
52
Page 53
No Box: 0 Not checkedBox 1: 1 Fully ambBox 2: 2 Amb w assistBox 3: 3 Cannot walk
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
36 Choice smoker[smoker] Smoking StatusStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Current smokerBox 2: 2 Former smokerBox 3: 3 Never smoker
Skip: 4 fields if value equals 3Plate Enter: Field Enter:
Field Exit: Plate Exit: ecTobacco()
37 Number cigppd[cigppd] Cigarettes Pack Per DayStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10Help:
Display: 4 Store: 4Format: nn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
38 Number cigarppd[cigarppd] Cigars Per DayStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10Help:
Display: 4 Store: 4Format: nn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
39 Number pipepd[pipepd] Pipes Per DayStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10Help:
Display: 4 Store: 4Format: nn.n
Skip: 0 fields if value equals Plate Enter:
53
Page 54
Field Enter: Field Exit: Plate Exit:
40 Number bowlpd[bowlpd] Bowls per DayStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10Help:
Display: 4 Store: 4Format: nn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
41 Number quityr[quityr] Tob Quit YearStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1900-2014Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
42 String LCUser013[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
43 String LCDate013[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
44 String LCTime013[LCTime] Last Change (Time)Style: LCTime
54
Page 55
Need: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 14 (Baseline (Med Hx), p4)
7 Number ID014[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials014[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice baseworkstat[baseworkstat] Baseline Work StatusStyle: Work statusNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Working full t imeBox 2: 2 Working part timeBox 3: 3 Not working, studentBox 4: 4 Not working, retiredBox 5: 5 Not working due to back painBox 6: 6 Not working other reason
Skip: 3 fields if value equals 3-5Plate Enter: Field Enter:
Field Exit: Plate Exit: ecWorkingHours()
55
Page 56
10 Choice painlimitwork[painlimitwork] Does Pain Prevent Working As Many HrsStyle: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
11 Number basehrsprev[basehrsprev] Baseline Hrs Prevented Working/WeekStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0.0001-80Help:
Display: 4 Store: 4Format: nn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice worktype[worktype] Work TypeStyle: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 ManualBox 2: 2 SedentaryBox 3: 3 N/A
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Check medcondnone[medcondnone] No Medical ConditionsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Number medbs1[medbs1] Med Body System 1Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14
56
Page 57
Help: Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
15 String medcond1[medcond1] Medical Condition 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Number medbs2[medbs2] Med Body System 2Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
17 String medcond2[medcond2] Medical Condition 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Number medbs3[medbs3] Med Body System 3Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
57
Page 58
Field Exit: Plate Exit: ecMedHistCond()
19 String medcond3[medcond3] Medical Condition 3Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Number medbs4[medbs4] Med Body System 4Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
21 String medcond4[medcond4] Medical Condition 4Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Number medbs5[medbs5] Med Body System 5Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
23 String medcond5[medcond5] Medical Condition 5Style: SimpleStringNeed: Optional Hidden: No Reason level: 0
58
Page 59
Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Number medbs6[medbs6] Med Body System 6Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
25 String medcond6[medcond6] Medical Condition 6Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Number medbs7[medbs7] Med Body System 7Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
27 String medcond7[medcond7] Medical Condition 7Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
59
Page 60
Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 Number medbs8[medbs8] Med Body System 8Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
29 String medcond8[medcond8] Medical Condition 8Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 Number medbs9[medbs9] Med Body System 9Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
31 String medcond9[medcond9] Medical Condition 9Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 Number medbs10[medbs10] Med Body System 10
60
Page 61
Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
33 String medcond10[medcond10] Medical Condition 10Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
34 Number medbs11[medbs11] Med Body System 11Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
35 String medcond11[medcond11] Medical Condition 11Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
36 Number medbs12[medbs12] Med Body System 12Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
61
Page 62
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
37 String medcond12[medcond12] Medical Condition 12Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
38 Number medbs13[medbs13] Med Body System 13Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
39 String medcond13[medcond13] Medical Condition 13Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
40 Number medbs14[medbs14] Med Body System 14Style: Body SystemNeed: Optional Hidden: No Reason level: 0Legal: 1-14Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedHistCond()
62
Page 63
41 String medcond14[medcond14] Medical Condition 14Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 65Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
42 String LCUser014[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
43 String LCDate014[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
44 String LCTime014[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 15 (Baseline (Meds), p5)
63
Page 64
7 Number ID015[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials015[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Check basenotnarc[basenotnarc] Baseline Not Taking NarcoticsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 6 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedNotTaking()
10 String narc1[narc1] Narcotic 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck(), ecBlank3()
11 Number narc1dose[narc1dose] Narcotic 1 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6
64
Page 65
Format: Skip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 String narc2[narc2] Narcotic 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
13 Number narc2dose[narc2dose] Narcotic 2 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 String narc3[narc3] Narcotic 3Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
15 Number narc3dose[narc3dose] Narcotic 3 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
65
Page 66
16 Check basenotnsaid[basenotnsaid] Baseline Not Taking NSAIDsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 6 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedNotTaking()
17 String nsaid1[nsaid1] NSAID 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck(), ecBlank3()
18 Number nsaid1dose[nsaid1dose] NSAID 1 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 String nsaid2[nsaid2] NSAID 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
20 Number nsaid2dose[nsaid2dose] NSAID 2 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
66
Page 67
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String nsaid3[nsaid3] NSAID 3Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
22 Number nsaid3dose[nsaid3dose] NSAID 3 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Check basenotacet[basenotacet] Baseline Not Taking AcetaminophenStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 2 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedNotTaking()
24 String acet[acet] AcetaminophenStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit:
67
Page 68
Plate Exit: ecMedCheck(), ecBlank2()
25 Number acetdose[acetdose] Acetaminophen Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Check basenotmusc[basenotmusc] Baseline Not Musc RelaxStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 4 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedNotTaking()
27 String musc1[musc1] Musc Relax 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck(), ecBlank2()
28 Number musc1dose[musc1dose] Musc Relax 1 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String musc2[musc2] Musc Relax 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
68
Page 69
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
30 Number musc2dose[musc2dose] Musc Relax 2 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 Check basenotster[basenotster] Baseline Not Taking SteroidStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 2 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedNotTaking()
32 String ster[ster] Oral SteroidStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck(), ecBlank2()
33 Number sterdose[sterdose] Steroid Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
69
Page 70
Plate Exit:
34 String othmed1[othmed1] Other Pain Med 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
35 Number otrmed1dose[otrmed1dose] Other Pain Med 1 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
36 String othmed2[othmed2] Other Pain Med 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
37 Number otrmed2dose[otrmed2dose] Other Pain Med 2 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 1-10000Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
38 Check basemednone[basemednone] No Baseline MedsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal:
70
Page 71
Help: Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
39 String basemed1[basemed1] Base Med 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 24Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherMedCheck()
40 String basemedreas1[basemedreas1] Base Med Reason 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 55 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
41 String basemed2[basemed2] Base Med 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 24Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherMedCheck()
42 String basemedreas2[basemedreas2] Base Med Reason 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 55 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
71
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Plate Enter: Field Enter:
Field Exit: Plate Exit:
43 String basemed3[basemed3] Base Med 3Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 24Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherMedCheck()
44 String basemedreas3[basemedreas3] Base Med Reason 3Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 55 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
45 String basemed4[basemed4] Base Med 4Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 24Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherMedCheck()
46 String basemedreas4[basemedreas4] Base Med Reason 4Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 55 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
72
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47 String basemed5[basemed5] Base Med 5Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 24Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherMedCheck()
48 String basemedreas5[basemedreas5] Base Med Reason 5Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 55 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
49 String basemed6[basemed6] Base Med 6Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 24Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherMedCheck()
50 String basemedreas6[basemedreas6] Base Med Reason 6Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 55 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
51 String basemed7[basemed7] Base Med 7Style: SimpleStringNeed: Optional Hidden: No Reason level: 0
73
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Legal: Help:
Display: 12 Store: 24Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherMedCheck()
52 String basemedreas7[basemedreas7] Base Med Reason 7Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 55 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
53 String basemed8[basemed8] Base Med 8Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 24Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherMedCheck()
54 String basemedreas8[basemedreas8] Base Med Reason 8Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 55 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
55 String basemed9[basemed9] Base Med 9Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 24Format:
74
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Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherMedCheck()
56 String basemedreas9[basemedreas9] Base Med Reason 9Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 55 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
57 String LCUser015[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
58 String LCDate015[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
59 String LCTime015[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
75
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Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 16 (Baseline (Phys Exam), p6)
7 Number ID016[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials016[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice faberl[faberl] FABER (L)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice faberr[faberr] FABER (R)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter:
76
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Field Enter: Field Exit: Plate Exit:
11 Choice compl[compl] Compression (L)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice compr[compr] Compression (R)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice thighl[thighl] Thigh Thrust (L)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice thighr[thighr] Thigh Thrust (R)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter:
77
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Field Enter: Field Exit: Plate Exit:
15 Choice distracl[distracl] Distraction (L)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice distracr[distracr] Distraction (R)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice gaenl[gaenl] Gaensler's (L)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice gaenr[gaenr] Gaensrer's (R)Style: Phys Exam FindNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter:
78
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Field Enter: Field Exit: Plate Exit:
19 String othtestnm1[othtestnm1] Other SIJ Test Name (1)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 35Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice othr1l[othr1l] Other PE Finding 1 (L)Style: Phys Exam FindNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice othr1r[othr1r] Other PE Finding 1 (R)Style: Phys Exam FindNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 String othtestnm2[othtestnm2] Other SIJ Test Name (2)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 35Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit:
79
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Plate Exit:
23 Choice othr2l[othr2l] Other PE Finding 2 (L)Style: Phys Exam FindNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Choice othr2r[othr2r] Other PE Finding 2 (R)Style: Phys Exam FindNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 PositiveBox 2: 2 NegativeBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Number kneeextl[kneeextl] PE: Knee Extension (L)Style: Motor Exam FindNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Number kneeextr[kneeextr] PE: Knee Extension (R)Style: Motor Exam FindNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Number kneeflexl[kneeflexl] PE: Knee Flexion (L)Style: Motor Exam Find
80
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Need: Required Hidden: No Reason level: 0Legal: 0-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 Number kneefrexr[kneefrexr] PE: Knee Frexion (R)Style: Motor Exam FindNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 Number ankdorsl[ankdorsl] PE: Ankle Dorsiflexion (L)Style: Motor Exam FindNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 Number ankdorsr[ankdorsr] PE: Ankre Dorsifrexion (R)Style: Motor Exam FindNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 Number ankplanl[ankplanl] PE: Ankle Plantarflexion (L)Style: Motor Exam FindNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
81
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Field Exit: Plate Exit:
32 Number ankplanr[ankplanr] PE: Ankle Plantarflexion (R)Style: Motor Exam FindNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
33 Check kneeextLND[kneeextLND] Knee Ext (Left) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
34 Check kneeexRND[kneeexRND] Knee Ext (Right) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
35 Check ankdorLND[ankdorLND] Ankle Dorsiflexion (Left) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
36 Check ankdorRND[ankdorRND] Ankre Dorsifrexion (Right) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
82
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Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
37 Check exthalLND[exthalLND] Ext Halluc (Left) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
38 Check exthalRND[exthalRND] Ext Halluc (Right) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
39 Check ankplaLND[ankplaLND] Ankle Plantar (Left) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
40 Check ankplaRND[ankplaRND] Ankle Plantar (Right) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
83
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41 Choice sensdefL[sensdefL] Sensory Deficit (Left)Style: NY CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
42 Choice sensdefR[sensdefR] Sensory Deficit (Right)Style: NY CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
43 Check sensdeflL1[sensdeflL1] Sens Deficit (Left) L1Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
44 Check sensdeflL2[sensdeflL2] Sens Deficit (Left) L2Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
45 Check sensdeflL3[sensdeflL3] Sens Deficit (Left) L3Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 Unchecked
84
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Check On: 1 CheckedSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
46 Check sensdeflL4[sensdeflL4] Sens Deficit (Left) L4Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
47 Check sensdeflL5[sensdeflL5] Sens Deficit (Left) L5Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
48 Check sensdeflS1[sensdeflS1] Sens Deficit (Left) S1Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
49 Check sensdefrL1[sensdefrL1] Sens Deficit (Right) L1Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
50 Check sensdefrL2[sensdefrL2] Sens Deficit (Right) L2
85
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Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
51 Check sensdefrL3[sensdefrL3] Sens Deficit (Right) L3Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
52 Check sensdefrL4[sensdefrL4] Sens Deficit (Right) L4Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
53 Check sensdefrL5[sensdefrL5] Sens Deficit (Right) L5Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
54 Check sensdefrS1[sensdefrS1] Sens Deficit (Right) S1Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter:
86
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Field Enter: Field Exit: Plate Exit:
55 String LCUser016[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
56 String LCDate016[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
57 String LCTime016[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 17 (Baseline (Phys Exam, QOL, Rand), p7)
7 Number ID017[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
87
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Field Exit: Plate Exit: DataNotification()
8 String initials017[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Check refkneeLND[refkneeLND] Reflex Knee (Left) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Number kneejerkl[kneejerkl] Knee Jerk LStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: 0-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Check refkneeRND[refkneeRND] Reflex Knee (Right) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Number kneejerkr[kneejerkr] Knee Jerk RStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: 0-3
88
Page 89
Help: Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Check refankLND[refankLND] Reflex Ankle (Left) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Number ankjerkl[ankjerkl] Ankle Jerk LStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: 0-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Check refankRND[refankRND] Reflex Ankle (Right) Not DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Number ankjerkr[ankjerkr] Ankre Jerk LStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: 0-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
89
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17 Choice sf36done017[sf36done] SF36 DoneStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice eq5ddone017[eq5ddone] EQ5d DoneStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Number randID[randID] Randomization IDStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: Help:
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice treat[treat] Treatment AssignmentStyle: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NSMBox 2: 2 iFuse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecShowNSMInterventions()
21 String LCUser017[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal:
90
Page 91
Help: Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 String LCDate017[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 String LCTime017[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 21 (Procedure, p1)
7 Number ID021[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials021[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
91
Page 92
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice stagedpl[stagedpl] Staged Proc PlannedStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Date procdt[procdt] Procedure DateStyle: VisitDateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/01-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice targsij[targsij] Target SI Joint SideStyle: Right LeftNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Number procstarthr[procstarthr] Proc Start HourStyle: HourNeed: Required Hidden: No Reason level: 0Legal: 0-23Help:
Display: 2 Store: 2Format:
92
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Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Number procstartmin[procstartmin] Proc Start MinStyle: MinutesNeed: Required Hidden: No Reason level: 0Legal: 0-59Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Number procendhr[procendhr] Procedure End HourStyle: HourNeed: Required Hidden: No Reason level: 0Legal: 0-23Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Number procendmin[procendmin] Proc End MinStyle: MinutesNeed: Required Hidden: No Reason level: 0Legal: 0-59Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: ecProcedureTime()Plate Exit: ecProcedureTime()
16 Number fluoromin021[fluoromin] Fluoro MinStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: 0-100Help:
Display: 5 Store: 5Format: nn.nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Number ebl[ebl] Estim Blood LossStyle: SimpleNumber
93
Page 94
Need: Required Hidden: No Reason level: 0Legal: 0-5000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice impside1[impside1] Implant Side 1Style: Right LeftNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecDiamLength()
19 Choice impdiam1[impdiam1] Implant Diam 1Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 4 mmBox 2: 2 7 mm
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice implen1[implen1] Implant Length 1Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 30Box 2: 2 35Box 3: 3 40Box 4: 4 45Box 5: 5 50Box 6: 6 55Box 7: 7 60Box 8: 8 65Box 9: 9 70
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
94
Page 95
21 Choice impside2[impside2] Implant Side 2Style: Right LeftNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecDiamLength()
22 Choice impdiam2[impdiam2] Implant Diam 2Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 4 mmBox 2: 2 7 mm
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Choice implen2[implen2] Implant Length 2Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 30Box 2: 2 35Box 3: 3 40Box 4: 4 45Box 5: 5 50Box 6: 6 55Box 7: 7 60Box 8: 8 65Box 9: 9 70
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Choice impside3[impside3] Implant Side 3Style: Right LeftNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
95
Page 96
Field Exit: Plate Exit: ecDiamLength()
25 Choice impdiam3[impdiam3] Implant Diam 3Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 4 mmBox 2: 2 7 mm
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Choice implen3[implen3] Implant Length 3Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 30Box 2: 2 35Box 3: 3 40Box 4: 4 45Box 5: 5 50Box 6: 6 55Box 7: 7 60Box 8: 8 65Box 9: 9 70
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Choice impside4[impside4] Implant Side 4Style: Right LeftNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecDiamLength()
28 Choice impdiam4[impdiam4] Implant Diam 4Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 4 mmBox 2: 2 7 mm
96
Page 97
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 Choice implen4[implen4] Implant Length 4Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 30Box 2: 2 35Box 3: 3 40Box 4: 4 45Box 5: 5 50Box 6: 6 55Box 7: 7 60Box 8: 8 65Box 9: 9 70
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 String LCUser021[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 String LCDate021[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 String LCTime021[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
97
Page 98
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 22 (Procedure, p2)
7 Number ID022[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials022[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice pin1[pin1] Advance Pin 1Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice drill1[drill1] Drill 1Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checked
98
Page 99
Box 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice bro1[bro1] Broach 1Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice deliv1[deliv1] Deliver 1Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice pin2[pin2] Advance Pin 2Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice drill2[drill2] Drill 2Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter:
99
Page 100
Field Enter: Field Exit: Plate Exit:
15 Choice bro2[bro2] Broach 2Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice deliv2[deliv2] Deliver 2Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice pin3[pin3] Advance Pin 3Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice drill3[drill3] Drill 3Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
100
Page 101
19 Choice bro3[bro3] Broach 3Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice deliv3[deliv3] Deliver 3Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice pin4[pin4] Advance Pin 4Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Choice drill4[drill4] Drill 4Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Choice bro4[bro4] Broach 4Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal:
101
Page 102
Help: No Box: 0 Not checked
Box 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Choice deliv4[deliv4] Deliver 4Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Choice proccomp[proccomp] Procedure ComplicationsStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 1 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
26 String compdesc[compdesc] Complication DescriptionStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 69 Store: 138Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Choice procadv[procadv] Procedure Adverse EventsStyle: NY CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
102
Page 103
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 String LCUser022[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String LCDate022[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 String LCTime022[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 23 (Contralat Proced, p1)
7 Number ID023[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals
103
Page 104
Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials023[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date procdt[procdt] Procedure DateStyle: VisitDateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/01-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice targsij[targsij] Target SI Joint SideStyle: Right LeftNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Number procstarthr[procstarthr] Proc Start HourStyle: HourNeed: Required Hidden: No Reason level: 0Legal: 0-23Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
104
Page 105
Plate Exit:
12 Number procstartmin[procstartmin] Proc Start MinStyle: MinutesNeed: Required Hidden: No Reason level: 0Legal: 0-59Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Number procendhr[procendhr] Procedure End HourStyle: HourNeed: Required Hidden: No Reason level: 0Legal: 0-23Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Number procendmin[procendmin] Proc End MinStyle: MinutesNeed: Required Hidden: No Reason level: 0Legal: 0-59Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: ecProcedureTime()Plate Exit: ecProcedureTime()
15 Number fluoromin023[fluoromin] Fluoro MinStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: Help:
Display: 5 Store: 5Format: nn.nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Number ebl[ebl] Estim Blood LossStyle: SimpleNumberNeed: Required Hidden: No Reason level: 0Legal: 0-5000Help:
Display: 6 Store: 6
105
Page 106
Format: nnnn.nSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice impside1[impside1] Implant Side 1Style: Right LeftNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice impdiam1[impdiam1] Implant Diam 1Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 4 mmBox 2: 2 7 mm
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice implen1[implen1] Implant Length 1Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 30Box 2: 2 35Box 3: 3 40Box 4: 4 45Box 5: 5 50Box 6: 6 55Box 7: 7 60Box 8: 8 65Box 9: 9 70
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice impside2[impside2] Implant Side 2Style: Right LeftNeed: Optional Hidden: No Reason level: 0Legal:
106
Page 107
Help: No Box: 0 Not checked
Box 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice impdiam2[impdiam2] Implant Diam 2Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 4 mmBox 2: 2 7 mm
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Choice implen2[implen2] Implant Length 2Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 30Box 2: 2 35Box 3: 3 40Box 4: 4 45Box 5: 5 50Box 6: 6 55Box 7: 7 60Box 8: 8 65Box 9: 9 70
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Choice impside3[impside3] Implant Side 3Style: Right LeftNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Choice impdiam3[impdiam3] Implant Diam 3
107
Page 108
Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 4 mmBox 2: 2 7 mm
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Choice implen3[implen3] Implant Length 3Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 30Box 2: 2 35Box 3: 3 40Box 4: 4 45Box 5: 5 50Box 6: 6 55Box 7: 7 60Box 8: 8 65Box 9: 9 70
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Choice impside4[impside4] Implant Side 4Style: Right LeftNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 Left
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Choice impdiam4[impdiam4] Implant Diam 4Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 4 mmBox 2: 2 7 mm
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
108
Page 109
Plate Exit:
28 Choice implen4[implen4] Implant Length 4Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 30Box 2: 2 35Box 3: 3 40Box 4: 4 45Box 5: 5 50Box 6: 6 55Box 7: 7 60Box 8: 8 65Box 9: 9 70
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String LCUser023[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 String LCDate023[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 String LCTime023[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
109
Page 110
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 24 (Contralat Proc, p2)
7 Number ID024[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials024[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice pin1[pin1] Advance Pin 1Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice drill1[drill1] Drill 1Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter:
110
Page 111
Field Enter: Field Exit: Plate Exit:
11 Choice bro1[bro1] Broach 1Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice deliv1[deliv1] Deliver 1Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice pin2[pin2] Advance Pin 2Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice drill2[drill2] Drill 2Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
111
Page 112
15 Choice bro2[bro2] Broach 2Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice deliv2[deliv2] Deliver 2Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice pin3[pin3] Advance Pin 3Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice drill3[drill3] Drill 3Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice bro3[bro3] Broach 3Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal:
112
Page 113
Help: No Box: 0 Not checked
Box 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice deliv3[deliv3] Deliver 3Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice pin4[pin4] Advance Pin 4Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Choice drill4[drill4] Drill 4Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Choice bro4[bro4] Broach 4Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
113
Page 114
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Choice deliv4[deliv4] Deliver 4Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Choice proccomp024[proccomp] Procedure ComplicationsStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 1 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
26 String compdesc[compdesc] Complication DescriptionStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 69 Store: 138Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Choice procadv[procadv] Procedure Adverse EventsStyle: NY CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
114
Page 115
Plate Exit:
28 String LCUser024[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String LCDate024[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 String LCTime024[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 31 (Discharge)
7 Number ID031[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
115
Page 116
8 String initials031[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date discxraydt[discxraydt] Discharge X-Ray DateStyle: WIC DateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice discinlet[discinlet] Disch Inlet/Outlet/Lat View DoneStyle: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(2)
11 String reasxrnd[reasxrnd] Reason DC X-Ray NDStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 34 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice dcxraysponsor[dcxraysponsor] Discharge X-Ray Sent to Sponsor
116
Page 117
Style: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(2)
13 String reasxrns[reasxrns] Reason DC X-Ray Not SentStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 34 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice aedisc[aedisc] AE Prior to DCStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Date hospdcdt[hospdcdt] Hospital DC DateStyle: VisitDateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/01-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Check samedaydis[samedaydis] Discharged Same DayStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0
117
Page 118
Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Number los[los] Length of StayStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-200Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice fuvissched[fuvissched] FU Visits ScheduledStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 String LCUser031[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 String LCDate031[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
118
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Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String LCTime031[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 41 (Follow-Up Visit, p1)
6 Choice visitseq041[visitseq] Visit SequenceStyle: FU Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 5 Month 1Choice 2: 6 Month 3Choice 3: 7 Month 6Choice 4: 8 Month 12Choice 5: 9 Month 18Choice 6: 10 Month 24Choice 7: 15 Month 1 (C)Choice 8: 16 Month 3 (C)Choice 9: 17 Month 6 (C)
Choice 10: 18 Month 12 (C)Choice 11: 19 Month 18 (C)Choice 12: 20 Month 24 (C)Choice 13: 35 Mo 1 (2)Choice 14: 36 Mo 3 (2)Choice 15: 37 Mo 6 (2)Choice 16: 38 Mo 12 (2)Choice 17: 39 Mo 18 (2)Choice 18: 40 Mo 24 (2)Choice 19: 1 Baseline
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID041[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6
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Format: Skip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials041[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date fuvisdt[fuvisdt] Follow-Up Visit DateStyle: VisitDateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/01-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice fupainvsbl[fupainvsbl] FU Pain Vs. BaselineStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 ImprovedBox 2: 2 SameBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice fuadlvsbl[fuadlvsbl] FU ADL vs. BaselineStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Limited moreBox 2: 2 Same as baseline
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Box 3: 3 Limited lessSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice fuwalkstatus[fuwalkstatus] FU Ambulatory StatusStyle: Walk StatusNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Ambulatory without assistanceBox 2: 2 Ambulatory with assistive deviceBox 3: 3 Cannot walk
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Date fullwalkdt[fullwalkdt] Full Walking DateStyle: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Check notfullwalk[notfullwalk] Not Fully Walking / Still Needs Amb DevStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice fuworkstat[fuworkstat] FU Work StatusStyle: Work statusNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Working full t imeBox 2: 2 Working part timeBox 3: 3 Not working, student
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Box 4: 4 Not working, retiredBox 5: 5 Not working due to back painBox 6: 6 Not working other reason
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice fupainprevwk[fupainprevwk] FU Pain Prevents WorkingStyle: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
17 Number fuhrslimit[fuhrslimit] FU Hours Limit WorkingStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0.5-80Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Number sesspoPT[sesspoPT] Sessions of Postop PTStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-100Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: ecHidePT()Field Enter:
Field Exit: Plate Exit:
19 Choice aelastvis[aelastvis] AE Since Last VisitStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
122
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Field Exit: Plate Exit:
20 String LCUser041[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String LCDate041[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 String LCTime041[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 42 (Follow-Up Visit, p2)
6 Choice visitseq042[visitseq] Visit SequenceStyle: FU Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 5 Month 1Choice 2: 6 Month 3Choice 3: 7 Month 6Choice 4: 8 Month 12Choice 5: 9 Month 18
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Choice 6: 10 Month 24Choice 7: 15 Month 1 (C)Choice 8: 16 Month 3 (C)Choice 9: 17 Month 6 (C)
Choice 10: 18 Month 12 (C)Choice 11: 19 Month 18 (C)Choice 12: 20 Month 24 (C)Choice 13: 35 Mo 1 (2)Choice 14: 36 Mo 3 (2)Choice 15: 37 Mo 6 (2)Choice 16: 38 Mo 12 (2)Choice 17: 39 Mo 18 (2)Choice 18: 40 Mo 24 (2)Choice 19: 1 Baseline
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID042[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials042[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Check funarcnt[funarcnt] FU Not Taking NarcoticsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
124
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10 String narc1042[narc1] Narcotic 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck(), ecBlank3()
11 Number narc1dose042[narc1dose] Narcotic 1 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 String narc2042[narc2] Narcotic 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
13 Number narc2dose042[narc2dose] Narcotic 2 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 String narc3042[narc3] Narcotic 3Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55
125
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Format: Mapping: None
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
15 Number narc3dose042[narc3dose] Narcotic 3 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Check funsaidnt[funsaidnt] FU Not Taking NSAIDsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 String nsaid1042[nsaid1] NSAID 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck(),, ecBlank3()
18 Number nsaid1dose042[nsaid1dose] NSAID 1 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
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19 String nsaid2042[nsaid2] NSAID 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
20 Number nsaid2dose042[nsaid2dose] NSAID 2 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String nsaid3042[nsaid3] NSAID 3Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
22 Number nsaid3dose042[nsaid3dose] NSAID 3 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Check fuacetnt[fuacetnt] FU Not Taking AcetaminophenStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
127
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Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 String acet042[acet] AcetaminophenStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck(), ecBlank1()
25 Number acetdose042[acetdose] Acetaminophen Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Check fumuscnt[fumuscnt] FU Not Taking Musc RelaxStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 String musc1042[musc1] Musc Relax 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit:
128
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Plate Exit: ecMedCheck(), ecBlank2()
28 Number musc1dose042[musc1dose] Musc Relax 1 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String musc2042[musc2] Musc Relax 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
30 Number musc2dose042[musc2dose] Musc Relax 2 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 Check fusternt[fusternt] FU Not Taking SteroidsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 String ster042[ster] Oral SteroidStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
129
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Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck(), ecBlank1()
33 Number sterdose042[sterdose] Steroid Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
34 String othmed1042[othmed1] Other Pain Med 1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
35 Number otrmed1dose042[otrmed1dose] Other Pain Med 1 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
36 String othmed2042[othmed2] Other Pain Med 2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
130
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Field Exit: Plate Exit: ecMedCheck()
37 Number otrmed2dose042[otrmed2dose] Other Pain Med 2 Dose (mg)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
38 Choice newmedst[newmedst] New Med Started vs. BaselineStyle: NY CheckNeed: Optional Hidden: Yes Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
39 String medstartbl[medstartbl] New Med Started Since BLStyle: SimpleStringNeed: Optional Hidden: Yes Reason level: 0Legal: Help:
Display: 21 Store: 45Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
40 Choice oldmedstp[oldmedstp] Old Med Stopped Vs. BLStyle: NY CheckNeed: Optional Hidden: Yes Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
41 String medstpbl[medstpbl] Old Med Stopped Since BLStyle: SimpleString
131
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Need: Optional Hidden: Yes Reason level: 0Legal: Help:
Display: 21 Store: 45Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
42 String LCUser042[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
43 String LCDate042[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
44 String LCTime042[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
45 String dep1042[dep1] Depression Med1Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55
132
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Format: Mapping: None
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
46 Number dep1dose042[dep1dose] Depression Med Dose 1Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
47 String dep2042[dep2] Depression Med2Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecMedCheck()
48 Number dep2dose042[dep2dose] Depression Med Dose 2Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
49 String dep3042[dep3] Depression Med3Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 45 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit:
133
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Plate Exit: ecMedCheck()
50 Number dep3dose042[dep3dose] Depression Med Dose 3Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10000Help:
Display: 6 Store: 6Format: nnnn.n
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
51 Check fudepnt[fudepnt] FU Not Taking Depression MedsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 43 (Follow-Up Visit, p3)
6 Choice visitseq043[visitseq] Visit SequenceStyle: FU Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 5 Month 1Choice 2: 6 Month 3Choice 3: 7 Month 6Choice 4: 8 Month 12Choice 5: 9 Month 18Choice 6: 10 Month 24Choice 7: 15 Month 1 (C)Choice 8: 16 Month 3 (C)Choice 9: 17 Month 6 (C)
Choice 10: 18 Month 12 (C)Choice 11: 19 Month 18 (C)Choice 12: 20 Month 24 (C)Choice 13: 35 Mo 1 (2)Choice 14: 36 Mo 3 (2)Choice 15: 37 Mo 6 (2)Choice 16: 38 Mo 12 (2)Choice 17: 39 Mo 18 (2)Choice 18: 40 Mo 24 (2)Choice 19: 1 Baseline
Skip: 0 fields if value equals Plate Enter: Field Enter:
134
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Field Exit: Plate Exit:
7 Number ID043[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials043[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Check fukneeextnd[fukneeextnd] FU Knee Ext NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
10 Choice fukneeextl[fukneeextl] FU Knee Extent (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Check fukneeextndr[fukneeextndr] FU Knee Ext NDStyle: SimpleCheck
135
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Need: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
12 Choice fukneeextr[fukneeextr] FU Knee Extent (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Check fukneeflend[fukneeflend] FU Knee Flex NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
14 Choice fukneeflel[fukneeflel] FU Knee Flex (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Check fukneeflendr[fukneeflendr] FU Knee Flex NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 Unchecked
136
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Check On: 1 CheckedSkip: 1 fields if value equals 1
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
16 Choice fukneefler[fukneefler] FU Knee Flex (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Check fuankdflend[fuankdflend] FU Flex DFlex NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
18 Choice fuankdflel[fuankdflel] FU Ankle DFlex (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Check fuankdflendr[fuankdflendr] FU Flex DFlex NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
137
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Field Exit: Plate Exit: ecPhysExamND()
20 Choice fuankdfler[fuankdfler] FU Ankle DFlex (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Check fuankpflend[fuankpflend] FU Flex PFlex NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
22 Choice fuankpflel[fuankpflel] FU Ankle PFlex (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Check fuankpflendr[fuankpflendr] FU Flex PFlex NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
24 Choice fuankpfler[fuankpfler] FU Ankle PFlex (R)
138
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Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Check antthighnd[antthighnd] Anterior Thigh Sensory NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
26 Choice antthighl[antthighl] Ant Thigh Sensory (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Check antthighndr[antthighndr] Anterior Thigh Sensory NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
28 Choice antthighr[antthighr] Ant Thigh Sensory (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
139
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No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 Check firstwsnd[firstwsnd] First WS Sensory NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
30 Choice firstwsl[firstwsl] First WS Sensory (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 Check firstwsndr[firstwsndr] First WS Sensory NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
32 Choice firstwsr[firstwsr] First WS Sensory (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
140
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Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
33 Check latcalfnd[latcalfnd] Lat Calf Sensory NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
34 Choice latcalfl[latcalfl] Lat Calf Sensory (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
35 Check latcalfndr[latcalfndr] Lat Calf Sensory NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
36 Choice latcalfr[latcalfr] Lat Calf Sensory (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
141
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Plate Exit:
37 Check latfootnd[latfootnd] Lat Foot Sensory NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
38 Choice latfootl[latfootl] Lat Foot Sensory (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
39 Check latfootndr[latfootndr] Lat Foot Sensory NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
40 Choice latfootr[latfootr] Lat Foot Sensory (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
41 Check postthighnd[postthighnd] Posterior Thigh Sensory NDStyle: SimpleCheck
142
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Need: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
42 Choice postthighl[postthighl] Posterior Thigh Sensory (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
43 Check postthighndr[postthighndr] Posterior Thigh Sensory NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
44 Choice postthighr[postthighr] Posterior Thigh Sensory (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
45 Check kneejerknd[kneejerknd] Knee Jerk NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 Unchecked
143
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Check On: 1 CheckedSkip: 1 fields if value equals 1
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
46 Choice kneejerkl043[kneejerkl] Knee Jerk SBW (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
47 Check kneejerkndr[kneejerkndr] Knee Jerk NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
48 Choice kneejerkr043[kneejerkr] Knee Jerk SBW (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
49 Check ankjerknd[ankjerknd] Ankle Jerk NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
144
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Field Exit: Plate Exit: ecPhysExamND()
50 Choice ankjerkl043[ankjerkl] Ankle Jerk SBW (L)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
51 Check ankjerkndr[ankjerkndr] Ankle Jerk NDStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecPhysExamND()
52 Choice ankjerkr043[ankjerkr] Ankle Jerk SBW (R)Style: SBWNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 SameBox 2: 2 BetterBox 3: 3 Worse
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
53 String LCUser043[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
145
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54 String LCDate043[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
55 String LCTime043[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 44 (Follow-Up Visit, p4)
6 Choice visitseq044[visitseq] Visit SequenceStyle: FU Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 5 Month 1Choice 2: 6 Month 3Choice 3: 7 Month 6Choice 4: 8 Month 12Choice 5: 9 Month 18Choice 6: 10 Month 24Choice 7: 15 Month 1 (C)Choice 8: 16 Month 3 (C)Choice 9: 17 Month 6 (C)
Choice 10: 18 Month 12 (C)Choice 11: 19 Month 18 (C)Choice 12: 20 Month 24 (C)Choice 13: 35 Mo 1 (2)Choice 14: 36 Mo 3 (2)Choice 15: 37 Mo 6 (2)Choice 16: 38 Mo 12 (2)Choice 17: 39 Mo 18 (2)Choice 18: 40 Mo 24 (2)Choice 19: 1 Baseline
Skip: 0 fields if value equals Plate Enter: Field Enter:
146
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Field Exit: Plate Exit:
7 Number ID044[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials044[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice fuvasdone[fuvasdone] FU VAS DoneStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice fuodidone[fuodidone] FU ODI DoneStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice fusf36done[fusf36done] FU SF36 DoneStyle: YN Check
147
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Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice fueq5ddone[fueq5ddone] FU EQ5D DoneStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice fudsijqdone[fudsijqdone] FU EQ5D DoneStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice fuzungdone[fuzungdone] FU EQ5D DoneStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice fuxrdone[fuxrdone] FU X-Ray DoneStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checked
148
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Box 1: 1 YesBox 2: 2 Not requiredBox 3: 3 Not done
Skip: 1 fields if value equals 2Plate Enter: ecFURadiography()Field Enter:
Field Exit: Plate Exit: ecFURadiographySub()
16 Date fuxrsentdt[fuxrsentdt] FU X-Ray Sent DateStyle: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 String reasxrnd044[reasxrnd] Reason FU X-Ray NDStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 24 Store: 31Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice hrctdone[hrctdone] HR CT DoneStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 Not requiredBox 3: 3 Not done
Skip: 0 fields if value equals Plate Enter: ecFUCTScan()Field Enter:
Field Exit: Plate Exit: ecFURadiographySub()
19 Date fuctsentdt[fuctsentdt] FU CT Sent DateStyle: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9
149
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Format: dd/mmm/yyYear: Inherit
Impute: InheritMapping: To Upper
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 String reasctnd044[reasctnd] Reason FU CT NDStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 24 Store: 32Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String LCUser044[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 String LCDate044[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 String LCTime044[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: None
150
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Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 45 (Healthcare Util Not Req Study)
6 Choice visitseq045[visitseq] Visit SequenceStyle: FU Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 5 Month 1Choice 2: 6 Month 3Choice 3: 7 Month 6Choice 4: 8 Month 12Choice 5: 9 Month 18Choice 6: 10 Month 24Choice 7: 15 Month 1 (C)Choice 8: 16 Month 3 (C)Choice 9: 17 Month 6 (C)
Choice 10: 18 Month 12 (C)Choice 11: 19 Month 18 (C)Choice 12: 20 Month 24 (C)Choice 13: 35 Mo 1 (2)Choice 14: 36 Mo 3 (2)Choice 15: 37 Mo 6 (2)Choice 16: 38 Mo 12 (2)Choice 17: 39 Mo 18 (2)Choice 18: 40 Mo 24 (2)Choice 19: 1 Baseline
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID045[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials045[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3
151
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Format: Mapping: To Upper
Skip: 0 fields if value equals Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Check nophysvis[nophysvis] No Add Physician VisitsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Number addphysvis[addphysvis] Additional Physician VisitsStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Check noaddproc[noaddproc] No Additional ProceduresStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Number addinj[addinj] Additional SIJ InjectionsStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
152
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13 Number addrfa[addrfa] Additional RFA ProceduresStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 String addproc1[addproc1] Additional Procedures (1)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 String addproc2[addproc2] Additional Procedures (2)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 String addproc3[addproc3] Additional Procedures (3)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 String addproc4[addproc4] Additional Procedures (4)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
153
Page 154
Display: 30 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Number addchir[addchir] Additional Visits to ChiropractorStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Number addacu[addacu] Additional Visits to AcupuncturistStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Number addpro[addpro] Additional Visits for ProlotherapyStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Check noaddrad[noaddrad] No Additional RadiographsStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
154
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22 Number addMRI[addMRI] Additional MRIsStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Number addCT[addCT] Additional CTsStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Number addXray[addXray] Additional X-RaysStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Check noaddptot[noaddptot] No Additional PT/OTStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Number addPT[addPT] Additional Visits to Phys TherapyStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
155
Page 156
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Number addOT[addOT] Additional Visits to Occup TherapStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 Check noaddmedeq[noaddmedeq] No Additional Medical EquipmentStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String medequip1[medequip1] Medical Equipment (1)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 String medequip2[medequip2] Medical Equipment (2)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
156
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31 String medequip3[medequip3] Medical Equipment (3)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 String medequip4[medequip4] Medical Equipment (4)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
33 String LCUser045[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
34 String LCDate045[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
35 String LCTime045[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal:
157
Page 158
Help: Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 46 (Contra/Cross)
6 Choice visitseq046[visitseq] Visit SequenceStyle: FU Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 5 Month 1Choice 2: 6 Month 3Choice 3: 7 Month 6Choice 4: 8 Month 12Choice 5: 9 Month 18Choice 6: 10 Month 24Choice 7: 15 Month 1 (C)Choice 8: 16 Month 3 (C)Choice 9: 17 Month 6 (C)
Choice 10: 18 Month 12 (C)Choice 11: 19 Month 18 (C)Choice 12: 20 Month 24 (C)Choice 13: 35 Mo 1 (2)Choice 14: 36 Mo 3 (2)Choice 15: 37 Mo 6 (2)Choice 16: 38 Mo 12 (2)Choice 17: 39 Mo 18 (2)Choice 18: 40 Mo 24 (2)Choice 19: 1 Baseline
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID046[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials046[initials] Init ialsStyle: Init ials
158
Page 159
Need: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice plancontra[plancontra] Planned Contralateral Done (iFuse)Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: ecGrayContra()Field Enter:
Field Exit: Plate Exit:
10 Choice unplancontra[unplancontra] Unplanned Contrlateral iFuse DoneStyle: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice nsmcross[nsmcross] NSM Subject CrossedStyle: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice nsmcrosscontra[nsmcrosscontra] NSM Subject Crossed and Had ContralateraStyle: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checked
159
Page 160
Box 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice nsmcrossunpcontra[nsmcrossunpcontra] NSM Crossed Had Unplanned ContralateralStyle: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 101 (Study Exit)
7 Number ID101[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials101[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date exitdt[exitdt] Exit DateStyle: VisitDateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/01-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
160
Page 161
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice exit[exit] Study ExitStyle: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 CompletedBox 2: 2 Discont Premature
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(2)
11 Choice reasexit[reasexit] Reason ExitStyle: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Withdrew consentBox 2: 2 AE prevent participationBox 3: 3 DeathBox 4: 4 LTFUBox 5: 5 Other
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(5)
12 String reasexitother[reasexitother] Reason Exit Other (Explain)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 37 Store: 255Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Check invrev[invrev] Investigator Review of CRFStyle: SimpleCheckNeed: Required Hidden: No Reason level: 0Legal: Help:
Check Off: 0 Unchecked
161
Page 162
Check On: 1 CheckedSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 String LCUser101[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 String LCDate101[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 String LCTime101[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 111 (Non-Surgical Management)
7 Number ID111[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
162
Page 163
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials111[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice reqpt[reqpt] Required PT SessionsStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Number numptsessnsm[numptsessnsm] Num PT Sessions (NSM)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-100Help:
Display: 4 Store: 4Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice reqster[reqster] Required Steroid InjectionsStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
163
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12 Date sterinjdt1[sterinjdt1] Steroid Injection Date (1)Style: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Date sterinjdt2[sterinjdt2] Steroid Injection Date (2)Style: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice reqrfa[reqrfa] Required RFAStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Date rfadt1[rfadt1] RFA Date (1)Style: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
164
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Field Exit: Plate Exit:
16 String rfadoc1[rfadoc1] RFA Physician (1)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 19 Store: 35Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Date rfadt2[rfadt2] RFA Date (2)Style: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 String rfadoc2[rfadoc2] RFA Physician (2)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 19 Store: 35Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice aensm[aensm] AE Assoc with NSMStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
165
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20 String LCUser111[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String LCDate111[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 String LCTime111[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 113 (Deviation)
6 Number devID[devID] Deviation IDStyle: Deviation IDNeed: Essential Hidden: No Reason level: 0Legal: 201-240Help:
Display: 3 Store: 3Format: 2nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
166
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7 Number ID113[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials113[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice devtime[devtime] Deviation TimingStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 EligBox 2: 2 BaselineBox 3: 3 ProcBox 4: 4 DischBox 5: 5 Mo 1Box 6: 6 Mo 3Box 7: 7 Mo 6Box 8: 8 Mo 12Box 9: 9 Mo 18
Box 10: 10 Mo 24Box 11: 11 ExitBox 12: 12 AEBox 13: 13 UnschBox 14: 14 Other
Skip: 1 fields if value equals 1-15Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(14)
10 String devtimothr[devtimothr] Deviation Timing Other (Spec)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 35Format:
167
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Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice devtype[devtype] Deviation TypeStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Cons form not signedBox 2: 2 Not meet elig criteriaBox 3: 3 Test/proc not doneBox 4: 4 Test/proc not acc protocolBox 5: 5 Test/proc outside windowBox 6: 6 Visit not doneBox 7: 7 Visit outside windowBox 8: 8 Other
Skip: 1 fields if value equals 1-7Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(8)
12 String devtypeother[devtypeother] Deviation Type Other (Spec)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 27 Store: 27Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 String devdesc[devdesc] Deviation DescriptionStyle: SimpleStringNeed: Required Hidden: No Reason level: 0Legal: Help:
Display: 56 Store: 156Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice devrptirb[devrptirb] Deviation Reported to IRBStyle: YN CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
168
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No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
15 Date devrptdt[devrptdt] Deviation IRB Report DateStyle: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Check invrevdev[invrevdev] Investigator Has Reviewed DeviationStyle: SimpleCheckNeed: Required Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: ecChangeAccess();Field Enter:
Field Exit: Plate Exit:
17 String LCUser113[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 String LCDate113[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: None
169
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Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 String LCTime113[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 121 (Adverse Event, p1)
6 Number AEID121[AEID] Adverse Event IDStyle: AE IDNeed: Essential Hidden: No Reason level: 0Legal: 301-340Help:
Display: 3 Store: 3Format: 3nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID121[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials121[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()
170
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Field Enter: Field Exit: ecGetInitials()Plate Exit:
9 Date aestartdt[aestartdt] AE Start DateStyle: WIC DateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Middle
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecCheckAEStartDateEnter()Field Enter:
Field Exit: ecCheckAEStartDate()Plate Exit:
10 String aedesc[aedesc] AE Description (Short)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 50 Store: 155Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 String aedesclong[aedesclong] AE Descr LongStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 49 Store: 1200Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice ifuseexp[ifuseexp] iFuse Explanted As Result of AEStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 1 fields if value equals 2Plate Enter: Field Enter:
Field Exit:
171
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Plate Exit: ecOtherSpecify(1)
13 String expreason[expreason] Explant ReasonStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 29 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice aesev[aesev] AE SeverityStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 MildBox 2: 2 ModerateBox 3: 3 Severe
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice aerelatdev[aerelatdev] AE Relatedness to iFuseStyle: RelatednessNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Not relatedBox 2: 2 Possibly relatedBox 3: 3 Probably relatedBox 4: 4 Definitely relatedBox 5: 5 Not applicableBox 6: 6 Unlikely to be related
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice aerelatproc[aerelatproc] AE Relatedness to ProcedureStyle: RelatednessNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Not relatedBox 2: 2 Possibly relatedBox 3: 3 Probably relatedBox 4: 4 Definitely relatedBox 5: 5 Not applicable
172
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Box 6: 6 Unlikely to be relatedSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice aerelatprocNSM[aerelatprocNSM] AE Relatedness to Proc for NSMStyle: RelatednessNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Not relatedBox 2: 2 Possibly relatedBox 3: 3 Probably relatedBox 4: 4 Definitely relatedBox 5: 5 Not applicableBox 6: 6 Unlikely to be related
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecAEExisting()
18 Choice aerelatothproc[aerelatothproc] AE Relatedness to Other Procedure on SIJStyle: RelatednessNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Not relatedBox 2: 2 Possibly relatedBox 3: 3 Probably relatedBox 4: 4 Definitely relatedBox 5: 5 Not applicableBox 6: 6 Unlikely to be related
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecAEExisting()
19 Choice aerelatpre[aerelatpre] AE Relatedness to Prev ConditionStyle: RelatednessNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Not relatedBox 2: 2 Possibly relatedBox 3: 3 Probably relatedBox 4: 4 Definitely relatedBox 5: 5 Not applicableBox 6: 6 Unlikely to be related
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecAEExisting()
173
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20 String precond[precond] Previous Condition (Relatedness)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 19 Store: 155Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String LCUser121[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 String LCDate121[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 String LCTime121[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 122 (Adverse Event, p2)
174
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6 Number AEID122[AEID] Adverse Event IDStyle: AE IDNeed: Essential Hidden: No Reason level: 0Legal: 301-340Help:
Display: 3 Store: 3Format: 3nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID122[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials122[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Check aedeath[aedeath] AE Lead to DeathStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Check aethreat[aethreat] AE Caused Life-Threatening ProblemStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 Unchecked
175
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Check On: 1 CheckedSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Check aeperm[aeperm] AE Caused Permanent InjuryStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Check aeprol[aeprol] AE Prolonged HospStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Check aeinterv[aeinterv] AE Required InterventionStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Check aenone[aenone] AE Consequences NoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Check aenotreat[aenotreat] AE Not Treatment
176
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Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Check aemed[aemed] AE Medical TreatmentStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 0Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
17 String aemedtreat[aemedtreat] Medical Treatment ProvidedStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 32 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Check aeproc[aeproc] AE Procedure TreatmentStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 0Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
19 String aeproctreat[aeproctreat] Procedure Treatment ProvidedStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 32 Store: 55Format:
Mapping: None
177
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Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Check aesurg[aesurg] AE Surgical TreatmentStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 0Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
21 String aesurgtreat[aesurgtreat] Surgical Treatment ProvidedStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 32 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Check aeoth[aeoth] AE Other TreatStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 1 fields if value equals 0Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(1)
23 String aeothtreat[aeothtreat] Other Treatment ProvidedStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 32 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
178
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24 Choice aeout[aeout] AE OutcomeStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 ResolvedBox 2: 2 OngoingBox 3: 3 DeathBox 4: 4 Other
Skip: 1 fields if value equals 1-3Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(4)
25 String aeoutother[aeoutother] AE Outcome Other (Spec)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 27 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Date aeoutdt[aeoutdt] AE Outcome DateStyle: WIC DateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Choice aerptirb[aerptirb] AE Reported to IRBStyle: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 1 fields if value equals 2Plate Enter: Field Enter:
Field Exit: Plate Exit:
179
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28 Date aeirbrptdt[aeirbrptdt] AE IRB Report DateStyle: WIC DateNeed: Optional Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String reasnotrep[reasnotrep] Reason Not ReportedStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 49 Store: 155Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 Check invrevae[invrevae] Investigator Has Reviewed Adv EventStyle: SimpleCheckNeed: Required Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: ecInvOnly()Field Enter:
Field Exit: Plate Exit: ecUncheckCoord()
31 String LCUser122[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 String LCDate122[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0
180
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Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
33 String LCTime122[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
34 Choice issae[issae] Is SAE (MM)Style: YN CheckNeed: Optional Hidden: Yes Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 1 YesChoice 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 124 (Revision)
6 Number AEID124[AEID] Adverse Event IDStyle: revisionIDNeed: Essential Hidden: No Reason level: 0Legal: 521-525Help:
Display: 3 Store: 3Format: 5nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID124[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)
181
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Help: Site ID*1000 + ptIDDisplay: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials124[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice revisedside[revisedside] Revised SideStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 IndexBox 2: 2 Contralateral
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Date insurgdt[insurgdt] Index surgery dateStyle: WIC DateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Date revsurgdt[revsurgdt] Revision Surgery DateStyle: WIC DateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
182
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Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 String reasrev[reasrev] Reason for RevisionStyle: SimpleStringNeed: Required Hidden: No Reason level: 0Legal: Help:
Display: 53 Store: 106Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 String revdes[revdes] Revision DescriptionStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 67 Store: 1005Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 131 (Narrative)
6 Number narrID131[narrID] Narrative IDStyle: Narr IDNeed: Essential Hidden: No Reason level: 0Legal: 401-420Help:
Display: 3 Store: 3Format: 4nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID131[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6
183
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Format: Skip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials131[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 String narr[narr] NarrativeStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 71 Store: 2059Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Date narrdate[narrdate] Narrative DateStyle: VisitDateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/01-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 String LCUser131[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
184
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Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 String LCDate131[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 String LCTime131[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 141 (Device Malfunction)
6 Number devmalID141[devmalID] Device Malfunction IDStyle: Dev Malf IDNeed: Essential Hidden: No Reason level: 0Legal: 501-510Help:
Display: 3 Store: 3Format: 5nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID141[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
185
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Field Exit: Plate Exit: DataNotification()
8 String initials141[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date devmalfdt[devmalfdt] Device Malfunction DateStyle: WIC DateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice malftype[malftype] Malfunction TypeStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Instrument brokeBox 2: 2 Broach did not create channelBox 3: 3 Soft tissue dilator did not engageBox 4: 4 Impactor did not directBox 5: 5 Pin damaged during drillingBox 6: 6 Pin guide inadequate spacingBox 7: 7 Drill bit stuck to pinBox 8: 8 Removal tool did not engageBox 9: 9 Other
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 String malftypeother[malftypeother] Malfunction Type OtherStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 52 Store: 156
186
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Format: Mapping: None
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 String malfdet[malfdet] Malfunction Detailed DescStyle: SimpleStringNeed: Required Hidden: No Reason level: 0Legal: Help:
Display: 58 Store: 290Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice aemalf[aemalf] AE Related to MalfunctionStyle: NY CheckNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 2 NoBox 2: 1 Yes
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 String LCUser141[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 String LCDate141[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter:
187
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Field Enter: Field Exit: Plate Exit:
16 String LCTime141[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 151 (VAS)
6 Number visitseq151[visitseq] Visit SequenceStyle: QOL Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID151[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials151[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()
188
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Plate Exit:
9 Number vaslb[vaslb] VAS Lower BackStyle: VASNeed: Required Hidden: No Reason level: 0Legal: 0-100Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Number vassij[vassij] VAS Pelvis/buttocksStyle: VASNeed: Required Hidden: No Reason level: 0Legal: 0-100Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 152 (ODI)
6 Number visitseq152[visitseq] Visit SequenceStyle: QOL Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID152[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials152[initials] Init ialsStyle: Init ials
189
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Need: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice odi1[odi1] ODI 1Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5Box 7: 99 99
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice odi2[odi2] ODI 2Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5Box 7: 99 99
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice odi3[odi3] ODI 3Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3
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Box 5: 4 4Box 6: 5 5Box 7: 99 99
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice odi4[odi4] ODI 4Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5Box 7: 99 99
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice odi5[odi5] ODI 5Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5Box 7: 99 99
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice odi6[odi6] ODI 6Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5Box 7: 99 99
191
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Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice odi7[odi7] ODI 7Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5Box 7: 99 99
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice odi8[odi8] ODI 8Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5Box 7: 99 99
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice odi9[odi9] ODI 9Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5Box 7: 99 99
Skip: 0 fields if value equals Plate Enter: Field Enter:
192
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Field Exit: Plate Exit:
18 Choice odi10[odi10] ODI 10Style: ODI 0-5_99Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 999 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5Box 7: 99 99
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 153 (SF36)
6 Number visitseq153[visitseq] Visit SequenceStyle: QOL Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID153[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials153[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To Upper
193
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Skip: 0 fields if value equals Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Number sf1[sf1] SF36-1Style: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Number sf2[sf2] SF36-2Style: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Number sf3a[sf3a] SF36-3aStyle: SF36 1-3Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Number sf3b[sf3b] SF36-3bStyle: SF36 1-3Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Number sf3c[sf3c] SF36-3cStyle: SF36 1-3
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Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Number sf3d[sf3d] SF36-3dStyle: SF36 1-3Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Number sf3e[sf3e] SF36-3eStyle: SF36 1-3Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Number sf3f[sf3f] SF36-3fStyle: SF36 1-3Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Number sf3g[sf3g] SF36-3gStyle: SF36 1-3Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
195
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Field Exit: Plate Exit:
18 Number sf3h[sf3h] SF36-3hStyle: SF36 1-3Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Number sf3i[sf3i] SF36-3iStyle: SF36 1-3Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Number sf3j[sf3j] SF36-3jStyle: SF36 1-3Need: Optional Hidden: No Reason level: 0Legal: 1-3Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Number sf4a[sf4a] SF36-4aStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Number sf4b[sf4b] SF36-4bStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
196
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Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Number sf4c[sf4c] SF36-4cStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Number sf4d[sf4d] SF36-4dStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Number sf5a[sf5a] SF36-5aStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Number sf5b[sf5b] SF36-5bStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
197
Page 198
27 Number sf5c[sf5c] SF36-5cStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 Number sf6[sf6] SF36-6Style: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 Number sf7[sf7] SF36-7Style: SF36 1-6Need: Optional Hidden: No Reason level: 0Legal: 1-6Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 Number sf8[sf8] SF36-8Style: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 Number sf9a[sf9a] SF36-9aStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals
198
Page 199
Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 Number sf9b[sf9b] SF36-9bStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
33 Number sf9c[sf9c] SF36-9cStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
34 Number sf9d[sf9d] SF36-9dStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
35 Number sf9e[sf9e] SF36-9eStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
36 Number sf9f[sf9f] SF36-9fStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0
199
Page 200
Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
37 Number sf9g[sf9g] SF36-9gStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
38 Number sf9h[sf9h] SF36-9hStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
39 Number sf9i[sf9i] SF36-9iStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
40 Number sf10[sf10] SF36-10Style: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
200
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Plate Exit:
41 Number sf11a[sf11a] SF36-11aStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
42 Number sf11b[sf11b] SF36-11bStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
43 Number sf11c[sf11c] SF36-11cStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
44 Number sf11d[sf11d] SF36-11dStyle: SF36 1-5Need: Optional Hidden: No Reason level: 0Legal: 1-5Help:
Display: 1 Store: 1Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 154 (EQ5D)
6 Number visitseq154[visitseq] Visit SequenceStyle: QOL Visit ID
201
Page 202
Need: Essential Hidden: No Reason level: 0Legal: Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID154[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials154[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice eq1[eq1] EQ5D-1Style: eq5dNeed: Required Hidden: No Reason level: 0Legal: 1-3Help:
No Box: 99 Not checkedBox 1: 1 1Box 2: 2 2Box 3: 3 3
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice eq2[eq2] EQ5D-2Style: eq5dNeed: Required Hidden: No Reason level: 0Legal: 1-3Help:
No Box: 99 Not checkedBox 1: 1 1
202
Page 203
Box 2: 2 2Box 3: 3 3
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice eq3[eq3] EQ5D-3Style: eq5dNeed: Required Hidden: No Reason level: 0Legal: 1-3Help:
No Box: 99 Not checkedBox 1: 1 1Box 2: 2 2Box 3: 3 3
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice eq4[eq4] EQ5D-4Style: eq5dNeed: Required Hidden: No Reason level: 0Legal: 1-3Help:
No Box: 99 Not checkedBox 1: 1 1Box 2: 2 2Box 3: 3 3
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice eq5[eq5] EQ5D-5Style: eq5dNeed: Required Hidden: No Reason level: 0Legal: 1-3Help:
No Box: 99 Not checkedBox 1: 1 1Box 2: 2 2Box 3: 3 3
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Number eqvas[eqvas] EQ5D VASStyle: VASNeed: Required Hidden: No Reason level: 0Legal: 0-100Help:
Display: 3 Store: 3Format:
203
Page 204
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 155 (Satisfaction)
6 Number visitseq155[visitseq] Visit SequenceStyle: QOL Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID155[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials155[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice satisf155[satisf] Satisfaction w TreatmentStyle: SimpleChoiceNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Very dissatisfiedBox 2: 2 Somewhat dissatisfiedBox 3: 3 Somewhat satisfiedBox 4: 4 Very satisfied
204
Page 205
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice ifagain[ifagain] Undergo iFuse AgainStyle: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Not haveBox 2: 2 Might haveBox 3: 3 Definitely haveBox 4: 9 NA
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 156 (Denver SIJ Questionnaire)
6 Number visitseq156[visitseq] Visit SequenceStyle: QOL Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID156[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials156[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To Upper
205
Page 206
Skip: 0 fields if value equals Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice dq1[dq1] DSIJQ Q1Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice dq2[dq2] DSIJQ Q2Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice dq3[dq3] DSIJQ Q3Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
206
Page 207
12 Choice dq4[dq4] DSIJQ Q4Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice dq5[dq5] DSIJQ Q5Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice dq6[dq6] DSIJQ Q6Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice dq7[dq7] DSIJQ Q7Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checked
207
Page 208
Box 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice dq8[dq8] DSIJQ Q8Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice dq9[dq9] DSIJQ Q9Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice dq10[dq10] DSIJQ Q10Style: DSIJQNeed: Required Hidden: No Reason level: 0Legal: 0-5Help:
No Box: 99 Not checkedBox 1: 0 0Box 2: 1 1Box 3: 2 2Box 4: 3 3Box 5: 4 4Box 6: 5 5
208
Page 209
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 157 (Zung Dep Scale)
6 Number visitseq157[visitseq] Visit SequenceStyle: QOL Visit IDNeed: Essential Hidden: No Reason level: 0Legal: Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID157[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials157[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice zung1[zung1] Zung 1Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
209
Page 210
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice zung2[zung2] Zung 2Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice zung3[zung3] Zung 3Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice zung4[zung4] Zung 4Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice zung5[zung5] Zung 5Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checked
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Box 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice zung6[zung6] Zung 6Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice zung7[zung7] Zung 7Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice zung8[zung8] Zung 8Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice zung9[zung9] Zung 9Style: Zung
211
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Need: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice zung10[zung10] Zung 10Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice zung11[zung11] Zung 11Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice zung12[zung12] Zung 12Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit:
212
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Plate Exit:
21 Choice zung13[zung13] Zung 13Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Choice zung14[zung14] Zung 14Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Choice zung15[zung15] Zung 15Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Choice zung16[zung16] Zung 16Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
213
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Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Choice zung17[zung17] Zung 17Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Choice zung18[zung18] Zung 18Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Choice zung19[zung19] Zung 19Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 Choice zung20[zung20] Zung 20Style: ZungNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checked
214
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Box 1: 1 A little of the timeBox 2: 2 Some of the timeBox 3: 3 Good part of the timeBox 4: 4 Most of the time
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
Plate # 201 (Unsch Visit)
6 Number unsvisitID201[unsvisitID] Unscheduled Visit IDStyle: Unsched VisitIDNeed: Essential Hidden: No Reason level: 0Legal: 601-620Help:
Display: 3 Store: 3Format: 6nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID201[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials201[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Date unsvisdt[unsvisdt] Unscheduled Visit DateStyle: WIC DateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9
215
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Format: dd/mmm/yyYear: Inherit
Impute: InheritMapping: To Upper
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 String reasvisit[reasvisit] Reason for Unsc VisitStyle: SimpleStringNeed: Required Hidden: No Reason level: 0Legal: Help:
Display: 48 Store: 96Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice pefind[pefind] Phys Exam FindingsStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NormalBox 2: 2 Not normal
Skip: 1 fields if value equals 1Plate Enter: Field Enter:
Field Exit: Plate Exit: ecOtherSpecify(2)
12 String pedesc[pedesc] Phys Exam DescriptionStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 46Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Check uxrdone[uxrdone] Unsc X-Ray DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals
216
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Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Check uctdone[uctdone] Unsc CT DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Check umridone[umridone] Unsc MRI DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Check uothdone[uothdone] Unsc Other Imaging DoneStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 String uothimgspec[uothimgspec] Unsc Other Imaging Done (Spec)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 11 Store: 35Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 String imgres[imgres] Imaging ResultsStyle: SimpleString
217
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Need: Optional Hidden: No Reason level: 0Legal: Help:
Display: 46 Store: 138Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 String LCUser201[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 String LCDate201[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 String LCTime201[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 202 (Unsch Visit, p2)
6 Number unsvisitID202[unsvisitID] Unscheduled Visit IDStyle: Unsched VisitID
218
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Need: Essential Hidden: No Reason level: 0Legal: 601-620Help:
Display: 3 Store: 3Format: 6nn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID202[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: DataNotification()
8 String initials202[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
Plate # 211 (Crossover)
7 Number ID211[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit: ecShowCrossoverVisits()
8 String initials211[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
219
Page 220
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice crossreas[crossreas] Crossover ReasonStyle: SimpleChoiceNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Continued painBox 2: 2 Other
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 String crossreasoth[crossreasoth] Crossover Reason (Specify)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 41 Store: 99Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Check intpt[intpt] Intervention: PTStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Number numPTbcross[numPTbcross] Num PT Before CrossoverStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 3 Store: 3Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
220
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Field Exit: Plate Exit:
13 String numsesswhy[numsesswhy] Num Sessions and WhyStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 255Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Check intster[intster] Intervention: Steroid InjectionStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Number crossnumster[crossnumster] Number of Steroid InjectionsStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10Help:
Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Check intrfa[intrfa] Intervention: RFAStyle: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Number crossnumrfa[crossnumrfa] Number of RFA ProceduresStyle: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: 0-10
221
Page 222
Help: Display: 2 Store: 2Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice vascross[vascross] VAS Prior to CrossoverStyle: YYNNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Yes, part of 6 mo visitBox 2: 2 Yes, unsch visitBox 3: 3 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice odicross[odicross] ODI Prior to CrossoverStyle: YYNNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Yes, part of 6 mo visitBox 2: 2 Yes, unsch visitBox 3: 3 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice sf36cross[sf36cross] SF36 Prior to CrossoverStyle: YYNNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Yes, part of 6 mo visitBox 2: 2 Yes, unsch visitBox 3: 3 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice eq5dcross[eq5dcross] EQ5d Prior to CrossoverStyle: YYNNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checked
222
Page 223
Box 1: 1 Yes, part of 6 mo visitBox 2: 2 Yes, unsch visitBox 3: 3 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Choice dsijqcross[dsijqcross] EQ5d Prior to CrossoverStyle: YYNNeed: Required Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Yes, part of 6 mo visitBox 2: 2 Yes, unsch visitBox 3: 3 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Date crossdt[crossdt] Crossover DateStyle: VisitDateNeed: Required Hidden: No Reason level: 0Legal: 01/JAN/01-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Choice crossproctp[crossproctp] Crossover Procedure TypeStyle: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 iFuseBox 2: 2 Open SIJ FusionBox 3: 3 Other
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 String othcrossproc[othcrossproc] Other Crossover ProcedureStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
223
Page 224
Display: 20 Store: 55Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 String LCUser211[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 String LCDate211[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 String LCTime211[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 13 Store: 13Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 311 ((R1) 12 Mo CT, apposition)
6 Choice visitseq311[visitseq] Visit SequenceStyle: CT visitIDNeed: Essential Hidden: No Reason level: 0Legal: Help:
224
Page 225
No Choice: 0 Not checkedChoice 1: 8 Month 12Choice 2: 18 Month 12 (Cross)Choice 3: 88 OtherChoice 4: 38 Month 12 (2nd)Choice 5: 10 Month 24Choice 6: 40 Month 24 (2nd)
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID311[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
8 String initials311[initials] Init ialsStyle: Init ialsNeed: Optional Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice implantloc311[implantloc] Implant Location (CT)Style: RightLeftBothNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 RightBox 2: 2 LeftBox 3: 3 Bilateral
Skip: 0 fields if value equals Plate Enter: ecCTDisableSide()Field Enter:
Field Exit: ecCTDisableSide()Plate Exit:
10 Choice appsac1r[appsac1r] Appos Sacral 1 (Right)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
225
Page 226
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice appil1r[appil1r] Appos Ilial 1 (Right)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice appsac2r[appsac2r] Appos Sacral 2 (Right)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice appil2r[appil2r] Appos Ilial 2 (Right)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice appsac3r[appsac3r] Appos Sacral 3 (Right)
226
Page 227
Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice appil3r[appil3r] Appos Ilial 3 (Right)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice appsac4r[appsac4r] Appos Sacral 4 (Right)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice appil4r[appil4r] Appos Ilial 4 (Right)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
227
Page 228
Field Exit: Plate Exit:
18 Choice appsac1l[appsac1l] Appos Sacral 1 (Left)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice appil1l[appil1l] Appos Ilial 1 (Left)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice appsac2l[appsac2l] Appos Sacral 2 (Left)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice appil2l[appil2l] Appos Ilial 2 (Left)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 Indeterminate
228
Page 229
Box 4: 4 Unable to assessSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Choice appsac3l[appsac3l] Appos Sacral 3 (Left)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Choice appil3l[appil3l] Appos Ilial 3 (Left)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 Choice appsac4l[appsac4l] Appos Sacral 4 (Left)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Choice appil4l[appil4l] Appos Ilial 4 (Left)Style: appositionNeed: Optional Hidden: No Reason level: 0Legal: Help:
229
Page 230
No Box: 0 Not checkedBox 1: 1 >30%Box 2: 2 <30%Box 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 String ctcomm[ctcomm] CT CommentsStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 61 Store: 555Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 String LCUser311[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 String LCDate311[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 String LCTime311[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 8 Store: 8Format:
230
Page 231
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: ecHideUser()Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 312 ((R1) 12 Mo CT, lucency)
6 Choice visitseq312[visitseq] Visit SequenceStyle: CT visitIDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 8 Month 12Choice 2: 18 Month 12 (Cross)Choice 3: 88 OtherChoice 4: 38 Month 12 (2nd)Choice 5: 10 Month 24Choice 6: 40 Month 24 (2nd)
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID312[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: ecDisableSideCTEvalP2()Field Enter:
Field Exit: Plate Exit:
8 String initials312[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice ctradiolucr[ctradiolucr] CT Radiolucency (Right)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal:
231
Page 232
Help: No Box: 0 Not checked
Box 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 String ctradioluccommr[ctradioluccommr] CT Radiolucency Comment (Right)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 500Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice ctradiolextr1[ctradiolextr1] CT Radiol Extent (Right 1)Style: radiolucCTNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <15%Box 3: 3 15-50%Box 4: 4 50-100%Box 5: 5 IndeterminateBox 6: 6 Unable to assessBox 7: 7 No implant
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Choice ctradiolextr2[ctradiolextr2] CT Radiol Extent (Right 2)Style: radiolucCTNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <15%Box 3: 3 15-50%Box 4: 4 50-100%Box 5: 5 IndeterminateBox 6: 6 Unable to assessBox 7: 7 No implant
Skip: 0 fields if value equals Plate Enter:
232
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Field Enter: Field Exit: Plate Exit:
13 Choice ctradiolextr3[ctradiolextr3] CT Radiol Extent (Right 3)Style: radiolucCTNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <15%Box 3: 3 15-50%Box 4: 4 50-100%Box 5: 5 IndeterminateBox 6: 6 Unable to assessBox 7: 7 No implant
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice ctradiolextr4[ctradiolextr4] CT Radiol Extent (Right 4)Style: radiolucCTNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <15%Box 3: 3 15-50%Box 4: 4 50-100%Box 5: 5 IndeterminateBox 6: 6 Unable to assessBox 7: 7 No implant
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Check ctradlocilr1[ctradlocilr1] CT Radioluc Location Ilial (Right 1)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Check ctradlocsacr1[ctradlocsacr1] CT Radioluc Location Sacral (Right 1)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
233
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Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Check ctradlocilr2[ctradlocilr2] CT Radioluc Location Ilial (Right 2)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Check ctradlocsacr2[ctradlocsacr2] CT Radioluc Location Sacral (Right 2)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Check ctradlocilr3[ctradlocilr3] CT Radioluc Location Ilial (Right 3)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Check ctradlocsacr3[ctradlocsacr3] CT Radioluc Location Sacral (Right 3)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
234
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21 Check ctradlocilr4[ctradlocilr4] CT Radioluc Location Ilial (Right 4)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 Check ctradlocsacr4[ctradlocsacr4] CT Radioluc Location Sacral (Right 4)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 Choice ctradiolucl[ctradiolucl] CT Radiolucency (Left)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 String ctradioluccomml[ctradioluccomml] CT Radiolucency Comment (Left)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 500Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 Choice ctradiolextl1[ctradiolextl1] CT Radiol Extent (Left 1)Style: radiolucCTNeed: Optional Hidden: No Reason level: 0Legal:
235
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Help: No Box: 0 Not checked
Box 1: 1 NoneBox 2: 2 <15%Box 3: 3 15-50%Box 4: 4 50-100%Box 5: 5 IndeterminateBox 6: 6 Unable to assessBox 7: 7 No implant
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 Choice ctradiolextl2[ctradiolextl2] CT Radiol Extent (Left 2)Style: radiolucCTNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <15%Box 3: 3 15-50%Box 4: 4 50-100%Box 5: 5 IndeterminateBox 6: 6 Unable to assessBox 7: 7 No implant
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
27 Choice ctradiolextl3[ctradiolextl3] CT Radiol Extent (Left 3)Style: radiolucCTNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <15%Box 3: 3 15-50%Box 4: 4 50-100%Box 5: 5 IndeterminateBox 6: 6 Unable to assessBox 7: 7 No implant
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
28 Choice ctradiolextl4[ctradiolextl4] CT Radiol Extent (Left 4)Style: radiolucCTNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 None
236
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Box 2: 2 <15%Box 3: 3 15-50%Box 4: 4 50-100%Box 5: 5 IndeterminateBox 6: 6 Unable to assessBox 7: 7 No implant
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
29 Check ctradlocill1[ctradlocill1] CT Radioluc Location Ilial (Left 1)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
30 Check ctradlocsacl1[ctradlocsacl1] CT Radioluc Location Sacral (Left 1)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
31 Check ctradlocill2[ctradlocill2] CT Radioluc Location Ilial (Left 2)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
32 Check ctradlocsacl2[ctradlocsacl2] CT Radioluc Location Sacral (Left 2)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter:
237
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Field Enter: Field Exit: Plate Exit:
33 Check ctradlocill3[ctradlocill3] CT Radioluc Location Ilial (Left 3)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
34 Check ctradlocsacl3[ctradlocsacl3] CT Radioluc Location Sacral (Left 3)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
35 Check ctradlocill4[ctradlocill4] CT Radioluc Location Ilial (Left 4)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
36 Check ctradlocsacl4[ctradlocsacl4] CT Radioluc Location Sacral (Left 4)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
37 String LCUser312[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal:
238
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Help: Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
38 String LCDate312[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
39 String LCTime312[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 8 Store: 8Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: ecHideUser()Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 313 ((R1) 12 Mo CT, failure/breach)
6 Choice visitseq313[visitseq] Visit SequenceStyle: CT visitIDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 8 Month 12Choice 2: 18 Month 12 (Cross)Choice 3: 88 OtherChoice 4: 38 Month 12 (2nd)Choice 5: 10 Month 24Choice 6: 40 Month 24 (2nd)
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
239
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7 Number ID313[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: ecDisableSideCTEvalP3()Field Enter:
Field Exit: Plate Exit:
8 String initials313[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice ctdevfailr[ctdevfailr] CT Device Failure (Right)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 String ctrdevfailcommr[ctrdevfailcommr] CT Dev Fail Comment (Right)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 500Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice ctdevbreachr[ctdevbreachr] CT Device Breach (Right)Style: devbreachNeed: Optional Hidden: No Reason level: 0
240
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Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 Present - sacral canalBox 3: 3 Present - sacral foramenBox 4: 4 Present - anterior sacrumBox 5: 5 Present - otherBox 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 String ctdevbreachcommr[ctdevbreachcommr] CT Device Breach Comment (Right)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 500Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice ctdevfaill[ctdevfaill] CT Device Failure (Left)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 String ctrdevfailcomml[ctrdevfailcomml] CT Dev Fail Comment (Left)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 29 Store: 500Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
241
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15 Choice ctdevbreachl[ctdevbreachl] CT Device Breach (Left)Style: devbreachNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 Present - sacral canalBox 3: 3 Present - sacral foramenBox 4: 4 Present - anterior sacrumBox 5: 5 Present - otherBox 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 String ctdevbreachcomml[ctdevbreachcomml] CT Device Breach Comment (Left)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 500Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 String LCUser313[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 String LCDate313[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
242
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19 String LCTime313[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 8 Store: 8Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: ecHideUser()Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 314 ((R1) 12 Mo CT, migration/bone rxn)
6 Choice visitseq314[visitseq] Visit SequenceStyle: CT visitIDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 8 Month 12Choice 2: 18 Month 12 (Cross)Choice 3: 88 OtherChoice 4: 38 Month 12 (2nd)Choice 5: 10 Month 24Choice 6: 40 Month 24 (2nd)
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID314[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
8 String initials314[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()
243
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Field Enter: Field Exit: ecGetInitials()Plate Exit:
9 Choice ctdevmigr[ctdevmigr] CT Device Migration (Right)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 String devmigrcomm[devmigrcomm] CT Dev Migration Comm (Right)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 255Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice ctadvr[ctadvr] CT Adverse Bone Rxn (Right)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 String ctadvcommr[ctadvcommr] CT Adv Bone Rxn Comm (Right)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 84Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter:
244
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Field Enter: Field Exit: Plate Exit:
13 Choice ctdevmigl[ctdevmigl] CT Device Migration (Left)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 String devmiglcomm[devmiglcomm] CT Dev Migration Comm (Left)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 255Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice ctadvl[ctadvl] CT Adverse Bone Rxn (Left)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 String ctadvcomml[ctadvcomml] CT Adv Bone Rxn Comm (Left)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 90Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter:
245
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Field Enter: Field Exit: Plate Exit:
17 String LCUser314[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 String LCDate314[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 String LCTime314[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 8 Store: 8Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: ecHideUser()Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 315 ((R1) 12 Mo CT, brid bone)
6 Choice visitseq315[visitseq] Visit SequenceStyle: CT visitIDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 8 Month 12Choice 2: 18 Month 12 (Cross)Choice 3: 88 OtherChoice 4: 38 Month 12 (2nd)
246
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Choice 5: 10 Month 24Choice 6: 40 Month 24 (2nd)
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID315[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
8 String initials315[initials] InitialsStyle: InitialsNeed: Required Hidden: No Reason level: 0Legal: Help: Initials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice ctbridboner[ctbridboner] CT Bridging Bone (Right)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 Present - adjacentBox 3: 3 Present - distantBox 4: 4 Present - adj and distBox 5: 5 IndeterminateBox 6: 6 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Choice ctbridbonel[ctbridbonel] CT Bridging Bone (Left)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 Absent
247
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Box 2: 2 Present - adjacentBox 3: 3 Present - distantBox 4: 4 Present - adj and distBox 5: 5 IndeterminateBox 6: 6 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 String ctbridbonecommr[ctbridbonecommr] CT Bridging Bone Comm (Right)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 32 Store: 64Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 String ctblidbonecomml[ctblidbonecomml] CT Bridging Bone Comm (Left)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 30 Store: 60Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Choice ctbridboneextr1[ctbridboneextr1] CT Bridging Bone Extent (Right, 1)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <5%Box 3: 3 5-15%Box 4: 4 15-30%Box 5: 5 30-100%Box 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice ctbridboneextr2[ctbridboneextr2] CT Bridging Bone Extent (Right, 2)Style: SimpleChoice
248
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Need: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <5%Box 3: 3 5-15%Box 4: 4 15-30%Box 5: 5 30-100%Box 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 Choice ctbridboneextr3[ctbridboneextr3] CT Bridging Bone Extent (Right, 3)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <5%Box 3: 3 5-15%Box 4: 4 15-30%Box 5: 5 30-100%Box 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice ctbridboneextr4[ctbridboneextr4] CT Bridging Bone Extent (Right, 4)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <5%Box 3: 3 5-15%Box 4: 4 15-30%Box 5: 5 30-100%Box 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Choice ctbridboneextl1[ctbridboneextl1] CT Bridging Bone Extent (Left, 1)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
249
Page 250
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <5%Box 3: 3 5-15%Box 4: 4 15-30%Box 5: 5 30-100%Box 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Choice ctbridboneextl2[ctbridboneextl2] CT Bridging Bone Extent (Left, 2)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <5%Box 3: 3 5-15%Box 4: 4 15-30%Box 5: 5 30-100%Box 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
19 Choice ctbridboneextl3[ctbridboneextl3] CT Bridging Bone Extent (Left, 3)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <5%Box 3: 3 5-15%Box 4: 4 15-30%Box 5: 5 30-100%Box 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Choice ctbridboneextl4[ctbridboneextl4] CT Bridging Bone Extent (Left, 4)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 NoneBox 2: 2 <5%
250
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Box 3: 3 5-15%Box 4: 4 15-30%Box 5: 5 30-100%Box 6: 6 IndeterminateBox 7: 7 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Number bridboneprop[bridboneprop] Bridging Bone Proportion (%)Style: SimpleNumberNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 3 Store: 3Format: nnn
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 String ctquantcomm[ctquantcomm] CT Quantitative Comm Brid BoneStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 60 Store: 120Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 String LCUser315[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 String LCDate315[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: None
251
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Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 String LCTime315[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 8 Store: 8Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: ecHideUser()Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 316 ((R1) 12 Mo CT, bone remod)
6 Choice visitseq316[visitseq] Visit SequenceStyle: CT visitIDNeed: Essential Hidden: No Reason level: 0Legal: Help:
No Choice: 0 Not checkedChoice 1: 8 Month 12Choice 2: 18 Month 12 (Cross)Choice 3: 88 OtherChoice 4: 38 Month 12 (2nd)Choice 5: 10 Month 24Choice 6: 40 Month 24 (2nd)
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID316[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
8 String initials316[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
252
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Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice ctboneremr[ctboneremr] CT Bone Remodeling (Right)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 String ctboneremcommr[ctboneremcommr] CT Bone Remod Comm (Right)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 28 Store: 112Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Choice ctbonereml[ctbonereml] CT Bone Remodeling (Left)Style: APIUNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 PresentBox 3: 3 IndeterminateBox 4: 4 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 String ctboneremcomml[ctboneremcomml] CT Bone Remod Comm (Left)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
253
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Display: 30 Store: 120Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 String LCUser316[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 String LCDate316[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
15 String LCTime316[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 8 Store: 8Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: ecHideUser()Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
Plate # 317 ((R1) 12 Mo CT, HO/other)
6 Choice visitseq317[visitseq] Visit SequenceStyle: CT visitIDNeed: Essential Hidden: No Reason level: 0Legal: Help:
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No Choice: 0 Not checkedChoice 1: 8 Month 12Choice 2: 18 Month 12 (Cross)Choice 3: 88 OtherChoice 4: 38 Month 12 (2nd)Choice 5: 10 Month 24Choice 6: 40 Month 24 (2nd)
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
7 Number ID317[ID] Patient numberStyle: Patient IDNeed: Essential Hidden: No Reason level: 1Legal: $(ids)Help: Site ID*1000 + ptID
Display: 6 Store: 6Format:
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
8 String initials317[initials] Init ialsStyle: Init ialsNeed: Required Hidden: No Reason level: 0Legal: Help: Init ials of patient
Display: 3 Store: 3Format:
Mapping: To UpperSkip: 0 fields if value equals
Plate Enter: ecGetInitials()Field Enter:
Field Exit: ecGetInitials()Plate Exit:
9 Choice cthor[cthor] CT Heterotopic Oss (Right)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 Present - islandsBox 3: 3 Present - spursBox 4: 4 Present - island & spursBox 5: 5 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
10 Check hosaccanr[hosaccanr] HO: Sacral Canal (Right)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0
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Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
11 Check hosacforr[hosacforr] HO: Sacral Neural Foramen (Right)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
12 Check hointrapr[hointrapr] HO: Intrapelvic (Right)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
13 Check hoextrapr[hoextrapr] HO: Extrapelvic (Right)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
14 Choice hogt2r[hogt2r] HO: >2 mm (Right)Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
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Field Exit: Plate Exit:
15 String cthocommr[cthocommr] HO: Comments (Right)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 29 Store: 58Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
16 Choice cthol[cthol] CT Heterotopic Oss (Left)Style: SimpleChoiceNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 AbsentBox 2: 2 Present - islandsBox 3: 3 Present - spursBox 4: 4 Present - island & spursBox 5: 5 Unable to assess
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
17 Check hosaccanl[hosaccanl] HO: Saclal Canal (Left)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
18 Check hosacforl[hosacforl] HO: Saclal Neural Foramen (Left)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
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19 Check hointrapl[hointrapl] HO: Intrapelvic (Left)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
20 Check hoextrapl[hoextrapl] HO: Extrapelvic (Left)Style: SimpleCheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
Check Off: 0 UncheckedCheck On: 1 Checked
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
21 Choice hogt2l[hogt2l] HO: >2 mm (Left)Style: YN CheckNeed: Optional Hidden: No Reason level: 0Legal: Help:
No Box: 0 Not checkedBox 1: 1 YesBox 2: 2 No
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
22 String cthocomml[cthocomml] HO: Comments (Left)Style: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 29 Store: 255Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
23 String ctextracomm[ctextracomm] CT Extra CommentsStyle: SimpleStringNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 65 Store: 555
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Format: Mapping: None
Skip: 0 fields if value equals Plate Enter: Field Enter:
Field Exit: Plate Exit:
24 String LCUser317[LCUser] Last Change UsernameStyle: LCUserNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 20Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
25 String LCDate317[LCDate] Last Change (Date)Style: LCDateNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 12 Store: 12Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: Field Enter:
Field Exit: Plate Exit:
26 String LCTime317[LCTime] Last Change (Time)Style: LCTimeNeed: Optional Hidden: No Reason level: 0Legal: Help:
Display: 8 Store: 8Format:
Mapping: NoneSkip: 0 fields if value equals
Plate Enter: ecHideUser()Field Enter:
Field Exit: Plate Exit: ecSaveUser(); DataNotification()
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Style Properties
[A listing of all properties locked in each style]
Study # 1 (INSITE)
Check SimpleCheckCheck Off: 0 UncheckedCheck On: 1 Checked
Choice SimpleChoice
Date SimpleDateDisplay: 8 Store: 8Format: yy/mm/dd
Year: InheritImpute: Inherit
Date SimpleDateYYYYDisplay: 10 Store: 10Format: yyyy/mm/dd
Year: InheritImpute: Inherit
Number SimpleNumber
String SimpleString
VAS SimpleVAS
Number AE IDName: AEID$(plate)[AEID]
Description: Adverse Event IDValue is: Essential
Legal: 301-340
Choice APIU
Choice apposition
Number Body SystemLegal: 1-14
Choice CT visitID
Number Dev Malf IDName: devmalID$(plate)[devmalID]
Description: Device Malfunction IDValue is: Essential
Legal: 501-510
Choice devbreachNo Choice: 0 Not checked
Choice 1: 1 AbsentChoice 2: 2 Present - sacral canalChoice 3: 3 Present - sacral foramenChoice 4: 4 Present - anterior sacrumChoice 5: 5 Present - other
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Choice 6: 6 IndeterminateChoice 7: 7 Unable to assess
Number Deviation IDName: devID[devID]
Description: Deviation IDValue is: Required
Legal: 201-240
Choice DSIJQValue is: Required
Legal: 0-5No Choice: 99 Not checked
Choice 1: 0 0Choice 2: 1 1Choice 3: 2 2Choice 4: 3 3Choice 5: 4 4Choice 6: 5 5
Choice DSIJQ VisitIDNo Choice: 999 Not checked
Choice 1: 1 BaselineChoice 2: 6 Month 3Choice 3: 7 Month 6Choice 4: 8 Month 12Choice 5: 10 Month 24Choice 6: 16 Month 3 (C)Choice 7: 17 Month 6 (C)Choice 8: 18 Month 12 (C)Choice 9: 20 Month 24 (C)
Choice eq5d
Choice EQ5DVisitIDNo Choice: 0 Not checked
Choice 1: 1 BaselineChoice 2: 4 Month 3Choice 3: 5 Month 6Choice 4: 6 Month 12Choice 5: 8 Month 24Choice 6: 14 Month 3 (c)Choice 7: 15 Month 6 (c)Choice 8: 16 Month 12 (c)Choice 9: 18 Month 24 (c)
Choice FU Visit IDNo Choice: 0 Not checked
Choice 1: 5 Month 1Choice 2: 6 Month 3Choice 3: 7 Month 6Choice 4: 8 Month 12Choice 5: 9 Month 18Choice 6: 10 Month 24Choice 7: 15 Month 1 (C)Choice 8: 16 Month 3 (C)Choice 9: 17 Month 6 (C)
Choice 10: 18 Month 12 (C)Choice 11: 19 Month 18 (C)Choice 12: 20 Month 24 (C)
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Choice 13: 35 Mo 1 (2)Choice 14: 36 Mo 3 (2)Choice 15: 37 Mo 6 (2)Choice 16: 38 Mo 12 (2)Choice 17: 39 Mo 18 (2)Choice 18: 40 Mo 24 (2)Choice 19: 1 Baseline
Number HourLegal: 0-23
String InitialsName: init ials$(plate)[init ials]
Description: Init ialsDisplay: 3 Store: 3
Plate Enter:
ecGetInitials()
Field Exit: ecGetInitials()
Choice Inv Visit IDNo Choice: 99 Not checked
Choice 1: 0 ScreeningChoice 2: 1 BaselineChoice 3: 2 ProcedureChoice 4: 3 DischargeChoice 5: 5 Month 1Choice 6: 6 Month 3Choice 7: 7 Month 6Choice 8: 8 Month 12Choice 9: 9 Month 18
Choice 10: 10 Month 24Choice 11: 12 Proc (2)Choice 12: 13 Disch (2)Choice 13: 15 Month 1 (2)Choice 14: 16 Month 3 (2)Choice 15: 17 Month 6 (2)Choice 16: 18 Month 12 (2)Choice 17: 19 Month 18 (2)Choice 18: 20 Month 24 (2)Choice 19: 21 Miscellaneous
Number Invoice IDName: invoiceID$(plate)[invoiceID]
Description: Invoice IDValue is: Required
Legal: 701-720
String LCDateName: LCDate$(plate)[LCDate]
Description: Last Change (Date)Display: 12 Store: 12
String LCTimeName: LCTime$(plate)[LCTime]
Description: Last Change (Time)Plate Exit: ecSaveUser(); DataNotification()
String LCUserName: LCUser$(plate)[LCUser]
Description: Last Change Username
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Value is: Optional Hidden: No Reason level: 0Display: 12 Store: 20
Number MinutesLegal: 0-59
Number MonthLegal: 1-12
Number Motor Exam FindLegal: 0-5
Number myDOBName: mydob$(plate)[mydob]
Description: Month Year DOB
Number Narr IDName: narrID$(plate)[narrID]
Description: Narrative IDValue is: Essential
Legal: 401-420
Choice Norm AbnormNo Choice: 0 Not checked
Choice 1: 1 NormalChoice 2: 2 Abnormal
Number NRSValue is: Required
Legal: 0-10
Choice NY CheckNo Choice: 0 Not checked
Choice 1: 2 NoChoice 2: 1 Yes
Number ODI 0-5Value is: Required
Legal: 0-5
Choice ODI 0-5_99Value is: Required
Legal:
Number Patient IDName: ID$(plate)[ID]
Description: Patient numberReason
level: 1
Legal: $(ids)Help: Site ID*1000 + ptID
Choice payment ID
Choice Phys Exam Find
Number QOL Visit ID
Choice radiolucCT
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Choice Relatedness
Number revisionIDName: AEID$(plate)[AEID]
Description: Adverse Event IDValue is: Essential
Legal: 521-525
Choice Right Left
Choice RightLeftBoth
Choice SBW
Choice Service Type
Number SF36 1-3Legal: 1-3
Number SF36 1-5Legal: 1-5
Number SF36 1-6Legal: 1-6
Choice SuffInsuffNo Choice: 0 Not checked
Choice 1: 1 SufficientChoice 2: 2 Insufficient
Number Unsched VisitIDName: unsvisitID$(plate)[unsvisitID]
Description: Unscheduled Visit IDValue is: Required
Legal: 601-620
Number VASLegal: 0-100
Date VisitDateValue is: Required
Legal: 01/JAN/01-todayDisplay: 9 Store: 9Format: dd/mmm/yy
Year: InheritImpute: Inherit
Choice Walk StatusNo Choice: 0 Not checked
Choice 1: 1 Ambulatory without assistanceChoice 2: 2 Ambulatory with assistive deviceChoice 3: 3 Cannot walk
Date WIC DateReason
level: 0
Legal: 01/JAN/12-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
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Year: Inherit
Date WIC Date HistReason
level: 0
Legal: 01/JAN/22-todayHelp:
Display: 9 Store: 9Format: dd/mmm/yy
Year: InheritPlate
Enter:
Field Enter: Field Exit: Plate Exit:
Date WIC Date ISOReason
level: 0
Legal: 2012/01/01-todayHelp:
Display: 10 Store: 10Format: yyyy/mm/dd
Year: InheritPlate
Enter:
Field Enter: Field Exit: Plate Exit:
Choice Work status
Choice xray visitIDNo Choice: 99 Not checked
Choice 1: 3 DischargeChoice 2: 6 Month 3Choice 3: 7 Month 6Choice 4: 10 Month 24Choice 5: 16 Month 3 (cross)Choice 6: 17 Month 6 (cross)Choice 7: 20 Month 24 (cross)Choice 8: 36 Month 3 (2)Choice 9: 37 Month 6 (2)
Choice 10: 40 Month 24 (2)
Number YearLegal: 1920-2014
Choice YN Check
Choice YN NANo Choice: 0 Not checked
Choice 1: 1 YesChoice 2: 2 NoChoice 3: 3 NA
Choice YYNNo Choice: 0 Not checked
Choice 1: 1 Yes, part of 6 mo visitChoice 2: 2 Yes, unsch visit
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Choice 3: 3 No
Choice Zung
Choice ZungBack
7
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