| CDASH Variable | Order | Question Text | Prompt | CRF Completion Instructions | Type | SDTMIG Target Variable | SDTM Target Mapping | Controlled Terminology Code List Name | Permissible Values | Pre-Populated Value | Query Display | List Style | Hidden |
| SCPERF | 1 | Were subject characteristics collected? | Subject Characteristics Collected | Indicate if subject characteristics information was collected. If Yes, record the appropriate details. | Text | SCSTAT | If SCPERF = "Y", NOT SUBMITTED. If SCPERF = "N", SCSTAT where SCTESTCD = "SCALL". | (NY) | Yes; No |
|
|
|
|
| EDLEVEL_SCORRES | 2 | What is the subject's education level? | Education Level | Indicate the subject's education level. | Text | SCORRES;SCTEST;SCTESTCD | SCORRES WHERE SCTESTCD = "EDLEVEL" |
| Did not complete Secondary School or Less than High School; Some Secondary School or High School Education; High School or Secondary School Degree Complete; Associate’s or Technical Degree Complete; College or Baccalaureate Degree Complete; Doctoral or Postgraduate Education |
| prompt | radio |
|
| JOBCLAS_SCORRES | 3 | What is the subject’s employment status? | Employment Status | Indicate the subject's employment status. | Text | SCORRES;SCTEST;SCTESTCD | SCORRES WHERE SCTESTCD = "JOBCLAS" | (EMPSTAT) | Full-time; Part-time; Not employed |
| prompt | radio |
|
| INCOME_SCORRES | 4 | What is the subject's income? | Income | Indicate the subject's income . | Text | SCORRES;SCTEST;SCTESTCD | SCORRES WHERE SCTESTCD = "INCOME" |
| <100% poverty guideline.;100-200% poverty guidelines; >200% poverty guidelines; |
|
|
|
|
| MARISTAT_SCORRES | 45 | What is the subject's marital status? | Marital Status | Indicate the subject's marital status. | Text | SCORRES;SCTEST;SCTESTCD | SCORRES WHERE SCTESTCD = "MARISTAT" | (MARISTAT) | Never Married; Married; Legally Divorced; Divorced; Widowed |
| prompt | radio |
|
| NATORIG_SCORRES | 56 | What is the subject's national origin status? | National Origin | Indicate the subject's national origin | Text | SCORRES;SCTEST;SCTESTCD | SCORRES WHERE SCTESTCD = "NATORIG" |
|
|
|
|
|
|
| JOBCLAS_SCORRES | 67 | What is the subject’s military status ? | Military Status | Indicate the subject's military status. | Text | SCORRES;SCTEST;SCTESTCD | SCORRES WHERE SCTESTCD = "MILTSTAT" | (xxxxx) | NO MILITARY SEVICE; ACTIVE SERVICE; VETERAN; |
| prompt | radio |
|
| SECHNDTB | 78 | Was the subject exposed to second hand smoke ? | Second Hand Smoke Exposure | Indicate the subject's exposure to second hand smoke | Text | SCORRES;SCTEST;SCTESTCD | SCORRES WHERE SCTESTCD = "SECHNDTB" |
| No Exposure to Second Hand smoke; Exposure at Home only; Exposure at work only; Exposure at Work and Home; |
|
| radio |
|