This is an example CRF used to collect some basic subject characteristics data.
Longest duration of previous abstinence ≤7 days,8–28 days,1–6 months, >6 months
Number Alcoholic drinks in last 7 days, n (%) IN SU--- 1-3, 4-6 7-9, >10
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| 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 |
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| | 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; |
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| | MARISTAT_SCORRES | 5 | 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 | 6 | What is the subject's national origin status? | National Origin | Indicate the subject's national origin | Text | SCORRES;SCTEST;SCTESTCD | SCORRES WHERE SCTESTCD = "NATORIG" |
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| | JOBCLAS_SCORRES | 7 | 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_SCORRES | 8 | 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; |
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| radio |
| | AGESTSMK__SCORRES | 9 | What was the age of the subject when they started smoking? | Age Started Smoking | Record the Age Category when the subject started smoking |
| SCORRES;SCTEST;SCTESTCD | SCORRES WHERE SCTESTCD = "AGESTSMK" |
| 16-24 years :25-34 years;45–64 years ;65 years and older |
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| 10 | Did the subject have any tobacco cessation counseling |
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