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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



Indicate if subject characteristics information was collected. If Yes, record the appropriate details.Were subject characteristics collected?
SCPERF If SCPERF = "Y", NOT SUBMITTED. If SCPERF = "N", SCSTAT where SCTESTCD = "SCALL".
<NY codelist>
Indicate the subject's education level.Education Level
EDLEVEL_SCORRES SCORRES WHERE SCTESTCD = "EDLEVEL"
Indicate the subject's employment status.Employment Status
JOBCLAS_SCORRES SCORRES WHERE SCTESTCD = "JOBCLAS"
<EMPSTAT codelist>
Indicate the subject's income .What is the subject's income?
INCOME_SCORRES SCORRES WHERE SCTESTCD = "INCOME"
Indicate the subject's marital status.Marital Status
MARISTAT_SCORRES SCORRES WHERE SCTESTCD = "MARISTAT"
<MARISTAT codelist>
Indicate the subject's national origin
NATORIG_SCORRES SCORRES WHERE SCTESTCD = "NATORIG"
_________________
Indicate the subject's military status.Military Status
JOBCLAS_SCORRES SCORRES WHERE SCTESTCD = "MILTSTAT"
Indicate the subject's exposure to second hand smokeWas the subject exposed to second hand smoke ?
SECHNDTB_SCORRES SCORRES WHERE SCTESTCD = "SECHNDTB"
Record the Age Category when the subject started smokingWhat was the age of the subject when they started smoking?
AGESTSMK__SCORRES SCORRES WHERE SCTESTCD = "AGESTSMK"
Indicate whether the subject had previous tobacco cessation counseling.Did the subject have any tobacco cessation counseling
TBCESSCO SCORRES WHERE SCTESTCD = "TBCESSCO"
<NY codelist>
Record the Longest Duration of Tobacco AbstinenceWhat is the longest duration of previous abstinence from tobacco use?
LDURABS SCORRES WHERE SCTESTCD = "LDURABS"
CDASH VariableOrderQuestion TextPromptCRF Completion InstructionsTypeSDTMIG Target VariableSDTM Target MappingControlled Terminology Code List NamePermissible ValuesPre-Populated ValueQuery DisplayList StyleHidden
SCPERF1Were subject characteristics collected?Subject Characteristics CollectedIndicate if subject characteristics information was collected. If Yes, record the appropriate details.TextSCSTATIf SCPERF = "Y", NOT SUBMITTED. If SCPERF = "N", SCSTAT where SCTESTCD = "SCALL".(NY)Yes; No



EDLEVEL_SCORRES2What is the subject's education level?Education LevelIndicate the subject's education level.TextSCORRES;SCTEST;SCTESTCDSCORRES 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
promptradio
JOBCLAS_SCORRES3What is the subject’s employment status?Employment StatusIndicate the subject's employment status.TextSCORRES;SCTEST;SCTESTCDSCORRES WHERE SCTESTCD = "JOBCLAS"(EMPSTAT)Full-time; Part-time; Not employed
promptradio
INCOME_SCORRES4What is the subject's income?Income Indicate the subject's  income .TextSCORRES;SCTEST;SCTESTCDSCORRES WHERE SCTESTCD = "INCOME"

<100% poverty guideline.;100-200% poverty guidelines; >200% poverty guidelines;





MARISTAT_SCORRES5What is the subject's marital status?Marital StatusIndicate the subject's marital status.TextSCORRES;SCTEST;SCTESTCDSCORRES WHERE SCTESTCD = "MARISTAT"(MARISTAT)Never Married; Married; Legally Divorced; Divorced; Widowed
promptradio
NATORIG_SCORRES6What is the subject's national origin status?National OriginIndicate the subject's national origin TextSCORRES;SCTEST;SCTESTCDSCORRES WHERE SCTESTCD = "NATORIG"





JOBCLAS_SCORRES7What is the subject’s military status ?Military StatusIndicate the subject's military status.TextSCORRES;SCTEST;SCTESTCDSCORRES WHERE SCTESTCD = "MILTSTAT"

NO MILITARY SEVICE;

ACTIVE SERVICE;

VETERAN;


promptradio
SECHNDTB_SCORRES8Was the subject exposed  to second hand smoke ?Second Hand Smoke Exposure  Indicate the subject's exposure to second hand smoke TextSCORRES;SCTEST;SCTESTCDSCORRES WHERE SCTESTCD = "SECHNDTB"

No Exposure to Second Hand smoke; 

Exposure at Home only; 

Exposure at work only; 

Exposure at Work and Home; 



radio
AGESTSMK__SCORRES9What was the age of the subject when they started smoking?  Age Started SmokingRecord the Age Category when the subject started smoking
SCORRES;SCTEST;SCTESTCDSCORRES WHERE SCTESTCD = "AGESTSMK"
16-24 years; 25-34 years; 45–64 years; 65 years and older

radio
TBCESSCO10Did  the subject have any tobacco cessation counselingAny Tobacco Cessation Counseling Indicate whether the subject had previous tobacco cessation counseling.
SCORRES;SCTEST;SCTESTCDSCORRES WHERE SCTESTCD = "TBCESSCO"(NY)Yes; No



LDURABS11What is the longest duration of previous abstinence from tobacco use? Longest Duration of  AbstinenceRecord the Longest Duration of Tobacco Abstinence
SCORRES;SCTEST;SCTESTCD where SCAT= "TOBACCO"SCORRES WHERE SCTESTCD = "LDURABS"
≤7 days; 8–28 days;1–6 months;  >6 months 




This is an example of the SDTM dataset based on the data collected on the above CRF.  

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RowSTUDYIDDOMAINUSUBJIDSCSEQSCTESTCDSCTESTSCORRESSCSTRESCSCSTATSCDTC
1ABCSCABC-001-0011NATORIGNational OriginUNITED STATESUSA
1999-06-19
2ABCSCABC-001-0012MARISTATMarital StatusDIVORCEDDIVORCED
1999-06-19
3ABCSCABC-001-0013EDLEVELEducational LevelCOLLEGE OR BACCALAURETE DEGREE COMPLETECOLLEGE OR BACCALAURETE DEGREE COMPLETE
1999-06-19
4ABCSCABC-001-0014MILTSTATMilitary Status VETERANVETERAN
1999-06-19
5ABCSCABC-001-0015JOBCLASEmployment StatusNOT EMPLOYEDNOT EMPLOYED
1999-06-19
6ABCSCABC-001-0016SECHNDTBSecond Hand Smoke Exposure  EXPOSURE AT WORK AND HOMEEXPOSURE AT WORK AND HOME
1999-06-19





INCOMEIncome <100% POVERTY GUIDELINES<100% POVERTY GUIDELINES
1999-06-19
7ABCSCABC-001-0021SCALLSUBJECT CHARACTERISTICS

NOT DONE2000-08-19
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