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OrderCDASH Variable Name Question TextPromptCRF Completion InstructionsSDTMIG Target VariableSDTM Target MappingControlled Terminology Code List NamePermissible ValuesPre-Populated Value
1SCPERFWere subject characteristics collected?Subject Characteristics CollectedIndicate if subject characteristics information was collected. If Yes, record the appropriate details.SCSTATIf SCPERF = "Y", NOT SUBMITTED. If SCPERF = "N", SCSTAT where SCTESTCD = "SCALL".(NY)Yes; No
2EDLEVEL_SCORRESWhat is the subject's education level?Education LevelIndicate the subject's education level.SCORRES;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 EducationLAST ATTEMPTED USE WITH THIS MEDICATION
3JOBCLAS_SCORRESWhat is the subject’s employment status?Employment StatusIndicate the subject's employment status.SCORRESSCORRES WHERE SCTESTCD = "JOBCLAS"(EMPSTAT)Full-time; Part-time; Not employed
4INCOME_SCORRESWhat is the subject's income?Income Indicate the subject's  income.SCORRESSCORRES WHERE SCTESTCD = "INCOME"

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


5MARISTAT_SCORRESWhat is the subject's marital status?Marital StatusIndicate the subject's marital status.SCORRESSCORRES WHERE SCTESTCD = "MARISTAT"(MARISTAT)Never Married; Married; Legally Separated; Divorced; Widowed
6NATORIG_SCORRESWhat is the subject's national origin status?National OriginIndicate the subject's national origin SCORRESSCORRES WHERE SCTESTCD = "NATORIG"


7MILTSTAT_SCORRESWhat is the subject’s military status ?Military StatusIndicate the subject's military status.SCORRESSCORRES WHERE SCTESTCD = "MILTSTAT"

NO MILITARY SEVICE;

ACTIVE SERVICE;

VETERAN;


8SECHNDTB_SCORRESWas the subject exposed  to second hand smoke ?Second Hand Smoke Exposure  Indicate the subject's exposure to second hand smoke SCORRESSCORRES WHERE SCTESTCD = "SECHNDTB"

No Exposure to Second Hand smoke; 

Exposure at Home only; 

Exposure at work only; 

Exposure at Work and Home; 


9AGESTSMK__SCORRESWhat was the age of the subject when they started smoking?  Age Started SmokingRecord the Age Category when the subject started smokingSCORRESSCORRES WHERE SCTESTCD = "AGESTSMK"
16-24 years; 25-34 years; 45–64 years; 65 years and older
10TBCESSCO__SCORRESDid the subject have any tobacco cessation counseling?Tobacco Cessation Counseling Indicate whether the subject had previous tobacco cessation counseling.SCORRESSCORRES WHERE SCTESTCD = "TBCESSCO"(NY)Yes; No
11LDURABS__SCORRESWhat is the longest duration of previous abstinence from tobacco use? Longest Duration of  AbstinenceRecord the longest duration of tobacco abstinenceSCORRESSCORRES WHERE SCTESTCD = "LDURABS"
≤7 days; 8–28 days;1–6 months;  >6 months 

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