LTR

Metadata Report

Medical History Questionnaire(MHQ)
Version 1.00

Key FieldField NameFull NameQuestion TextTypeLength and DecimalsExpected
*SITECenterC5Yes
*PROTProtocolC5Yes
*PROJIDParticipant IDC5Yes
*PROTSEGSegmentC1Yes
*DTASSESSDate of assessmentD8Yes
MHQANGINAnginaAngina:C1Yes
MHQHRTFLHeart failureHeart failure (congestive heart failure or congestive heart disease):C1Yes
MHQTHROMThromboembolicThromboembolic (blood clots in leg of lung):C1Yes
MHQARTHArrhythmiaArrhythmia (irregular heart beat):C1Yes
MHQHYPHyperlipidemiaHyperlipidemia (high cholesterol):C1Yes
MHQRENRenal failureRenal failure (kidney failure):C1Yes
MHQHEPAHepatitisHepatitis (liver infection or inflammation):C1Yes
MHQCIRRHCirrhosis or otherCirrhosis or other serious, chronic liver disease:C1Yes
MHQDIABDiabetesDiabetes:C1Yes
MHQHIVHIVHIV:C1Yes
MHQLCANCLung CancerLung Cancer:C1Yes
MHQOTCANOther CancerOther Cancer (excluding basal cell carcinoma):C1Yes
MHQCANSPCancer specifyIf Yes, specify:C100Yes
MHQRARheumatoid ArthritisRheumatoid Arthritis:C1Yes
MHQSCLSclerodermaScleroderma:C1Yes
MHQLUPUSLupusLupus:C1Yes
MHQPOLYMPolymyositisPolymyositis:C1Yes
MHQOTVASOther collagen vascularOther collagen vascular disease:C1Yes
MHQCOLSPCollagen specifyIf Yes, specify:C100Yes
MHQGERDGERDGastroesophageal Reflux Disease (GERD):C1Yes
MHQASTHAsthmaAsthma:C1Yes
MHQASTDRAsthma confirmedWas it confirmed by doctor?C1Yes
MHQPLHTNPulmonary HypertensionPulmonary Hypertension:C1Yes
MHQBRNAttacks of bronchitisHave you ever had attacks of bronchitis?C1Yes
MHQBRNDRBronchitis confirmedWas it confirmed by a doctor?C1Yes
MHQBRNAGBronch first attack ageAt what age was your first attack?N2(0)Yes
MHQBAUKAttack age unknownC1No
MHQRESPFRespiratory failureHave you ever had respiratory failure requiring a ventilator?C1Yes
MHQWTLOSWeight lossHave you unexpectedly lost a lot of weight in the past three months? (A lot is 10% or more of your body weight):C1Yes
MHQTRACHTracheotomy TracheostomyTracheotomy/Tracheostomy:C1Yes
MHQREMOVRemoval of lungBullectomy, pneumonectomy or lobectomy (removal of all or part of the lung)/Prior surgical lung biopsy:C1Yes
MHQLRUKLung procedure unknownWhich lung(s) and lobe(s) did you have the procedure on? (Please check all that apply).C1No
MHQRTUPRight upperRight upper:C1Yes
MHQRTMIDRight middleRight middle:C1Yes
MHQRTLOWRight lowerRight lower:C1Yes
MHQLTUPLeft upperLeft upper:C1Yes
MHQLINGULingulaLingula:C1Yes
MHQLTLOWLeft lowerLeft lower:C1Yes
MHQANYOTAny other chest operationAny other chest operations?C1Yes
MHQANYSPChest operation specifyIf Yes, specify:C100Yes
MHQINJURAny chest injuriesHave you ever had any chest injuries?C1Yes
MHQINJSPChest injury specifyIf Yes, specify:C100Yes
MHQCCOPDCurrent COPDChronic Obstructive Pulmonary Disease (COPD):C1Yes
MHQCBRNCurrent BronchitisChronic Bronchitis:C1Yes
MHQCEMPHCurrent EmphysemaEmphysema:C1Yes
MHQCASTHCurrent AsthmaAsthma:C1Yes
MHQCA1ADCurrent A1ADDo you have alpha-1 antitrypsin deficiency?C1Yes
MHQFIBROCurrent fibrotic lung disHas a doctor told you that you have a fibrotic lung disease?C1Yes
MHQFDOCFibrotic lung documentWas the fibrotic lung disease documented by surgical biopsy?C1Yes
MHQCOMMCommentsComments:M4No