CDEs
Forms
PROMIS Adult Short Form 6b Pain Interference v1.0 PAININ26 Past 7 Days How Often Did Pain Prevented Socializing with Others Score 5 Point Scale
Substance Abuse Prescription Illicit Substance Over the Counter Product Concurrent Use Personal Medical History Yes No Indicator
Substance Abuse Prescription Illicit Substance Past Year Personal Medical History Count
Marital Status Description Type
Substance Abuse Illicit Substance Opioid Personal Medical History Frequency
PROMIS Parent Proxy Short Form 8 Pain Interference v1.0 Pf2pain4 Past 7 Days Child Had Trouble Running When in Pain Score 5 Point Scale
Mental Health Not Good Past 30 Day Count
Substance Abuse Prescription Illicit Substance Over the Counter Product Blackout Flashbacks Personal Medical History Yes No Indicator
Substance Abuse Prescription Illicit Substance Over the Counter Product Substance Withdrawal Syndrome Personal Medical History Yes No Indicator
Substance Abuse Illicit Substance Other Substance of Abuse Personal Medical History Frequency
Timeline Followback Method Illicit Substance Benzodiazepines Assessment Yes No Indicator
Timeline Followback Method Illicit Substance Cocaine Assessment Yes No Indicator
Substance Abuse Prescription Illicit Substance Over the Counter Product Associated Disease or Disorder Personal Medical History Yes No Indicator
Timeline Followback Method Illicit Substance Crack Cocaine Assessment Yes No Indicator
PROMIS Parent Proxy Short Form 8 Pain Interference v1.0 Pf4pain6 Past 7 Days Child Had Trouble Staying Standing When in Pain Score 5 Point Scale
Timeline Followback Method Illicit Substance Inhalants Assessment Yes No Indicator
Substance Abuse Illicit Substance Other Substance of Abuse Personal Medical History Specify
Substance Abuse Prescription Illicit Substance Over the Counter Product Crime Obtain Personal Medical History Yes No Indicator
Timeline Followback Method Illicit Substance Other Substance of Abuse Assessment Yes No Indicator
Other Pacific Islander Race Category Specify
1
2
3
4
5
6