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Form: ADAPTABLE patient reported item set [ADAPTABLE]

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Enrollment item set [ADAPTABLE]

Have you had a severe bleeding problem in the past with aspirin?
If you are currently taking aspirin, are you willing to change the dose?
Are you currently taking any of these anticoagulant medications?
Are you currently pregnant?
Are you currently nursing?
In general, how would you describe your current health?
I am able to run errands and shop
I felt depressed in past 7 days
I feel fatigued during the past 7 days
I had a problem with my sleep 7 days
I have trouble doing all of my regular leisure activities with others in the past 7 days
How much did pain interfere with your day to day activities in past 7 days?
How would you rate your overall experience in using the ADAPTABLE web site today?
Did the information provided and time spent reading the Adaptable web site feel:
Gender

Early visit item set [ADAPTABLE]

You have my permission to send text reminder messages for upcoming visits to my cell phone number. (There may be a charge for this)
Race
Is your ethnicity Hispanic?
Are you covered through Medicare?
Select your insurance provider:
Are you currently a cigarette smoker (at least one cigarette a day)?
Before joining ADAPTABLE were you regularly taking aspirin?
What dosage were you taking BEFORE joining ADAPTABLE?
Now that you are a part of ADAPTABLE are you regularly taking aspirin?
Which dose are you taking?
Is your aspirin tablet enteric coated?
Why did you stop taking aspirin?
Are you currently taking any of these blood thinning medications?
Are you currently taking any nonsteroidal anti-inflammatory drugs (NSAIDs) several times a week?
Are you currently taking any of these medications that are typically for stomach upset?
Have you been hospitalized since you joined the ADAPTABLE study?
Reason for hospitalization [Type]
Did any of the following occur during the hospitalization?

Follow-up visit item set [ADAPTABLE]

Now that you are a part of ADAPTABLE are you regularly taking aspirin?
Which dose are you taking?
Is your aspirin tablet enteric coated?
Why did you stop taking aspirin?
Are you currently taking any of these blood thinning medications?
Are you currently taking any nonsteroidal anti-inflammatory drugs (NSAIDs) several times a week?
Are you currently taking any of these medications that are typically for stomach upset?
Have you been hospitalized since you joined the ADAPTABLE study?
Reason for hospitalization [Type]
Did any of the following occur during the hospitalization?
Form is copyrighted, but can be freely used. More information can be found at the provided link(s)

General Details

Name:
ADAPTABLE patient reported item set [ADAPTABLE]
Description:
ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) aims to identify the optimal dose of aspirin therapy for secondary prevention in atherosclerotic cardiovascular disease. The set of patient report items is part of a project to develop, pilot and evaluate methods to validate and integrate patient-reported information with data obtained from the EHR in the context of the ADAPTABLE.
Used By:
External Forms
Is a Bundle:
No
Copyrighted:
Form is copyrighted, but can be freely used. More information can be found at the provided link(s)
Origin:
Version:
2
Steward:
NLM
Last import:
09/20/2018 @ 7:13PM
Created:
09/20/2018 @ 7:13PM
Updated:
11/13/2018 @ 4:39PM
Name:
LOINC
Registration Status:
Trial – caution, may change

Status

Registration Status:
Qualified
Administrative Status:
Published
Publish Date:
09/20/2018

Other Names & Definitions

Name:
ADAPTABLE patient reported item set [ADAPTABLE]
Tags:
Name Source:

Definitions

Definition:
ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) aims to identify the optimal dose of aspirin therapy for secondary prevention in atherosclerotic cardiovascular disease. The set of patient report items is part of a project to develop, pilot and evaluate methods to validate and integrate patient-reported information with data obtained from the EHR in the context of the ADAPTABLE.
Tags:
Name Source:

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Properties

RELATED NAMES:
PanPanlRandom
PanelPnlSURVEY.GNHLTH

Fully-Specified Name:
ComponentPropertyTimeSystemScaleMethod
ADAPTABLE patient reported item set-Pt^Patient-ADAPTABLE

BASIC ATTRIBUTES:
Class/TypePanel TypeFirst Released in VersionLast Updated in VersionOrder vs ObsStatus
PANEL.SURVEY.GNHLTH/SurveyPanel2.642.64OrderTrial – caution, may change

BASIC ATTRIBUTES:
OrganizationCopyrightTerms of UseURL
PROMISCopyright © 2010 PROMIS Health Organization or other individuals/entities that have contributed information and materials to Assessment Center, and are being used with the permission of the copyright holders.Use of PROMIS instruments (e.g., item banks, short forms, profile measures) are subject to the PROMIS Terms and Conditions available at: http://www.assessmentcenter.net/TandC.aspxhttp://www.healthmeasures.net/explore-measurement-systems/promis

LOINC_Copyright:
Copyright © 2018 Regenstrief Institute, Inc. All Rights Reserved. To the extent included herein, the LOINC table and LOINC codes are copyright © 1995-2018, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee.

LOINC_3rd_Party_Copyright:
Code System: http://snomed.info/sct This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. “SNOMED” and “SNOMED CT” are registered trademarks of the IHTSDO. This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov. Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org. This may incur a fee in SNOMED International non-Member countries.

Identifiers

SourceIdVersion
NLM71NfcK7ImL2
LOINC89070-72.64

History

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