crf1a2_version |
|
radio |
CRF1 Version Completed |
1, Unversioned ; 2, 1.0 ; 3, 1.1 ; 4, 1.2 ; 5, 1.3 ; 6, 1.4 ; 7, 1.5 ; 8, 2.0 |
crf1a_com_card_mi |
Cardiovascular |
yesno |
i) Myocardial Infarction |
1, Yes ; 0, No |
crf1a_com_card_ihd |
|
yesno |
ii) Ischaemic Heart Disease |
1, Yes ; 0, No |
crf1a_com_card_af |
|
yesno |
iii) Atrial fibrillation |
1, Yes ; 0, No |
crf1a_com_card_ht |
|
yesno |
iv) Hypertension |
1, Yes ; 0, No |
crf1a_com_card_chf |
|
yesno |
v) Congestive heart failure |
1, Yes ; 0, No |
crf1a_com_card_chd |
|
yesno |
vi) Congenital heart disease |
1, Yes ; 0, No |
crf1a_com_card_vhd |
|
yesno |
vii) Valvular Heart Disease |
1, Yes ; 0, No |
crf1a_com_card_pid |
|
yesno |
viii) Pacemaker/Implantable defibrillator |
1, Yes ; 0, No |
crf1a_com_card_pvd |
|
yesno |
ix) Peripheral vascular disease |
1, Yes ; 0, No |
crf1a_com_card_hcd |
|
yesno |
x) Hypercholesterolaemia/dyslipidaemia |
1, Yes ; 0, No |
crf1a_com_card_catia |
|
radio |
xi) Cerebrovascular accident or transient ischemic attack |
1, Previous but no residual weakness ; 2, Previous with residual hemiplegia ; 0, No |
crf1a_com_card_other_yn |
|
yesno |
xii) Other chronic cardiovascular disease |
1, Yes ; 0, No |
crf1a_com_card_other |
|
notes |
xii) Other chronic cardiovascular disease - Detail |
|
crf1a_com_neupsy_dem |
Neurological and Psychiatric |
yesno |
i) Dementia |
1, Yes ; 0, No |
crf1a_com_neupsy_other_yn |
|
yesno |
ii) Any other chronic neurological disorder |
1, Yes ; 0, No |
crf1a_com_neupsy_da |
|
yesno |
iii) Depression or Anxiety |
1, Yes ; 0, No |
crf1a_com_neupsy_chron |
|
yesno |
iv) Chronic fatigue syndrome, fibromyalgia or chronic pain |
1, Yes ; 0, No |
crf1a_com_neupsy_pam |
|
yesno |
v) Any previous treatment with antidepressant medication |
1, Yes ; 0, No |
crf1a_com_neupsy_ptm |
|
yesno |
vi) Any previous treatment by a mental health professional (eg. psychologist, psychiatrist, councillor) for a mental health problem |
1, Yes ; 0, No |
crf1a_com_neupsy_other |
|
notes |
Other chronic neurological disorder |
|
crf1a_com_res_copd |
Respiratory |
yesno |
i) Chronic obstructive pulmonary disease |
1, Yes ; 0, No |
crf1a_com_res_ast |
|
yesno |
ii) Asthma |
1, Yes ; 0, No |
crf1a_com_res_ild_yn |
|
yesno |
iii) Interstitial lung disease |
1, Yes ; 0, No |
crf1a_com_res_bron |
|
yesno |
iv) Bronchiectasis |
1, Yes ; 0, No |
crf1a_com_res_osa |
|
yesno |
v) Obstructive sleep apnoea |
1, Yes ; 0, No |
crf1a_com_res_ohs |
|
yesno |
vi) Obesity hypoventilation syndrome |
1, Yes ; 0, No |
crf1a_com_res_pe |
|
yesno |
vii) Pleural effusion |
1, Yes ; 0, No |
crf1a_com_res_other_yn |
|
yesno |
viii) Other chronic respiratory disorder |
1, Yes ; 0, No |
crf1a_com_res_ild |
|
notes |
Interstitial lung disease - Detail |
|
crf1a_com_res_other |
|
notes |
Other chronic respiratory disorder - Detail |
|
crf1a_com_rheu_ctd |
Rheumatological |
yesno |
i) Connective tissue disease |
1, Yes ; 0, No |
crf1a_com_rheu_ra |
|
yesno |
ii) Rheumatoid arthritis |
1, Yes ; 0, No |
crf1a_com_rheu_ost |
|
yesno |
iii) Osteoarthritis |
1, Yes ; 0, No |
crf1a_com_rheu_other_yn |
|
yesno |
iv) Other chronic rheumatological disease |
1, Yes ; 0, No |
crf1a_com_rheu_other |
|
notes |
Other chronic rheumatological disease - Detail |
|
crf1a_com_gast_pud |
Gastrointestinal |
yesno |
i) Peptic ulcer disease |
1, Yes ; 0, No |
crf1a_com_gast_ld |
|
radio |
ii) Liver Disease |
1, Mild ; 2, Mod/severe ; 0, No |
crf1a_com_gast_gord |
|
yesno |
iii) Gastro-oesophageal reflux disease |
1, Yes ; 0, No |
crf1a_com_gast_ibd |
|
yesno |
iv) Inflammatory bowel disease |
1, Yes ; 0, No |
crf1a_com_gast_ibs |
|
yesno |
v) Irritable bowel syndrome |
1, Yes ; 0, No |
crf1a_com_gast_other_yn |
|
yesno |
vi) Other chronic gastrointestinal disorder |
1, Yes ; 0, No |
crf1a_com_gast_other |
|
notes |
Other chronic gastrointestinal disorder - Detail |
|
crf1a_com_mer_diab |
Metabolic/Endocrine/Renal |
radio |
i) Diabetes |
1, Type 1 ; 2, Type 2 ; 0, No |
crf1a_com_mer_diab_com |
|
radio |
i) DiabetesComplications |
1, Uncomplicated ; 2, End-organ damage |
crf1a_com_mer_hypot |
|
yesno |
ii) Hypothyroidism |
1, Yes ; 0, No |
crf1a_com_mer_hypert |
|
yesno |
iii) Hyperthyroidism |
1, Yes ; 0, No |
crf1a_com_mer_ckd_yn |
|
yesno |
iv) Chronic kidney disease |
1, Yes ; 0, No |
crf1a_com_mer_other_yn |
|
yesno |
v) Other chronic metabolic/endocrine disorder |
1, Yes ; 0, No |
crf1a_com_mer_ckd_stage |
|
radio |
Chronic kidney diseaseStage (if known) |
1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 |
crf1a_com_mer_other |
|
notes |
Other chronic metabolic/endocrine disorderSpecify: |
|
crf1a_com_mh_stm |
Malignancy/ Haematological |
radio |
i) Solid Tumour Malignancy |
1, Localised ; 2, Metastatic ; 0, No |
crf1a_com_mh_stm_detail |
|
notes |
i) Solid Tumour Malignancy - Detail |
|
crf1a_com_mh_leuk_yn |
|
yesno |
ii) Leukaemia |
1, Yes ; 0, No |
crf1a_com_mh_lymp_yn |
|
yesno |
iii) Lymphoma |
1, Yes ; 0, No |
crf1a_com_mh_other_yn |
|
yesno |
iv) Other chronic haematological disorder |
1, Yes ; 0, No |
crf1a_com_mh_leuk_detail |
|
notes |
Leukaemia - Detail |
|
crf1a_com_mh_lymp |
|
notes |
Lymphoma - Detail |
|
crf1a_com_mh_other |
|
notes |
Other chronic haematological disorder - Detail |
|
crf1a_com_id_aids |
Infectious disease |
yesno |
i) AIDS (Not including HIV without complications) |
1, Yes ; 0, No |
crf1a_com_id_hiv |
|
yesno |
ii) HIV |
1, Yes ; 0, No |
crf1a_com_id_cvh |
|
radio |
iii) Chronic viral hepatitis |
0, None ; 1, Hepatitis B ; 2, Hepatitis C |
crf1a_com_id_mt |
|
radio |
iv) Mycobacterium Tuberculosis |
0, Never ; 1, Current active TB ; 2, Previously treated active TB ; 3, Previously treated latent TB |
crf1a_com_id_other_yn |
|
yesno |
v) Other chronic infectious disease |
1, Yes ; 0, No |
crf1a_com_id_other |
|
notes |
Other chronic infectious disease - Detail |
|
crf1a_com_other |
|
notes |
9.i) Other co-morbidities |
|