= i2b2 Import from Onyx Mapping Version 1

The mapping is made up of 13 questionnaires.  These are:

1. Acute Verbal Consent for samples collection
1. Participant Consent
1. Paper Consent
1. Recruitment Context
1. Risk Factor
1. Patient-reported medical history
1. Samples Preliminary
1. Blood samples collection
1. Urine sample collection
1. End of patient contact
1. Notes-recorded medical history
1. Data submission
1. Conclusion

The mapping of each questionnaire is show in the sections below:

== Acute Verbal Consent for samples collection

Export folder: !VerbalConsentQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Was acute verbal consent given ||  Radio button: yes,no  || n ||
|| Name of witness || Free text with radio button || y ||


== Participant Consent

Export folder: Consent

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Type of consent || Radio button: Electronic, Paper || n ||
|| Consent form language || Select: various languages || n ||
|| Consent Confirmation (paper only?) || Radio buttons: 'read and signed', 'refused to sign' || n ||

* '''QUESTION: The confirmation comes through as consent_q[1-5] and consent_q[1-5]_signed.  Does this relate to the different language options?'''
* '''The only data that appears in i2b2 is an accepted field that only seems to contain NULL values.'''


== Paper Consent

Export folder: !ManualConsentQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Does the participant understand the request for consent? || Radio button: yes, no || y ||
|| Does the participant consent to donate blood and urine || Radio button: yes, no || y ||
|| Does the participant consent to entry in the BRICCS database? || Radio button: yes, no || y ||
|| Does the participant consent to further contact from BRU? || Radio button: yes, no || y ||
|| Does the participant understand the rules of withdrawal? || Radio button: yes, no || y ||

* '''''These values appear in i2b2 as consent_q1, consent_q2, etc and not the actual name of the question.  Also, they have leave nodes for the Y and N answers as opposed to the questions having values.'''''

== Recruitment Context

Export folder: !RecruitmentContextQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Interview Language || Select: languages || y ||
|| Recruitment episode type || Radio button: inpatient, outpatient, healthy control, study specific, don't know || y ||
|| Inpatient admission type || Radio button: Actute, Elective, Don't know || y ||
|| Hospital || Radio button: Glenfield, LGH, LRI, Don't know || y ||
|| Admitting Ward || Select: list of wards, and radio button: don't know || y ||
|| Admitting Consultant || Select: list of consultants, and radio button: don't know || y ||
|| Outpatient clinic attended || select: list of clinics, and radio button: don't know || y ||
|| Consultant || Select: list of consultants, and radio button: don't know || y ||
|| Study Reference || Radio button: !GeneFast AS Study, Study Reference2, Study Reference3, Don't know || y ||

* '''''Yep.  In i2b2 the names of the field as opposed to the descriptions.  The answers are created as leaf nodes as opposed to enumerated values.'''''

== Risk Factor

Export folder: !RiskFactorQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Have you ever smoked or used any tobacco or nicotine product? || Radio button: no, yes, prefer not to answer, don't know || y ||
|| Which of the following have you ever smoked or used? || tick boxes: cigarettes, cigars, pipe tobacco, snuff or chewing tobacco, any other|| y ||
|| Have you ever smoked cigarettes on most days? || Radio button: no, yes, prefer not to answer, Don't know || y ||
|| Do you currently smoke cigarettes || Radio button: y, n, pnta, dk || y ||
|| On average, how many cigarettes did you smoke per day when you were smoking the most || numeric box, pnta, dk || y ||
|| How old were you when you began smoking cigarettes on most days || numeric box, pnta, dk || y ||
|| How old were you when you stopped smoking cigarettes || numeric box, pnta, dk || y ||
|| On average, how many cigarettes do you currently smoke per day? || numeric box, pnta, dk || y ||
|| When was the last time you had a cigarette || Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) || y ||
|| Have you ever smoked cigars regularly || Radio buttons: y, n, pnta, dk || y ||
|| Do you currently smoke  cigars || Radio buttons: y, n, pnta, dk || y ||
|| On average, how many cigars did you smoke per day when you were smoking the most || numeric box, pnta, dk || y ||
|| How old were you when you began smoking cigars on most days || numeric box, pnta, dk || y ||
|| How old were you when you stopped smoking cigars || numeric box, pnta, dk || y ||
|| On average, how many cigars do you currently smoke per day? || numeric box, pnta, dk || y ||
|| When was the last time you had a cigarette || Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) || y ||
|| Have you ever smoked a pipe regularly || Radio buttons: y, n, pnta, dk || y ||
|| Do you currently smoke a pipe || Radio buttons: y, n, pnta, dk || y ||
|| How much tobacco did you smoke per day when you were smoking the most || numeric box, pnta, dk || y ||
|| How old were you when you began smoking a pipe on most days || numeric box, pnta, dk || y ||
|| How old were you when you stopped smoking a pipe || numeric box, pnta, dk || y ||
|| How much tobacco do you currently smoke per day? || numeric box, pnta, dk || y ||
|| When was the last time you smoked a pipe || Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) || y ||
|| Have you ever used snuff or chewing tobacco regularly || Radio buttons: y, n, pnta, dk || y ||
|| Do you currently use snuff or chewing tobacco || Radio buttons: y, n, pnta, dk || y ||
|| How much snuff or chewing tobacco did you smoke per day when you were using the most || numeric box, pnta, dk || y ||
|| How old were you when you began using snuff or chewing tobacco || numeric box, pnta, dk || y ||
|| How old were you when you stopped using snuff or chewing tobacco || numeric box, pnta, dk || y ||
|| How much snuff or chewing tobacco do you use per week? || numeric box, pnta, dk || y ||
|| When was the last time you has snuff or chewing tobacco || Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) || y ||
|| Have you ever used any other tobacco or nicotine product for at least 6 months || y, n, pnta, dk || y ||
|| Do you currently use any other tobacco or nicotine product || y, n, pnta, dk || y ||
|| How much of the tobacco or nicotine product per week did you use when you were using the most? || numeric box, pnta, dk || y ||
|| How old were you when you began using the tobacco or nicotine product? || numeric box, pnta, dk || y ||
|| How old were you when you stopped using the tobacco or nicotine product? || numeroc box, pnta, dk || y ||
|| How much of the tobacco or nicotine product do you use per week? || numeric box, pnta, dk || y ||
|| When was the last time you had any tobacco or nicotine? || Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) || y ||
|| Have you ever drunk alcohol? || y, n, pnta, dk || y ||
|| Have you ever drunk alcohol at least once per week? || y, n, pnta, dk || y ||
|| Do you currently drink alcohol at least once per week? || y, n, pnta, dk || y ||
|| How many pints of beer do you drink in a typical week? || numeric box, pnta, dk || y ||
|| How many glasses of white wine do you drink in a typical week? || numeric box, pnta, dk || y ||
|| How many glasses of red wine do you drink in a typical week? || numeric box, pnta, dk || y ||
|| How many glasses of rose wine do you drink in a typical week? || numeric box, pnta, dk || y ||
|| How many measures of spirits do you drink in a typical week? || numeric box, pnta, dk || y ||
|| How old were you when you began drinking alcohol? || numeric box, pnta, dk || y ||
|| When was the last time you had a drink containing alcohol? || Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) || y ||
|| How would you describe your diet? || Radio buttons: various diets || y ||
|| If you work, does your work involve any physical activity? || Radio buttons || y ||
|| Apart from work, do you undertake any regular physical exercise over and above that of daily living? || Radio buttons || y ||
|| Number of Family members || see below || y ||
|| How many brothers do you have? || numeric, pnta, dk || n ||
|| How many sisters do you have? || numeric, pnta, dk || n ||
|| How many children do you have? || numeric, pnta, dk || n ||
|| Have any of your relatives suffered angina or other Coronary Artery Disease? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| Have any of your relatives suffered a heart attack or Myocardial Infarction? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| Have any of your relatives ever been diagnosed with heart failure? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| Have any of your relatives ever suffered Atrial Fibrillation (AF)? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| Have any of your relatives ever suffered a stroke or CVA? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| Have any of your relatives been diagnosed with high blood pressure? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| Have any of your relatives been diagnosed with valvular heart disease? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| At what age did they first suffer from angina or Coronary Artery Disease? || see below || y ||
|| Father || numeric box, pnta, dk || n ||
|| Mother || numeric box, pnta, dk || n ||
|| Brother || numeric box, pnta, dk || n ||
|| Sister || numeric box, pnta, dk || n ||
|| Child || numeric box, pnta, dk || n ||
|| Have they received treatment for their angina or Coronary Artery Disease? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| At what age did they suffer their first heart attack or Myocardial Infarction? || see below || y ||
|| Father || numeric box, pnta, dk || n ||
|| Mother || numeric box, pnta, dk || n ||
|| Brother || numeric box, pnta, dk || n ||
|| Sister || numeric box, pnta, dk || n ||
|| Child || numeric box, pnta, dk || n ||
|| Have they received treatment for their angina or Coronary Artery Disease? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| At what age did they first suffer from heart failure? || see below || y ||
|| Father || numeric box, pnta, dk || n ||
|| Mother || numeric box, pnta, dk || n ||
|| Brother || numeric box, pnta, dk || n ||
|| Sister || numeric box, pnta, dk || n ||
|| Child || numeric box, pnta, dk || n ||
|| Have they received treatment for their heart failure? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| At what age did they first suffer from Atrial Fibrillation? || see below || y ||
|| Father || numeric box, pnta, dk || n ||
|| Mother || numeric box, pnta, dk || n ||
|| Brother || numeric box, pnta, dk || n ||
|| Sister || numeric box, pnta, dk || n ||
|| Child || numeric box, pnta, dk || n ||
|| Have they received treatment for their Atrial Fibrillation? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| At what age did they suffer their first stroke or CVA? || see below || y ||
|| Father || numeric box, pnta, dk || n ||
|| Mother || numeric box, pnta, dk || n ||
|| Brother || numeric box, pnta, dk || n ||
|| Sister || numeric box, pnta, dk || n ||
|| Child || numeric box, pnta, dk || n ||
|| Were they treated for the stroke or CVA? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| At what age did they first suffer from high blood pressure? || see below || y ||
|| Father || numeric box, pnta, dk || n ||
|| Mother || numeric box, pnta, dk || n ||
|| Brother || numeric box, pnta, dk || n ||
|| Sister || numeric box, pnta, dk || n ||
|| Child || numeric box, pnta, dk || n ||
|| Have they received treatment for their high blood pressure? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| At what age did they first suffer from valvular heart disease? || see below || y ||
|| Father || numeric box, pnta, dk || n ||
|| Mother || numeric box, pnta, dk || n ||
|| Brother || numeric box, pnta, dk || n ||
|| Sister || numeric box, pnta, dk || n ||
|| Child || numeric box, pnta, dk || n ||
|| Have they received treatment for their valvular heart disease? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| Are all of your relatives still alive? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| Do you know the cause of your father's death? || Radio buttons || y ||
|| Do you know the cause of your Mother's death? || Radio buttons || y ||
|| Do you know the cause of your brother's death? || Radio buttons || y ||
|| Do you know the cause of your sister's death? || Radio buttons || y ||
|| Do you know the cause of your child's death? || Radio buttons || y ||
|| At what age did they die? || see below || y ||
|| Father || numeric box, pnta, dk || n ||
|| Mother || numeric box, pnta, dk || n ||
|| Brother || numeric box, pnta, dk || n ||
|| Sister || numeric box, pnta, dk || n ||
|| Child || numeric box, pnta, dk || n ||
|| Was their death sudden and unexpected? || see below || y ||
|| Father || Radio buttons: y, n, pnta, dk || n ||
|| Mother || Radio buttons: y, n, pnta, dk || n ||
|| Brother || Radio buttons: y, n, pnta, dk || n ||
|| Sister || Radio buttons: y, n, pnta, dk || n ||
|| Child || Radio buttons: y, n, pnta, dk || n ||
|| What is your current marital status? || Radio buttons || y ||
|| Do you live with a spouse or partner? || Radio buttons || y ||
|| How many people live in your household? || Radio buttons || y ||
|| What is your current work status? || Radio buttons || y ||
|| What was the highest level of education you completed? || Radio buttons || y ||
|| Which of the following best describes the work you do or did?  || Radio buttons || y ||

* '''''Again all the answers are represented in i2b2 as nodes as opposed to enumerations.'''''
* '''''Also, there are separate hierarchies for each question and then each family member.  What questions might this be used to answer?'''''
* '''''We can represent the data in multiple ways if this allows us to cover different types of question.  For example, aggregate ('Family history of AS') and specific ('Father had AS').'''''

== Patient-reported medical history

Export folder: !MedicalHistoryInterviewQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Have you ever suffered from high blood pressure? || y, n, pnta, dk || y ||
|| When did you first suffer from high blood pressure? || numeric box, pnta, dk || y ||
|| Have you received treatment for your high blood pressure? || y, n, pnta, dk || y ||
|| Have you ever suffered from diabetes? || y, n, pnta, dk || y ||
|| Which type of diabetes? || radio button list || y ||
|| When did you first suffer from diabetes? || numeric box, pnta, dk || y ||
|| Have you received treatment for your diabetes? || y, n, pnta, dk || y ||
|| What treatment are you receiving for your diabetes? || radio button list || y ||
|| Have you ever suffered from high cholesterol? || y, n, pnta, dk || y ||
|| When did you first suffer from high cholesterol? || numeric box, pnta, dk || y ||
|| Have you received treatment for your high cholesterol? || y, n, pnta, dk || y ||
|| Have you ever suffered a heart attack or myocardial infarction (M.I.)? || y, n, pnta, dk || y ||
|| How many heart attacks or MIs have you had? || numeric box, pnta, dk || y ||
|| Year of occurrence of each MI (one per instance) || numeric box, pnta, dk || y ||
|| Have you received treatment for your MI? || y, n, pnta, dk || y ||
|| Have you ever had a stroke or a cerebrovascular accident (CVA)? || y, n, pnta, dk || y ||
|| How many CVAs have you suffered? || numeric box, pnta, dk || y ||
|| Year of occurrence of each CVA (one per instance) || numeric box, pnta, dk || y ||
|| Have you received treatment for your CVA? || y, n, pnta, dk || y ||
|| Have you ever suffered from transient ischaemic attack (TIA)? || y, n, pnta, dk || y ||
|| How many TIAs have you suffered? || numeric box, pnta, dk || y ||
|| Year of occurrence of each TIA (one per instance) || numeric box, pnta, dk || y ||
|| Have you received treatment for your TIA? || y, n, pnta, dk || y ||
|| Have you ever suffered from angina? || y, n, pnta, dk || y ||
|| When did you first suffer from angina? || numeric box, pnta, dk || y ||
|| Have you received treatment for your angina? || y, n, pnta, dk || y ||
|| Have you ever suffered from peripheral vascular disease (PVD)?  || y, n, pnta, dk || y ||
|| When did you first suffer from peripheral vascular disease (PVD)? || numeric box, pnta, dk || y ||
|| Have you received treatment for your PVD? || y, n, pnta, dk || y ||
|| Have you ever suffered from valvular heart disease?  || y, n, pnta, dk || y ||
|| Which type of Valvular Heart Disease have you had? || radio button list || y ||
|| When did you first suffer from valvular heart disease? || numeric box, pnta, dk || y ||
|| Have you received treatment for your valvular heart disease? || y, n, pnta, dk || y ||
|| Have you ever suffered from an aortic aneurysm?  || y, n, pnta, dk || y ||
|| When did you first suffer from aortic aneurysm? || numeric box, pnta, dk || y ||
|| Have you received treatment for your aortic aneurysm? || y, n, pnta, dk || y ||
|| Have you ever suffered from chronic renal failure?  || y, n, pnta, dk || y ||
|| When did you first suffer from chronic renal failure? || numeric box, pnta, dk || y ||
|| Have you received treatment for your chronic renal failure? || y, n, pnta, dk || y ||
|| Have you ever suffered from chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD)?  || y, n, pnta, dk || y ||
|| When did you first suffer from COAD or COPD? || numeric box, pnta, dk || y ||
|| Have you received treatment for your COAD or COPD? || y, n, pnta, dk || y ||
|| Have you ever suffered from liver disease? || y, n, pnta, dk || y ||
|| When did you first suffer from liver disease? || numeric box, pnta, dk || y ||
|| Have you received treatment for your liver disease? || y, n, pnta, dk || y ||
|| Have you ever suffered from asthma? || y, n, pnta, dk || y ||
|| When did you first suffer from asthma? || numeric box, pnta, dk || y ||
|| Have you received treatment for your asthma? || y, n, pnta, dk || y ||
|| Have you ever suffered from Atrial Fibrillation (AF)? || y, n, pnta, dk || y ||
|| When did you first suffer from AF? || numeric box, pnta, dk || y ||
|| Have you received treatment for your AF? || y, n, pnta, dk || y ||
|| Have you ever suffered from any other heart rhythm disturbance? || y, n, pnta, dk || y ||
|| When did you first suffer from other heart rhythm disturbance? || numeric box, pnta, dk || y ||
|| Have you received treatment for your other heart rhythm disturbance? || y, n, pnta, dk || y ||
|| Past History of Interventions || tickbox list with radio buttons for none & unknown || y ||
|| How many times have you undergone CABG? || numeric box || y ||
|| Enter the year for each CABG (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you undergone Valve Surgery? || numeric box || y ||
|| Enter the year for each Valve_Surgery (one per occurrance) || numeric box and unknown radio button || y ||
|| In which year was your TAVI performed? || numeric box and unknown radio button || y ||
|| How many times have you undergone a Primary PCI? || numeric box || y ||
|| Enter the year for each Primary PCI (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you undergone a PCI other than a Primary PCI? || numeric box || y ||
|| When did you have the other PCI procedures? (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had pacemaker surgery? || numeric box || y ||
|| Enter the year for each pacemaker. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had an ICD implanted? || numeric box || y ||
|| Enter the year for each ICD. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had DC cardioversion? || numeric box || y ||
|| Enter the year for each DC cardioversion. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had an LVAD fitted? || numeric box || y ||
|| Enter the year for each LVAD. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had thrombolysis? || numeric box || y ||
|| Enter the year for each thrombolysis treatment. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had an ablation? || numeric box || y ||
|| Enter the year for each ablation. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had an Aortic Balloon Pump fitted? || numeric box || y ||
|| Enter the year for each Aortic Balloon Pump. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had a bare metal stent fitted? || numeric box || y ||
|| Enter the year for each bare metal stent. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had a drug-eluting stent fitted? || numeric box || y ||
|| How many times have you had a drug-eluting stent fitted. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had ? || numeric box || y ||
|| Enter the year for each CPAP. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times have you had a heart transplant ? || numeric box || y ||
|| Enter the year for each heart transplant. (one per occurrance) || numeric box and unknown radio button || y ||

* '''''Again the question name and not description is being used and the answers are nodes.'''''

== Samples Preliminary

Export folder: !SamplesPreliminaryQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Do you have a blood clotting disease such as haemophilia? || y,n,pnta,dk || y ||
|| Have you received a blood transfusion or donated blood in the past 24 hours? || y,n,pnta,dk || y ||
|| Have you received a blood transfusion in the past three months? || y,n,pnta,dk || y ||
|| Have you received radiotherapy or chemotherapy treatment in the past twelve weeks? || y,n,pnta,dk || y ||
|| When was the last time you had something to eat || Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) || y ||
|| When was the last time you had anything to drink other than plain water || Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) || y ||
|| When was the last time you had a drink containing caffeine, including tea, coffee or an energy drink? || Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) || y ||

* '''''Again the question name and not description is being used and the answers are nodes.'''''

== Blood samples collection

Export folder: !BloodSamplesCollection

I suspect this is going to be more comlicated than I can replicate.

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Tube barcode || textbox || n ||

* '''''There are other questions here, but I couldn't get to them on the test system because I didn't have a bar code.'''''

== Urine sample collection

Export folder: !UrineSamplesQuestionnaire

I suspect this is going to be more complicated than I can replicate.

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Tube barcode || textbox || n ||

== End of patient contact

Export folder: !EndContactQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Measurement around the waist (in centimetres): || Numeric, or radio buttons: unable to measure, participant refused || y ||
|| Measurement around the hips (in centimetres): || Numeric, or radio buttons: unable to measure, participant refused || y ||
|| Skin-fold measurement - biceps (in millimetres): || Numeric, or radio buttons: unable to measure, participant refused || y ||
|| Skin-fold measurement - triceps (in millimetres): || Numeric, or radio buttons: unable to measure, participant refused || y ||
|| Skin-fold measurement - subscapular (in millimetres): || Numeric, or radio buttons: unable to measure, participant refused || y ||
|| Skin-fold measurement - supra-iliac (in millimetres): || Numeric, or radio buttons: unable to measure, participant refused || y ||
|| Primary email address || textbox || y ||
|| Additional email address || textbox || y ||


== Notes-recorded medical history

Export folder: !MedicalHistoryQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Is hypertension documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of high blood pressure? || Numeric or Radio button: unknown || y ||
|| Is diabetes documented in the notes? || Radio button: y, n, unknown || y ||
|| Which type of diabetes? || Radio button list || y ||
|| Year of onset of diabetes? || Numeric or Radio button: unknown || y ||
|| Is high cholesterol documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of high cholesterol? || Numeric or Radio button: unknown || y ||
|| Is heart attack or myocardial infarction (M.I.) documented in the notes? || Radio button: y, n, unknown || y ||
|| How many MIs have been documented? || Numeric or Radio button: unknown || y ||
|| Year of occurrence of each MI: (one per occurrence) || Numeric or Radio button: unknown || y ||
|| Is stroke or a cerebrovascular accident (CVA) documented in the notes? || Radio button: y, n, unknown || y ||
|| How many CVAs have been documented? || Numeric or Radio button: unknown || y ||
|| Year of occurrence of each CVA: (one per occurrence) || Numeric or Radio button: unknown || y ||
|| Is transient ischaemic attack (TIA) documented in the notes? || Radio button: y, n, unknown || y ||
|| How many TIAs have been documented? || Numeric or Radio button: unknown || y ||
|| Year of occurrence of each TIA: (one per occurrence) || Numeric or Radio button: unknown || y ||
|| Is angina documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of angina? || Numeric or Radio button: unknown || y ||
|| Is peripheral vascular disease (PVD) documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of peripheral vascular disease (PVD)? || Numeric or Radio button: unknown || y ||
|| Is valvular heart disease documented in the notes? || Radio button: y, n, unknown || y ||
|| Which type of Valvular Heart Disease? || Radio button list || y ||
|| Year of onset of valvular heart disease? || Numeric or Radio button: unknown || y ||
|| Is an aortic aneurysm documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of aortic aneurysm? || Numeric or Radio button: unknown || y ||
|| Is chronic renal failure documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of chronic renal failure? || Numeric or Radio button: unknown || y ||
|| Is chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD) documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD)? || Numeric or Radio button: unknown || y ||
|| Is liver disease documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of liver disease? || Numeric or Radio button: unknown || y ||
|| Is asthma documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of asthma? || Numeric or Radio button: unknown || y ||
|| Is Atrial Fibrillation (AF) documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of AF? || Numeric or Radio button: unknown || y ||
|| Is there any other heart rhythm disturbance documented in the notes? || Radio button: y, n, unknown || y ||
|| Year of onset of heart rhythm disturbance? || Numeric or Radio button: unknown || y ||
|| History of Interventions || Text box list with radio buttons for none and unknown || y ||
|| How many times has the participant undergone CABG? || numeric box || y ||
|| Enter the year for each CABG (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant undergone Valve Surgery? || numeric box || y ||
|| Enter the year for each Valve_Surgery (one per occurrance) || numeric box and unknown radio button || y ||
|| Enter the year TAVI was performed? || numeric box and unknown radio button || y ||
|| How many times has the participant undergone Primary PCI? || numeric box || y ||
|| Enter the year for each Primary PCI (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant undergone PCI other than Primary PCI? || numeric box || y ||
|| Enter the year of each other PCI? (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant undergone Pacemaker surgery? || numeric box || y ||
|| Enter the year for each pacemaker. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant had a ICD implanted? || numeric box || y ||
|| Enter the year for each ICD. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant undergone DC Cardioversion? || numeric box || y ||
|| Enter the year for each DC cardioversion. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant had LVAD surgery? || numeric box || y ||
|| Enter the year for each LVAD. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant had thrombolysis? || numeric box || y ||
|| Enter the year for each thrombolysis treatment. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant had an ablation? || numeric box || y ||
|| Enter the year for each ablation. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant had an Aortic Balloon Pump fitted? || numeric box || y ||
|| Enter the year for each Aortic Balloon Pump. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant had a bare metal stent fitted? || numeric box || y ||
|| Enter the year for each bare metal stent. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant had a drug-eluting stent fitted? || numeric box || y ||
|| Enter the year for each drug-eluting stent. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant had CPAP treatment ? || numeric box || y ||
|| Enter the year for each CPAP. (one per occurrance) || numeric box and unknown radio button || y ||
|| How many times has the participant had a heart transplant ? || numeric box || y ||
|| Enter the year for each heart transplant. (one per occurrance) || numeric box and unknown radio button || y ||

== Data submission

Export folder: !DataSubmissionQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Principal Symptoms || Tickbox list, radio buttons for none or unknown || y ||
|| Please supply details of the additional symptom(s) || text area || y ||
|| When was the First Onset of Symptoms? || (numeric year and select month) or (unknown radio button) || y ||
|| Presenting Primary Diagnosis || radio button list || y ||
|| Acute associated diagnoses || tickbox list with radio button for none || y ||
|| Please supply details of the other secondary diagnosis || text area || y ||
|| Interventions during this clinical episode || see below || y ||
|| CABG Coronary Artery Bypass Graft || Date || n ||
|| Valve Surgery || Date || n ||
|| TAVI - Transcatheter Aortic Valve Implantation || Date || n ||
|| PPCI - Primary Percutaneous Coronary Intervention || Date || n ||
|| Other PCI || Date || n ||
|| Pacemaker insertion || Date || n ||
|| ICD - Implantable Cardioverter Defibrillator || Date || n ||
|| DC Cardioversion || Date || n ||
|| LVAD - Left Ventricular Assist Device || Date || n ||
|| Thrombolysis || Date || n ||
|| Electrophysiology (EP) / Radiofrequency (RF) Ablation || Date || n ||
|| Coronary Angiography || Date || n ||
|| First recorded Heart Rate during this episode of care || numeric or radio button: not recorded|| n ||
|| First recorded Systolic Blood Pressure || numeric or radio button: not recorded|| n ||
|| First recorded Diastolic Blood Pressure || numeric or radio button: not recorded|| n ||
|| Latest recorded Heart Rate || numeric or radio button: not recorded|| n ||
|| Latest recorded Systolic Blood Pressure || numeric or radio button: not recorded|| n ||
|| Latest recorded Diastolic Blood Pressure || numeric or radio button: not recorded|| n ||
|| Height || numeric or radio button: not recorded|| n ||
|| Weight|| numeric or radio button: not recorded|| n ||

== Conclusion

Export folder: !ConclusionQuestionnaire

=== Visible fields on the form:

||=  Label =||=  Answer Type =||= Has comment =||
|| Discharge Method || Radio button list || y ||
|| Drugs on discharge or departure from clinic || tickbox list or radio buttons: none, unknown ||