PATIENT RESPONSE RECORD (continued) Data Field Element XML Element Attributes Description Valid Values Data Type Size Required Q52 None Because of a physical, mental, Yes 1 Alphanumeric 1 Yes difficulty-concentrating or emotional condition, do No 2 character Each element must have a closing tag that you have serious difficulty MISSING/DK M is the same as the opening tag but with a concentrating, remembering, forward slash. This patient response data or making decisions? element should only occur once per patient. Example: Q53 None Do you have serious difficulty Yes 1 Alphanumeric 1 Yes difficulty-walking walking or climbing stairs? No 2 character Each element must have a closing tag that MISSING/DK M is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example: Q54 None Do you have difficulty Yes 1 Alphanumeric 1 Yes difficulty-dressing dressing or bathing? No 2 character Each element must have a closing tag that MISSING/DK M is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example:
PATIENT RESPONSE RECORD (continued) XML Element Attributes Description Valid Values Data Type Field Size Data Element Required Q52 difficulty-concentrating Each element must have a closing tag that is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example: None Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions? Yes 1 No 2 MISSING/DK M Alphanumeric character 1 Yes Q53 difficulty-walking Each element must have a closing tag that is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example: None Do you have serious difficulty walking or climbing stairs? Yes 1 No 2 MISSING/DK M Alphanumeric character 1 Yes Q54 difficulty-dressing Each element must have a closing tag that is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example: None Do you have difficulty dressing or bathing? Yes 1 No 2 MISSING/DK M Alphanumeric character 1 Yes
ICH_SurveyAdminManual_Ver4_Feb2016.docx