PATIENT RESPONSE RECORD (continued) Data Field Element XML Element Attributes Description Valid Values Data Type Size Required Q22 None In the last 3 months, how Never 1 Alphanumeric 1 Yes check-closely often did dialysis center staff Sometimes 2 character Each element must have a closing tag that check you as closely as you Usually 3 is the same as the opening tag but with a wanted while you were on the 4 forward slash. This patient response data dialysis machine? NOT APPLICABLE X element should only occur once per MISSING/DK M patient. Example: check-closely1/check-closely Q23 None In the last 3 months, did any Yes 1 Alphanumeric 1 Yes problems problems occur during your No 2 character Each element must have a closing tag that dialysis? NOT APPLICABLE X is the same as the opening tag but with a MISSING/DK M forward slash. This patient response data element should only occur once per patient. Example: problems1/problems Q24 None In the last 3 months, how Never 1 Alphanumeric 1 Yes manage-problems often was the dialysis center Sometimes 2 character Each element must have a closing tag that staff able to manage problems Usually 3 is the same as the opening tag but with a during your dialysis? 4 forward slash. This patient response data NOT APPLICABLE X element should only occur once per MISSING/DK M patient. Example:
PATIENT RESPONSE RECORD (continued) XML Element Attributes Description Valid Values Data Type Field Size Data Element Required Q22 check-closely 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: check-closely1/check-closely None In the last 3 months, how often did dialysis center staff check you as closely as you wanted while you were on the dialysis machine? Never 1 Sometimes 2 Usually 3 4 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes Q23 problems 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: problems1/problems None In the last 3 months, did any problems occur during your dialysis? Yes 1 No 2 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes Q24 manage-problems 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 In the last 3 months, how often was the dialysis center staff able to manage problems during your dialysis? Never 1 Sometimes 2 Usually 3 4 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes
ICH_SurveyAdminManual_Ver4_Feb2016.docx