data dictionar y codebook hackensack mer idian health ... · data dictionar y codebook 04/10/2020...

4/10/2020 Hackensack Meridian Health COVID-19 Database Logistics Project | REDCap

https://redcap.hackensackumc.net/Redcap/redcap_v9.3.6/Design/data_dictionary_codebook.php?pid=700 1/35

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Data Dictionary Codebook 04/10/2020 10:59am

# Variable / Field Name Field LabelField Note

Field Attributes (Field Type, Validation, Choices,Calculations, etc.)

Instrument: Study Id (study_id) Enabled as survey

1 study_id Patient Unique Identifier text, Required

2 study_id_complete Section Header: Form Status

Complete?dropdown0 Incomplete

1 Unverified

2 Complete

Instrument: User (user) Enabled as survey

3 user Section Header: Enter Name of Data Manager

Please enter your full name:This is the full name of the user entering the patient data for this survey

text, Required

4 user_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: Demographics (demographics) Enabled as survey

5 mrn Section Header: Demographic Characteristics

MRNtext (number), Required, Identifier

6 dob DOBMM-DD-YYYY

text (date_mdy), Required, Identifier

7 patient_name Last name, first name text, Required, Identifier

8 diagnosis_age Age at COVID19 diagnosis calcCalculation: round(datediff([dob],'today','y','mdy'),0)

9 sex Sex (M/F) dropdown, Required0 Female

1 Male

10 zip Zip Code text (number), Identifier

11 diagnosis_covid_status COVID-19 Diagnosis dropdown0 Positive

1 Suspected

12 diagnosis_date

Show the field ONLY if:[diagnosis_covid_status] = "0"

Date of diagnosis (when sample was drawn)MM-DD-YYYY

text (date_mdy)

13 readmit_days number of days from when patient recently discharged from ER orhospital (leave blank if not true)OPTIONAL

text

14 for_cur_smoker Current or Former Smoker?Choose Neither for patients that have never smoked

dropdown0 Current

1 Former

2 Neither (Non-Smoker)

Hackensack Meridian Health COVID-19 Database Logistics Project

Codebook



15 is_smoker

Show the field ONLY if:[for_cur_smoker] = "0" or [for_cur_smoker] = "1"

SMOKER(Yes,Yes over 20 pack years, or No)

dropdown0 Yes

1 Yes over 20 pack years

2 No

16 race RACE dropdown1 Caucasian

2 African American

3 Hispanic

4 Asian

5 Other

17 race_other

Show the field ONLY if:[race] = "5"

Other Race text

18 hospital Hospital dropdown1 Bayshore Medical Center

2 Hackensack Meridian Health (DO NOT CHOOSE -DEPRECATED)

3 Hackensack University Medical Center

4 Heart and Vascular Hospital

5 Jersey Shore University Medical Center

6 JFK Medical Center

7 JFK Rehabilitation Institute

8 John Theurer Cancer Center

9 Joseph M. Sanzari Children's Hospital

10 K. Hovnanian Children's Hospital

11 Mountainside Medical Center

12 Ocean Medical Center

13 Palisades Medical Center

14 Pascack Valley Medical Center

15 Raritan Bay Medical Center Old Bridge

16 Raritan Bay Medical Center Perth Amboy

17 Riverview Medical Center

18 Shore Rehabilitation

19 Southern Ocean Medical Center

19 hospital_care_type

Show the field ONLY if:[hospital] ""

Academic/Quaternary Care or CommunityAcademic/Quaternary Care = 1, Community = 0

calcCalculation: if([hospital] = 3, 1, 0) + if([hospital] = 8, 1, 0)

20 healthcare_worker HEALTHCARE WORKER dropdown1 Yes outpatient

2 Yes inpatient

3 Yes ER

4 Yes ICU

5 No

21 nurs_home NURSING HOME or REHAB resident dropdown1 YES

2 NO

22 vis_urg_er_14 Visits to urgent care or ER in last 14 days dropdown0 0

1 1

2 2

3 more than 2



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23 outpt_dx OUTPATIENT diagnosis?if outpatient diagnosis, only fill out comorbidity section, hospital labs and vitals(use outpatient imaging vitals and labs if done) and survival status

dropdown1 Yes

2 No

24 demographics_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: Presenting Symptoms (presenting_symptoms) Enabled as survey

25 fever Section Header: Presenting Symptoms

Fever?dropdown0 Yes

1 No

26 sob Shortness of Breath? dropdown0 Yes

1 No

27 cough Cough? dropdown0 Yes

1 No

28 sympt_ams ALTERED MENTAL STATE (AMS)? dropdown1 Yes without seizure

2 Yes with seizure

3 No

29 gi GI? dropdown0 Yes

1 No

30 gi_spec

Show the field ONLY if:[gi] = "0"

If Yes, nausea or diarrhea?Check all that apply

checkbox0 gi_spec___0 Nausea

1 gi_spec___1 Diarrhea

31 tos Lack of taste or smell? dropdown0 Yes

1 No

32 tos_spec

Show the field ONLY if:[tos] = "0"

If Yes, lack of tast or lack of smell? dropdown0 Lack of Taste

1 Lack of Smell

2 Lack of Both Taste and Smell

33 sympt_dur_days Approximate number of days with symptoms prior to admit(a few = 3, several = 3, couple = 2)

dropdown, Required1 One

2 Two

3 Three

7 Five

4 Seven

5 More than 7

6 unknown

34 sympt_dur_days_7more

Show the field ONLY if:[sympt_dur_days] = "5"

Number of days if more than 7, leave blank if unknown:Please enter number

text (number, Min: 8)

35 presenting_symptoms_complete

Section Header: Form Status


1 Unverified

2 Complete



CollapseInstrument: Comorbidities (comorbidities) Enabled as survey

36 diabetes Section Header: Comorbidities

Diabetesdropdown0 Yes

1 No

37 diabetes_a1c

Show the field ONLY if:[diabetes] = "0"

Hemoglobin A1c (numeric value) text (number)

38 insulin INSULIN ? dropdown0 Yes

1 No

39 copd COPD dropdown0 Yes

1 No

40 copd_o2

Show the field ONLY if:[copd] = "0"

if YES, on home oxygen too? dropdown0 Yes

1 No

41 asthma ASTHMA dropdown0 Yes

1 No

42 inhaled_cort_roid

Show the field ONLY if:[copd] = "0" or [asthma] = "0"

Inhaled Corticosteroid dropdown0 Yes

1 No

43 asthma_hospitalized

Show the field ONLY if:[asthma] = "0"

if YES, hospitalized or in ER last 1 year? dropdown0 Yes

1 No

44 hypertension Hypertension dropdown0 Yes

1 No

45 hypertension_meds

Show the field ONLY if:[hypertension] = "0"

if YES, number of medications? dropdown1 1

2 2

3 3

4 over 3

46 hypertension_ace


if YES, ACE-inhibitor? dropdown0 Yes

1 No

47 hypertension_ace_hos_cont

Show the field ONLY if:[hypertension] = "0" and [hypertension_ace] = "0"

ACE-inhibitor continued during hospitalization? dropdown0 Yes

1 No

48 hypertension_arb


if YES, ARB? dropdown0 Yes

1 No

49 hypertension_arb_hos_cont

Show the field ONLY if:[hypertension] = "0" and [hypertension_arb] = "0"

ARB continued during hospitalization? dropdown0 Yes

1 No

50 hypertension_beta_blocker


if YES, beta-blocker? dropdown0 Yes

1 No



51 hypertension_ccb


If YES, Calcium channel blocker? dropdown0 Yes

1 No

52 hypertension_thia


If YES, Thiazide? dropdown0 Yes

1 No

53 cancer Cancer dropdown0 Yes

1 No

54 cancer_hem

Show the field ONLY if:[cancer] = "0"

if YES, hematologic cancer? dropdown0 Yes

1 No

55 cancer_lung


if yes, LUNG CANCER dropdown0 Yes

1 No

56 cancer_chemo


if YES, on active chemotherapy? dropdown0 Yes

1 No

57 cancer_chemo_reg


Name chemotherapy text

58 coronary Coronary Disease dropdown0 Yes

1 No

59 coronary_stroke Stroke dropdown0 Yes

1 No

60 coronary_heart Heart Failure dropdown0 Yes

1 No

61 coronary_arrhythmia Arrhythmia dropdown0 Yes

1 No

62 renal_failure Renal failure dropdown0 Yes

1 No

63 renal_failure_ckd

Show the field ONLY if:[renal_failure] = "0"

if YES, CKD stage III or higher? dropdown0 Yes

1 No

64 renal_failure_dial

Show the field ONLY if:[renal_failure] = "0"

If Yes, end stage renal disease on dialysis dropdown0 Yes

1 No

65 creat_base baseline creatinine (numeric value) text (number)

66 rheumatologic_disorder Rheumatologic disorder dropdown0 Yes

1 No

67 rheumatologic_disorder_nod

Show the field ONLY if:[rheumatologic_disorder] = "0"

if YES, name disease text



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68 rheu_dis_immunomed

Show the field ONLY if:[rheumatologic_disorder] = "0"

If YES, what immunosuppressant medicine?steroids, methotrexate, plaquenil etc.

text

69 pregnancy PREGNANCY dropdown0 Yes

1 No

70 hiv_hep HIV AND/OR HEPATITIS dropdown0 Yes HIV

1 Yes Hepatitis

2 Yes HIV and Hepatitis

4 No

71 inflammatory_bd INFLAMMATORY BOWEL DISEASE dropdown0 Yes

1 No

72 adv_liver_d ADVANCED LIVER DISEASE dropdown0 Yes

1 No

73 comorbidities_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: Hospitalization (hospitalization) Enabled as survey

74 admission_date Section Header: Hospital Admission

Date of admissionMM-DD-YYYY

text (date_mdy)

75 discharge Discharged (Y/N) dropdown0 Yes

1 No

76 discharge_date

Show the field ONLY if:[discharge] = "0"

Discharge DateMM-DD-YYYY

text (date_mdy)

77 hospitalization_duration

Show the field ONLY if:[discharge_date] "" and [admission_date] ""

Duration of Hospitalization (DC date - ER date)Number of days

calcCalculation: round(datediff([admission_date],[discharge_date],'d','mdy'),0)

78 time_admit_to_diag

Show the field ONLY if:[admission_date] "" and [diagnosis_date] ""

Time from admission to diagnosis dateNumber of days

calcCalculation: round(datediff([admission_date],[diagnosis_date],'d','mdy'),0)

79 time_diag_to_discharge

Show the field ONLY if:[diagnosis_date] "" and [discharge_date] ""

Time from diagnosis to dischargeNumber of days

calcCalculation: round(datediff([diagnosis_date],[discharge_date],'d','mdy'),0)

80 rehospitalization Patient re-admitted to the Hospital? dropdown0 Yes

1 No

81 admission_date2

Show the field ONLY if:[rehospitalization] = "0"

Date of readmissionMM-DD-YYYY

text (date_mdy)

82 hospitalization_complete Section Header: Form Status


1 Unverified

2 Complete



CollapseInstrument: Hospital Labs (hospital_labs) Enabled as survey

83 wbc_day1_hospital Section Header: Hospital labs reported within 48 hours of admission date (usefirst available value)

WBC (numeric value)

text (number)

84 abs_neut_hospital Abs neutrophil count (numeric value) text (number)

85 abs_lymph_ct_d1_hospital ABS LYMPHOCYTE CT (numeric value) text (number)

86 abs_neut_lymph_ratio_d1_hos

Show the field ONLY if:[abs_neut_hospital] "" and[abs_lymph_ct_d1_hospital] ""

Neutrophil to Lymphocyte Ratio calcCalculation:round([abs_neut_hospital]/[abs_lymph_ct_d1_hospital],3)

87 plt_d1_hospital PLATELET (numeric value) text (number)

88 hgb_d1_hospital HGB (numeric value) text (number)

89 ldh_d1_hospital LDH (numeric value) text (number)

90 fe_d1_hospital FERRITIN (numeric value) text (number)

91 ddimer_d1_hospital Ddimer (numeric value) text (number)

92 ddimer_d1_hospital_corr

Show the field ONLY if:[ddimer_d1_hospital] > 130

Ddimer correctionif over 130, divide by 1000

calcCalculation: [ddimer_d1_hospital]/1000

93 crp_d1_hospital CRP (numeric value) text (number)

94 trop_d1_hospital troponin (numeric value) text (number)

95 bnp_d1_hospital BNP (numeric value) text (number)

96 creat_d1_hospital Creatinine (numeric value) text (number)

97 e_lfts_d1_hospital ELEVATED LFTs (Y/N) dropdown0 Yes

1 No

98 ast_d1_hospital

Show the field ONLY if:[e_lfts_d1_hospital] = "0"

If Yes, AST (numeric value) text (number)

99 alt_d1_hospital

Show the field ONLY if:[e_lfts_d1_hospital] = "0"

If Yes, ALT (numeric value) text (number)

100 bili_d1_hospital BILIRUBIN (numeric value) text (number)

101 rpp_pos_d1_hospital RPP Positive dropdown0 Positive

1 Negative

102 rpp_pos_virus_d1_hospital

Show the field ONLY if:[rpp_pos_d1_hospital] = "0"

IF YES, name virus text

103 bacteremia_d1_hospital BACTEREMIA dropdown0 Yes

1 No

104 bacteremia_d1_hospital_name

Show the field ONLY if:[bacteremia_d1_hospital] = "0"

if YES, name bacteria text

105 bacteremia_acquired_d1_hospital

Show the field ONLY if:[bacteremia_d1_hospital] = "0"

If yes, hospital acquired or community acquired? dropdown0 Hospital Acquired

1 Community acquired

106 pos_sputum_cult_d1_hospital POSITIVE SPUTUM CULTURE dropdown0 Yes

1 No



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107 pos_sputum_cult_acquired_d1_hospital

Show the field ONLY if:[pos_sputum_cult_d1_hospital]= "0"



108 il6_admission_d1_hospital IL-6 (upon admission) text (number)

109 il6_recent_d1_hospital IL-6 (most recent) text (number)

110 hospital_labs_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: Hospital Vitals (hospital_vitals) Enabled as survey

111 init_temp_d1_hospital Section Header: Hospitalized Patient Vital Values

initial Temptext (number)

112 init_hr_d1_hospital initial HR text (number)

113 init_bpsys_d1_hospital Initial Blood Pressure (systolic) text (number)

114 init_bpdia_d1_hospital Initial Blood Pressure (diastolic) text (number)

115 artpress_d1_hospital Mean Arterial Pressure calcCalculation: ([init_bpsys_d1_hospital]*(1/3))+([init_bpdia_d1_hospital]*(2/3))

116 weight Weight (kg) text (number)

117 height Height (cm) text (number)

118 bmi BMI calcCalculation: round(([weight]*10000)/(([height])^(2)),1)

119 bmi_ac1

Show the field ONLY if:[bmi] > 30

BMI > 30 dropdown0 Yes

1 No

120 bmi_greater40

Show the field ONLY if:[bmi] > 40


1 No

121 init_rr_d1_hosptial initial respiratory rate text (number)

122 oxygenation_d1_hospital Oxygenation < 94 dropdown0 Yes

1 No

123 oxygenation_more_d1_hospital

Show the field ONLY if:[oxygenation_d1_hospital] ="0"

if YES, nasal cannula, high flow, ventimask, CPAP, or BiPAP dropdown1 Nasal Cannula

2 High Flow

3 Ventimask

4 CPAP

5 BiPAP

6 non-rebreather

124 imag_d1_hospital Abnormal CXR or CT chest? dropdown0 Yes

1 No

125 imag_spec_d1_hospital

Show the field ONLY if:[imag_d1_hospital] = "0"

If YES, Bilateral Infiltrate, Unilateral Infiltrate or Other? dropdown0 Bilateral Infiltrate

1 Unilateral Infiltrate

2 Other



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126 prone_pos_d1_hospital PRONE POSITIONING (Yes in Hospital,Yes before Hospital, or No) dropdown1 Yes in Hospital

2 Yes before Hospital

3 No

127 intubated_d1_hospital Successful intubation? (Y/N) dropdown0 Yes

1 No

128 intubated_date_d1_hospital

Show the field ONLY if:[intubated_d1_hospital] = "0"

Date of successful intubationMM-DD-YYYY

text (date_mdy)

129 ecmo_d1_hospital ECMO dropdown0 Yes

1 No

130 dial_d1_hospital Dialysis during non-ICU hospitalization dropdown0 Yes

1 No

131 hospital_vitals_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: Hospital Medications (hospital_medications) Enabled as survey

132 steroids_d1_hospital Section Header: Hospitalized Patient Medications *** Fill out only if admitted tothe hospital initially ***

STEROIDS

dropdown0 Yes

1 No

133 steroid_dose_d1_hospital

Show the field ONLY if:[steroids_d1_hospital] = "0"

IF YES, name steroid used and dose text

134 hcq_d1_hospital PLAQUENIL dropdown0 Yes

1 No

135 hcq_qtc_d1_hospital

Show the field ONLY if:[hcq_d1_hospital] = "0"

IF YES, QTc text (number)

136 hcq_d1_hospital_dose


Dose of PLAQUENIL (mg) dropdown1 400 mg bid day 1, then 200mg bid for days 2-5

2 200mg tid for 5 days

3 Other

4 800 mg Day 1, 400 mg days 2-5

137 hcq_d1_hospital_dose_other

Show the field ONLY if:[hcq_d1_hospital] = "0" and [hcq_d1_hospital_dose] = "3"

If Other PLAQUENIL dose (mg):Enter Dose in mg if same for all days given

text (number)

138 hcq_d1_hospital_dose_freq_o


If Other PLAQUENIL frequency:Enter frequency of dose if same for all days given

dropdown1 QD

2 BID

3 TID

4 QID

5 Other



139 hcq_d1_hospital_dose_other2


If Other PLAQUENIL variable dose, explain:Enter: dose (mg), Frequency, days (day 1, day 2-5 etc.) *separate by comma

notes

140 hcq_d1_hospital_sdate


Date of First Dose of PLAQUENILMM-DD-YYYY

text (date_mdy)

141 hcq_d1_hospital_edate

Show the field ONLY if:[hcq_d1_hospital] = "0" and [hcq_d1_hospital_sdate] ""

Date of Last Dose of PLAQUENILMM-DD-YYYY

text (date_mdy)

142 hcq_d1_hospital_ddl

Show the field ONLY if:[hcq_d1_hospital] = "0" and [hcq_d1_hospital_sdate] "" and[hcq_d1_hospital_edate] ""

Duration on PLAQUENILNumber of days

calcCalculation: round(datediff([hcq_d1_hospital_sdate],[hcq_d1_hospital_edate],'d','mdy'),0)

143 hcq_d1_hospital_route


Route of Administration of PLAQUENIL dropdown0 PO

1 IV

2 Other

Field Annotation: @HIDDEN

144 hcq_d1_hospital_route_other

Show the field ONLY if:[hcq_d1_hospital] = "0" and [hcq_d1_hospital_route] = "2"

If Other Route, enter Route of PLAQUENIL administration textField Annotation: @HIDDEN

145 hcq_d1_hospital_to_admit

Show the field ONLY if:[hcq_d1_hospital] = "0" and [hcq_d1_hospital_sdate] "" and[admission_date] ""

Time from hospital admission to first does of PLAQUENILNumber of days

calcCalculation: round(datediff([admission_date],[hcq_d1_hospital_sdate],'d','mdy'),0)

146 hcq_sympt_to_presc_days


Number of days from start of symptoms to plaquenil prescription(use admission date if unknown start of symptoms)numerical value (days)

text (number)

147 hcq_d1_hospital_dnt_why

Show the field ONLY if:[hcq_d1_hospital] ""

If stopped taking PLAQUENIL prior to completing 5 days of dosing,why?Select all that apply

checkbox1 hcq_d1_hospital_dnt_why___1 Died within 24

hours

2 hcq_d1_hospital_dnt_why___2 Went to hospicewithin 24 hours

3 hcq_d1_hospital_dnt_why___3 Physician notedcontraindication

4 hcq_d1_hospital_dnt_why___4 Known arrhythmia

5 hcq_d1_hospital_dnt_why___5 QTc problem

6 hcq_d1_hospital_dnt_why___6 Other

148 hcq_d1_hospital_dnt_other

Show the field ONLY if:[hcq_d1_hospital_dnt_why(6)] ="1"

Other Reason why did not take or stopped PLAQUENIL text

149 hcq_o2_status_hos_48h


Oxygen status at 48 hours (2 days) post first dose of PLAQUENIL dropdown1 Intubated

2 Not intubated, non rebreather (100% fi02)

3 Not intubated, high flow oxygen or ventimask

4 Nasal canulla

5 Room air




150 hcq_o2_status_hos_48h_fio2

Show the field ONLY if:[hcq_d1_hospital] = "0" and [hcq_o2_status_hos_48h] = "1" or[hcq_o2_status_hos_48h] = "3"

How much FiO2 at 48 hours (2 days) post first dose ofPLAQUENIL?Enter number only: 40 if 40% etc.

text (number, Min: 0, Max: 100)Field Annotation: @HIDDEN

151 hcq_o2_status_hos_48h_o2

Show the field ONLY if:[hcq_d1_hospital] = "0" and [hcq_o2_status_hos_48h] = "4"

How many liters of O2 at 48 hours (2 days) post first dose ofPLAQUENIL?Enter number of liters of O2

text (number)Field Annotation: @HIDDEN






4 Nasal canulla

5 Room air






154 hcq_o2_status_hos_h_72o2









4 Nasal canulla

5 Room air










158 az_d1_hospital AZITHROMYCIN dropdown0 Yes

1 No

159 az_d1_hospital_dose

Show the field ONLY if:[az_d1_hospital] = "0"

Dose of AZITHROMYCIN (mg)Dose in mg, day (day 1, day 2-5 etc) *separate by comma

textField Annotation: @HIDDEN

160 az_d1_hospital_dose_freq


Frequency of AZITHROMYCIN dose dropdown1 QD

2 BID

3 TID

4 QID

5 Other




161 az_d1_hospital_dose_freq_other

Show the field ONLY if:[az_d1_hospital] = "0" and [az_d1_hospital_dose_freq] = "5"

If Other Frequency of AZITHROMYCIN, enter Frequency:Use abbreviation (QD etc.)


162 az_d1_hospital_route


Route of Administration of AZITHROMYCIN dropdown0 PO

1 IV

2 Other


163 az_d1_hospital_route_other

Show the field ONLY if:[az_d1_hospital] = "0" and [az_d1_hospital_route] = "2"


164 az_d1_hospital_sdate


Date of First Dose of AZITHROMYCINMM-DD-YYYY

text (date_mdy)

165 az_d1_hospital_edate

Show the field ONLY if:[az_d1_hospital] = "0" and [az_d1_hospital_sdate] ""

Date of Last Dose of AZITHROMYCINMM-DD-YYYY

text (date_mdy)

166 az_d1_hospital_ddl

Show the field ONLY if:[az_d1_hospital] = "0" and [az_d1_hospital_sdate] "" and [az_d1_hospital_edate] ""

Duration on AZITHROMYCINNumber of days

calcCalculation: round(datediff([az_d1_hospital_sdate],[az_d1_hospital_edate],'d','mdy'),0)

167 az_d1_hospital_to_admit

Show the field ONLY if:[az_d1_hospital] = "0" and [admission_date] "" and [az_d1_hospital_sdate] ""

Time from hospital admission to first dose of AZITHROMYCINNumber of days

calcCalculation: round(datediff([admission_date],[az_d1_hospital_sdate],'d','mdy'),0)

168 az_d1_hospital_dnt_why

Show the field ONLY if:[az_d1_hospital] ""

If stopped taking AZITHROMYCIN prior to completing 5 days ofdosing, why?Select all that apply

checkbox1 az_d1_hospital_dnt_why___1 Died within 24 hours

2 az_d1_hospital_dnt_why___2 Went to hospicewithin 24 hours

3 az_d1_hospital_dnt_why___3 Physician notedcontraindication

4 az_d1_hospital_dnt_why___4 Known arrhythmia

5 az_d1_hospital_dnt_why___5 QTc problem

6 az_d1_hospital_dnt_why___6 Other

169 az_d1_hospital_dnt_other

Show the field ONLY if:[az_d1_hospital_dnt_why(6)] ="1"

Other Reason why did not take or stopped AZITHROMYCIN text

170 hcq_az_hos_other_anti

Show the field ONLY if:[hcq_d1_hospital] = "0" or [az_d1_hospital] = "0"

Taken in combination of doxycycline or other antibioticsSelect all that apply

checkbox0 hcq_az_hos_other_anti___0 Doxycycline

1 hcq_az_hos_other_anti___1 Other antibiotics

171 hcq_az_hos_other_anti_txt

Show the field ONLY if:[hcq_d1_hospital] = "0" or [az_d1_hospital] = "0" and [hcq_az_hos_other_anti(1)] = "1"

If Other antibiotics, Enter the antibiotic(s) notes



172 az_o2_status_hos_48h


Oxygen status at 48 hours (2 days) post first dose ofAZITHROMYCIN

dropdown1 Intubated



4 Nasal canulla

5 Room air


173 az_o2_status_hos_48h_fio2

Show the field ONLY if:[az_d1_hospital] = "0" and [az_o2_status_hos_48h] = "1" or [az_o2_status_hos_48h] = "3"

How much FiO2 at 48 hours (2 days) post first dose ofAZITHROMYCIN?Enter number only: 40 if 40% etc.


174 az_o2_status_hos_48h_o2

Show the field ONLY if:[az_d1_hospital] = "0" and [az_o2_status_hos_48h] = "4"

How many liters of O2 at 48 hours (2 days) post first dose ofAZITHROMYCIN?Enter number of liters of O2





dropdown1 Intubated



4 Nasal canulla

5 Room air













dropdown1 Intubated



4 Nasal canulla

5 Room air










181 hcq_az_hos_comp_se

Show the field ONLY if:[hcq_d1_hospital] = "0" or [az_d1_hospital] = "0"

Complications/side effects:Select all that apply

checkbox1 hcq_az_hos_comp_se___1 Arrhythmia

2 hcq_az_hos_comp_se___2 QTc prolongation (ifknown)

3 hcq_az_hos_comp_se___3 Hepatic failure(azithromycin)



182 rem_d1_hospital REMDESIVIR dropdown0 Yes

1 No

183 rem_d1_hospital_sdate

Show the field ONLY if:[rem_d1_hospital] = "0"

Date of First Dose of REMDESIVIRMM-DD-YYYY

text (date_mdy)

184 rem_d1_hospital_edate

Show the field ONLY if:[rem_d1_hospital] = "0" and [rem_d1_hospital_sdate] ""

Date of Last Dose of REMDESIVIRMM-DD-YYYY

text (date_mdy)

185 rem_d1_hospital_ddl

Show the field ONLY if:[rem_d1_hospital] = "0" and [rem_d1_hospital_sdate] "" and [rem_d1_hospital_edate] ""

Duration on REMDESIVIRNumber of days

calcCalculation: round(datediff([rem_d1_hospital_sdate],[rem_d1_hospital_edate],'d','mdy'),0)

186 rem_d1_hospital_to_admit

Show the field ONLY if:[rem_d1_hospital] = "0" and [rem_d1_hospital_sdate] "" and [admission_date] ""

Time from hospital admission to first does of REMDESIVIRNumber of days

calcCalculation: round(datediff([admission_date],[rem_d1_hospital_sdate],'d','mdy'),0)

187 tosi_used_d1_hospital TOCILIZUMAB dropdown0 Yes

1 No

188 tosi_d1_hospital_sdate

Show the field ONLY if:[tosi_used_d1_hospital] = "0"

Date of First Dose of TOCILIZUMABMM-DD-YYYY

text (date_mdy)

189 tosi_d1_hospital_edate


Date of Last Dose of TOCILIZUMABMM-DD-YYYY

text (date_mdy)

190 tosi_d1_hospital_ddl

Show the field ONLY if:[tosi_used_d1_hospital] = "0" and [tosi_d1_hospital_sdate] "" and [tosi_d1_hospital_edate] ""

Duration on TOCILIZUMABNumber of days

calcCalculation: round(datediff([tosi_d1_hospital_sdate],[tosi_d1_hospital_edate],'d','mdy'),0)

191 tosi_d1_hospital_to_admit

Show the field ONLY if:[tosi_used_d1_hospital] = "0" and [tosi_d1_hospital_sdate] "" and [admission_date] ""

Time from hospital admission to first does of TOCILIZUMABNumber of days

calcCalculation: round(datediff([admission_date],[tosi_d1_hospital_sdate],'d','mdy'),0)

192 tosi_pf_24hp_hos


PaO2:FiO2 (PF) ratio prior to medicine given (up to 24 hrs prior)range: 0-1200


193 tosi_pf_6_12a_hos


PaO2:FiO2 (PF) ratio 6-12 hours after medicine administeredrange: 0-1200 (if lab was not drawn, can skip)


194 tosi_pf_24ha_hos


PaO2:FiO2 (PF) ratio 24 hours after medicine administeredrange: 0-1200




PaO2:FiO2 (PF) ratio 48 hrs (2 days) after medicine administeredrange: 0-1200








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PaO2:FiO2 (PF) ratio 96 (4 days) hrs after medicine administeredrange: 0-1200






199 anti_inflam_drug_other_d1_hospital

OTHER ANTI INFLAMMATORY DRUG (Name drug, i.e. siltuximab,anakinra)

text

200 is_clin_trial_d1_hospital Clinical trial? dropdown0 Yes

1 No

201 on_clin_trial_drug_d1_hospital

Show the field ONLY if:[is_clin_trial_d1_hospital] = "0"

On Clinical trial (name trial and drug) text

202 hospital_medications_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: ICU (icu) Enabled as survey

203 icu_date_admit Section Header: ICU Admission

Date of ICU Admission?MM-DD-YYYY

text (date_mdy)

204 time_admit_to_icu

Show the field ONLY if:[admission_date] "" and [icu_date_admit] ""

Time from admission to ICU transfer? calcCalculation: round(datediff([admission_date],[icu_date_admit],'d','mdy'),0)

205 duraction_icu

Show the field ONLY if:[discharge_date] "" and [icu_date_admit] ""

Duration of ICU stay calcCalculation: round(datediff([icu_date_admit],[icu_trans_dis],'d','mdy'),0)

206 mech_vent Mechanical Ventilator dropdown0 Yes

1 No

207 mech_vent_date

Show the field ONLY if:[mech_vent] = "0"

Date on Mechanical VentilatorMM-DD-YYYY

text (date_mdy)

208 mech_vent_date_off

Show the field ONLY if:[mech_vent_date] ""

Date off Mechanical VentilatorMM-DD-YYYY

text (date_mdy)

209 time_admit_to_mech_vent

Show the field ONLY if:[mech_vent] = "0" and [mech_vent_date] "" and [admission_date] ""

Time from admission to Mechanical Ventilator calcCalculation: round(datediff([admission_date],[mech_vent_date],'d','mdy'),0)

210 duration_vent

Show the field ONLY if:[mech_vent] = "0" and [mech_vent_date] "" and [mech_vent_date_off] ""

Duration on ventilator calcCalculation: round(datediff([mech_vent_date],[mech_vent_date_off],'d','mdy'),0)

211 icu_trans_dis

Show the field ONLY if:[icu_date_admit] ""

Date of transfer/discharge OUT of ICU to medical floor (leaveblank if not known yet)MM-DD-YYYY

text (date_mdy)



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212 icu_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: ICU Labs (icu_labs) Enabled as survey

213 wbc_day1_icu Section Header: ICU Patient Laboratory Values

WBC (numeric value)text (number)

214 abs_neut_icu Abs neutrophil count (numeric value) text (number)

215 abs_lymph_ct_d1_icu ABS LYMPHOCYTE CT (numeric value) text (number)

216 abs_neut_lymph_ratio_d1_icu

Show the field ONLY if:[abs_neut_icu] "" and [abs_lymph_ct_d1_icu] ""

Neutrophil to Lymphocyte Ratio calcCalculation:round([abs_neut_icu]/[abs_lymph_ct_d1_icu],3)

217 plt_d1_icu PLATELET (numeric value) text (number)

218 hgb_d1_icu HGB (numeric value) text (number)

219 ldh_d1_icu LDH (numeric value) text (number)

220 fe_d1_icu FERRITIN (numeric value) text (number)

221 ddimer_d1_icu Ddimer (numeric value) text (number)

222 ddimer_d1_icu_corr

Show the field ONLY if:[ddimer_d1_icu] > 130

Ddimer correctionIf ddimer > 130, divide by 1000

calcCalculation: [ddimer_d1_icu]/1000

223 crp_d1_icu CRP (numeric value) text (number)

224 trop_d1_icu troponin (numeric value) text (number)

225 bnp_d1_icu BNP (numeric value) text (number)

226 creat_d1_icu Creatinine (numeric value) text (number)

227 e_lfts_d1_icu ELEVATED LFTs dropdown0 Yes

1 No

228 ast_d1_icu

Show the field ONLY if:[e_lfts_d1_icu] = "0"


229 alt_d1_icu

Show the field ONLY if:[e_lfts_d1_icu] = "0"


230 bili_d1_icu BILIRUBIN (numeric value) text (number)

231 rpp_pos_d1_icu RPP Positive dropdown0 Positive

1 Negative

232 rpp_pos_virus_d1_icu

Show the field ONLY if:[rpp_pos_d1_icu] = "0"


233 bacteremia_d1_icu BACTEREMIA dropdown0 Yes

1 No

234 bacteremia_acquired_d1_icu

Show the field ONLY if:[bacteremia_d1_icu] = "0"

If yes, ICU acquired or community acquired? dropdown0 ICU Acquired


235 bacteremia_d1_icu_name

Show the field ONLY if:[bacteremia_d1_icu] = "0"

If YES, name bacteria text



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236 pos_sputum_cult_d1_icu POSITIVE SPUTUM CULTURE dropdown0 Yes

1 No

237 pos_sputum_cult_acquired_d1_icu

Show the field ONLY if:[pos_sputum_cult_d1_icu] = "0"

If yes, hospital acquired or community acquired? dropdown0 ICU Acquired


238 il6_admission_d1_icu IL-6 (upon admission) text (number)

239 il6_recent_d1_icu IL-6 (most recent) text (number)

240 icu_labs_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: ICU Vitals (icu_vitals) Enabled as survey

241 init_temp_d1_icu Section Header: ICU Patient Vital Values

initial Temptext (number)

242 init_hr_d1_icu initial HR text (number)

243 init_bpsys_d1_icu Initial Blood Pressure (systolic) text (number)

244 init_bpdia_d1_icu Initial Blood Pressure (diastolic) text (number)

245 artpress_d1_icu Mean Arterial Pressure calcCalculation: ([init_bpsys_d1_icu]*(1/3))+([init_bpdia_d1_icu]*(2/3))

246 init_rr_d1_icu initial respiratory rate text (number)

247 oxygenation_d1_icu Oxygenation < 94 dropdown0 Yes

1 No

248 oxygenation_more_d1_icu

Show the field ONLY if:[oxygenation_d1_icu] = "0"


2 High Flow

3 Ventimask

4 CPAP

5 BiPAP

6 Non-rebreather

249 prone_pos_d1_icu PRONE POSITIONING (Yes in ICU,Yes before ICU, or No) dropdown1 Yes in ICU

2 Yes before ICU

3 No

250 intubated_d1_icu Successful intubation? (Y/N) dropdown0 Yes

1 No

251 intubated_date_d1_icu

Show the field ONLY if:[intubated_d1_icu] = "0"


text (date_mdy)

252 ecmo_d1_icu ECMO dropdown0 Yes

1 No

253 dial_d1_icu Dialysis during ICU dropdown0 Yes

1 No



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254 icu_vitals_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: ICU Medications (icu_medications) Enabled as survey

255 steroids_d1_icu Section Header: ICU Patient Medications *** Fill out only if admitted to the ICUinitially ***

STEROIDS

dropdown0 Yes

1 No

256 steroid_dose_d1_icu

Show the field ONLY if:[steroids_d1_icu] = "0"


257 hcq_d1_icu PLAQUENIL dropdown0 Yes

1 No

258 hcq_qtc_d1_icu

Show the field ONLY if:[hcq_d1_icu] = "0"

IF YES, QTc text

259 hcq_d1_icu_dose




3 Other

4 800 mg Day 1, 400 mg days 2-5

260 hcq_d1_icu_dose_other

Show the field ONLY if:[hcq_d1_icu] = "0" and [hcq_d1_icu_dose] = "3"

If Other PLAQUENIL dose (mg):Dose in mgEnter Dose in mg if same for all days given

text (number)

261 hcq_d1_icu_dose_freq_o


If Other PLAQUENIL frequency:Enter Dose in mg if same for all days given

dropdown1 QD

2 BID

3 TID

4 QID

5 Other

262 hcq_d1_icu_dose_other2



notes

263 hcq_d1_icu_sdate



text (date_mdy)

264 hcq_d1_icu_edate

Show the field ONLY if:[hcq_d1_icu] = "0" and [hcq_d1_icu_sdate] ""


text (date_mdy)

265 hcq_d1_icu_ddl

Show the field ONLY if:[hcq_d1_icu] = "0" and [hcq_d1_icu_sdate] "" and [hcq_d1_icu_edate] ""


calcCalculation: round(datediff([hcq_d1_icu_sdate],[hcq_d1_icu_edate],'d','mdy'),0)

266 hcq_d1_icu_route



1 IV

2 Other




267 hcq_d1_icu_route_other

Show the field ONLY if:[hcq_d1_icu] = "0" and [hcq_d1_icu_route] = "2"


268 hcq_d1_icu_to_admit

Show the field ONLY if:[hcq_d1_icu] = "0" and [hcq_d1_icu_sdate] "" and [icu_date_admit] ""

Time from ICU admission to first does of PLAQUENILNumber of days

calcCalculation: round(datediff([icu_date_admit],[hcq_d1_icu_sdate],'d','mdy'),0)

269 hcq_sympt_to_presc_days_icu



text (number)

270 hcq_d1_icu_dnt_why

Show the field ONLY if:[hcq_d1_icu] ""


checkbox1 hcq_d1_icu_dnt_why___1 Died within 24 hours

2 hcq_d1_icu_dnt_why___2 Went to hospice within24 hours

3 hcq_d1_icu_dnt_why___3 Physician notedcontraindication

4 hcq_d1_icu_dnt_why___4 Known arrhythmia

5 hcq_d1_icu_dnt_why___5 QTc problem

6 hcq_d1_icu_dnt_why___6 Other

271 hcq_d1_icu_dnt_other

Show the field ONLY if:[hcq_d1_icu_dnt_why(6)] = "1"


272 hcq_o2_status_icu_48h





4 Nasal canulla

5 Room air


273 hcq_o2_status_icu_48h_fio2

Show the field ONLY if:[hcq_d1_icu] = "0" and [hcq_o2_status_icu_48h] = "1" or [hcq_o2_status_icu_48h] = "3"



274 hcq_o2_status_icu_48h_o2

Show the field ONLY if:[hcq_d1_icu] = "0" and [hcq_o2_status_icu_48h] = "4"








4 Nasal canulla

5 Room air






277 hcq_o2_status_icu_h_72o2











4 Nasal canulla

5 Room air






280 hcq_o2_status_icu_120h_o2




281 az_d1_icu AZITHROMYCIN dropdown0 Yes

1 No

282 az_d1_icu_dose

Show the field ONLY if:[az_d1_icu] = "0"



283 az_d1_icu_dose_freq



2 BID

3 TID

4 QID

5 Other


284 az_d1_icu_dose_freq_other

Show the field ONLY if:[az_d1_icu] = "0" and [az_d1_icu_dose_freq] = "5"



285 az_d1_icu_route



1 IV

2 Other


286 az_d1_icu_route_other

Show the field ONLY if:[az_d1_icu] = "0" and [az_d1_icu_route] = "2"


287 az_d1_icu_sdate



text (date_mdy)

288 az_d1_icu_edate

Show the field ONLY if:[az_d1_icu] = "0" and [az_d1_icu_sdate] ""


text (date_mdy)

289 az_d1_icu_ddl

Show the field ONLY if:[az_d1_icu] = "0" and [az_d1_icu_sdate] "" and [az_d1_icu_edate] ""


calcCalculation: round(datediff([az_d1_icu_sdate],[az_d1_icu_edate],'d','mdy'),0)



290 az_d1_icu_to_admit

Show the field ONLY if:[az_d1_icu] = "0" and [icu_date_admit] "" and [az_d1_icu_sdate] ""

Time from ICU admission to first dose of AZITHROMYCINNumber of days

calcCalculation: round(datediff([icu_date_admit],[az_d1_icu_sdate],'d','mdy'),0)

291 az_d1_icu_dnt_why

Show the field ONLY if:[az_d1_icu] ""


checkbox1 az_d1_icu_dnt_why___1 Died within 24 hours

2 az_d1_icu_dnt_why___2 Went to hospice within 24hours

3 az_d1_icu_dnt_why___3 Physician notedcontraindication

4 az_d1_icu_dnt_why___4 Known arrhythmia

5 az_d1_icu_dnt_why___5 QTc problem

6 az_d1_icu_dnt_why___6 Other

292 az_d1_icu_dnt_other

Show the field ONLY if:[az_d1_icu_dnt_why(6)] = "1"


293 hcq_az_icu_other_anti

Show the field ONLY if:[hcq_d1_icu] = "0" or [az_d1_icu] = "0"


checkbox0 hcq_az_icu_other_anti___0 Doxycycline

1 hcq_az_icu_other_anti___1 Other antibiotics

294 hcq_az_icu_other_anti_txt

Show the field ONLY if:[hcq_d1_icu] = "0" or [az_d1_icu] = "0" and [hcq_az_icu_other_anti(1)] = "1"


295 az_o2_status_icu_48h



dropdown1 Intubated



4 Nasal canulla

5 Room air


296 az_o2_status_icu_48h_fio2

Show the field ONLY if:[az_d1_icu] = "0" and [az_o2_status_icu_48h] = "1" or [az_o2_status_icu_48h] = "3"



297 az_o2_status_icu_48h_o2

Show the field ONLY if:[az_d1_icu] = "0" and [az_o2_status_icu_48h] = "4"






dropdown1 Intubated



4 Nasal canulla

5 Room air















dropdown1 Intubated



4 Nasal canulla

5 Room air










304 hcq_az_icu_comp_se

Show the field ONLY if:[hcq_d1_icu] = "0" or [az_d1_icu] = "0"


checkbox1 hcq_az_icu_comp_se___1 Arrhythmia

2 hcq_az_icu_comp_se___2 QTc prolongation (ifknown)

3 hcq_az_icu_comp_se___3 Hepatic failure(azithromycin)

305 rem_d1_icu REMDESEVIR dropdown0 Yes

1 No

306 rem_d1_icu_sdate

Show the field ONLY if:[rem_d1_icu] = "0"


text (date_mdy)

307 rem_d1_icu_edate

Show the field ONLY if:[rem_d1_icu] = "0" and [rem_d1_icu_sdate] ""


text (date_mdy)

308 rem_d1_icu_ddl

Show the field ONLY if:[rem_d1_icu] = "0" and [rem_d1_icu_sdate] "" and [rem_d1_icu_edate] ""


calcCalculation: round(datediff([rem_d1_icu_sdate],[rem_d1_icu_edate],'d','mdy'),0)

309 rem_d1_icu_to_admit

Show the field ONLY if:[rem_d1_icu] = "0" and [rem_d1_icu_sdate] "" and [icu_date_admit] ""

Time from ICU admission to first does of REMDESIVIRNumber of days

calcCalculation: round(datediff([icu_date_admit],[rem_d1_icu_sdate],'d','mdy'),0)

310 tosi_used_d1_icu TOCILUZIMAB dropdown0 Yes

1 No

311 tosi_d1_icu_sdate

Show the field ONLY if:[tosi_used_d1_icu] = "0"


text (date_mdy)

312 tosi_d1_icu_edate



text (date_mdy)



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313 tosi_d1_icu_ddl

Show the field ONLY if:[tosi_used_d1_icu] = "0" and [tosi_d1_icu_sdate] "" and [tosi_d1_icu_edate] ""


calcCalculation: round(datediff([tosi_d1_icu_sdate],[tosi_d1_icu_edate],'d','mdy'),0)

314 tosi_d1_icu_to_admit

Show the field ONLY if:[tosi_used_d1_icu] = "0" and [tosi_d1_icu_sdate] "" and [icu_date_admit] ""

Time from ICU admission to first does of TOCILIZUMABNumber of days

calcCalculation: round(datediff([icu_date_admit],[tosi_d1_icu_sdate],'d','mdy'),0)

315 tosi_pf_24hp_icu




316 tosi_pf_6_12a_icu


PaO2:FiO2 (PF) ratio 6-12 hours after medicine administeredrange: 0-1200 (if lab was not drawn, can skip)


317 tosi_pf_24ha_icu


PaO2:FiO2 (PF) ratio 24 hours after medicine administeredrange: 0-1200












PaO2:FiO2 (PF) ratio 96 (4 days) hrs after medicine administeredrange: 0-1200






322 anti_inflam_drug_other_d1_icu OTHER ANTI INFLAMMATORY DRUG (Name drug, i.e. siltuximab,anakinra)

text

323 is_clin_trial_d1_icu Clinical trial? dropdown0 Yes

1 No

324 on_clin_trial_drug_d1_icu

Show the field ONLY if:[is_clin_trial_d1_icu] = "0"

On Clinical trial (name trial and drug) text

325 icu_medications_complete Section Header: Form Status


1 Unverified

2 Complete

Instrument: Hospital Labs Readmission (hospital_labs_readmission) Enabled as survey

326 readmit1 Section Header: Hospital labs reported within 48 hours of Readmission date (usefirst available value) *** Patient re-admitted to the Hospital? must be markedYES on Hospitalization form to continue ***

*** Please also enter date of readmission on HospitalizationForm ***

descriptive

327 wbc_day1_hospital2


WBC (numeric value) text (number)

328 abs_neut_hospital2


Abs neutrophil count (numeric value) text (number)



329 abs_lymph_ct_d1_hospital2


ABS LYMPHOCYTE CT (numeric value) text (number)

330 abs_neut_lymph_ratio_d1_hos2

Show the field ONLY if:[abs_neut_hospital2] "" and[abs_lymph_ct_d1_hospital2] <> "" and [rehospitalization] ="0"

Neutrophil to Lymphocyte Ratio calcCalculation:round([abs_neut_hospital2]/[abs_lymph_ct_d1_hospital2],3)

331 plt_d1_hospital2


PLATELET (numeric value) text (number)

332 hgb_d1_hospital2


HGB (numeric value) text (number)

333 ldh_d1_hospital2


LDH (numeric value) text (number)

334 fe_d1_hospital2


FERRITIN (numeric value) text (number)

335 ddimer_d1_hospital2


Ddimer (numeric value) text (number)

336 ddimer_d1_hospital_corr2

Show the field ONLY if:[ddimer_d1_hospital2] > 130 and [rehospitalization] = "0"

Ddimer correctionif over 130, divide by 1000

calcCalculation: [ddimer_d1_hospital2]/1000

337 crp_d1_hospital2


CRP (numeric value) text (number)

338 trop_d1_hospital2


troponin (numeric value) text (number)

339 bnp_d1_hospital2


BNP (numeric value) text (number)

340 creat_d1_hospital2


Creatinine (numeric value) text (number)

341 e_lfts_d1_hospital2


ELEVATED LFTs (Y/N) dropdown0 Yes

1 No

342 ast_d1_hospital2

Show the field ONLY if:[e_lfts_d1_hospital2] = "0" and[rehospitalization] = "0"


343 alt_d1_hospital2

Show the field ONLY if:[e_lfts_d1_hospital2] = "0" and[rehospitalization] = "0"


344 bili_d1_hospital2


BILIRUBIN (numeric value) text (number)

345 rpp_pos_d1_hospital2


RPP Positive dropdown0 Positive

1 Negative



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346 rpp_pos_virus_d1_hospital2

Show the field ONLY if:[rpp_pos_d1_hospital2] = "0" and [rehospitalization] = "0"


347 bacteremia_d1_hospital2


BACTEREMIA dropdown0 Yes

1 No

348 bacteremia_d1_hospital_name2

Show the field ONLY if:[bacteremia_d1_hospital2] ="0" and [rehospitalization] ="0"

if YES, name bacteria text

349 bacteremia_acquired_d1_hospital2

Show the field ONLY if:[bacteremia_d1_hospital2] ="0" and [rehospitalization] ="0"



350 pos_sputum_cult_d1_hospital2


POSITIVE SPUTUM CULTURE dropdown0 Yes

1 No

351 pos_sputum_cult_acquired_d1_hospital2

Show the field ONLY if:[pos_sputum_cult_d1_hospital2] = "0" and [rehospitalization]= "0"



352 il6_admission_d1_hospital2


IL-6 (upon readmission) text (number)

353 il6_recent_d1_hospital2


IL-6 (most recent) text (number)

354 hospital_labs_readmission_complete



1 Unverified

2 Complete

Instrument: Hospital Vitals Readmission (hospital_vitals_readmission) Enabled as survey

355 readmit2 Section Header: Hospitalized Patient Vital Values (Readmission) *** Patient re-admitted to the Hospital? must be marked YES on Hospitalization form tocontinue ***


descriptive

356 init_temp_d1_hospital2


initial Temp text (number)

357 init_hr_d1_hospital2


initial HR text (number)

358 init_bpsys_d1_hospital2


Initial Blood Pressure (systolic) text (number)

359 init_bpdia_d1_hospital2


Initial Blood Pressure (diastolic) text (number)



360 artpress_d1_hospital2


Mean Arterial Pressure calcCalculation: ([init_bpsys_d1_hospital2]*(1/3))+([init_bpdia_d1_hospital2]*(2/3))

361 weight2


Weight (kg) text (number)

362 height2


Height (cm) text (number)

363 bmi2


BMI calcCalculation: round(([weight2]*10000)/(([height2])^(2)),1)

364 bmi_ac12

Show the field ONLY if:[bmi2] > 30 and [rehospitalization] = "0"


1 No

365 bmi_greater402

Show the field ONLY if:[bmi2] > 40 and [rehospitalization] = "0"


1 No

366 init_rr_d1_hosptial2


initial respiratory rate text (number)

367 oxygenation_d1_hospital2


Oxygenation < 94 dropdown0 Yes

1 No

368 oxygenation_more_d1_hospital2

Show the field ONLY if:[oxygenation_d1_hospital2] ="0" and [rehospitalization] ="0"


2 High Flow

3 Ventimask

4 CPAP

5 BiPAP

6 non-rebreather

369 imag_d1_hospital2


Abnormal CXR or CT chest? dropdown0 Yes

1 No

370 imag_spec_d1_hospital2

Show the field ONLY if:[imag_d1_hospital2] = "0" and[rehospitalization] = "0"

If YES, Bilateral Infiltrate, Unilateral Infiltrate or Other? dropdown0 Bilateral Infiltrate

1 Unilateral Infiltrate

2 Other

371 prone_pos_d1_hospital2


PRONE POSITIONING (Yes in Hospital,Yes before Hospital, or No) dropdown1 Yes in Hospital

2 Yes before Hospital

3 No

372 intubated_d1_hospital2


Successful intubation? (Y/N) dropdown0 Yes

1 No

373 intubated_date_d1_hospital2

Show the field ONLY if:[intubated_d1_hospital2] = "0"and [rehospitalization] = "0"


text (date_mdy)



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374 ecmo_d1_hospital2


ECMO dropdown0 Yes

1 No

375 dial_d1_hospital2


Dialysis during non-ICU hospitalization dropdown0 Yes

1 No

376 hospital_vitals_readmission_complete



1 Unverified

2 Complete

Instrument: Hospital Medications Readmission (hospital_medications_readmission) Enabled as survey

377 readmit3 Section Header: Hospitalized Patient Medications Readmission *** Patient re-admitted to the Hospital? must be marked YES on Hospitalization form tocontinue ***


descriptive

378 steroids_d1_hospital2


STEROIDS dropdown0 Yes

1 No

379 steroid_dose_d1_hospital2

Show the field ONLY if:[steroids_d1_hospital2] = "0" and [rehospitalization] = "0"


380 hcq_d1_hospital2


PLAQUENIL dropdown0 Yes

1 No

381 hcq_qtc_d1_hospital2

Show the field ONLY if:[hcq_d1_hospital2] = "0" and [rehospitalization] = "0"

IF YES, QTc text (number)

382 hcq_d1_hospital_dose2




3 Other

4 800 mg Day 1, 400 mg days 2-5

383 hcq_d1_hospital_dose_other_2

Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_d1_hospital_dose2] = "3" and [rehospitalization] = "0"

If Other PLAQUENIL dose (mg):Enter Dose in mg if same for all days given

text (number)

384 hcq_d1_hospital_dose_freq_o2


If Other PLAQUENIL frequency:Enter frequency of dose if same for all days given

dropdown1 QD

2 BID

3 TID

4 QID

5 Other

385 hcq_d1_hospital_dose_other_22



notes

386 hcq_d1_hospital_sdate2



text (date_mdy)



387 hcq_d1_hospital_edate2

Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_d1_hospital_sdate2] "" and [rehospitalization] = "0"


text (date_mdy)

388 hcq_d1_hospital_ddl2

Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_d1_hospital_sdate2] "" and [hcq_d1_hospital_edate2] <> "" and [rehospitalization] ="0"


calcCalculation: round(datediff([hcq_d1_hospital_sdate2],[hcq_d1_hospital_edate2],'d','mdy'),0)

389 hcq_d1_hospital_route2



1 IV

2 Other


390 hcq_d1_hospital_route_other2

Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_d1_hospital_route2] = "2" and [rehospitalization] = "0"


391 hcq_d1_hospital_to_admit2

Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_d1_hospital_sdate2] "" and [admission_date2] "" and [rehospitalization] = "0"

Time from hospital readmission to first does of PLAQUENILNumber of days

calcCalculation: round(datediff([admission_date2],[hcq_d1_hospital_sdate2],'d','mdy'),0)

392 hcq_sympt_to_presc_days2




393 hcq_d1_hospital_dnt_why2

Show the field ONLY if:[hcq_d1_hospital2] "" and [rehospitalization] = "0"


checkbox1 hcq_d1_hospital_dnt_why2___1 Died within 24

hours

2 hcq_d1_hospital_dnt_why2___2 Went to hospicewithin 24 hours

3 hcq_d1_hospital_dnt_why2___3 Physician notedcontraindication

4 hcq_d1_hospital_dnt_why2___4 Known arrhythmia

5 hcq_d1_hospital_dnt_why2___5 QTc problem

6 hcq_d1_hospital_dnt_why2___6 Other

394 hcq_d1_hospital_dnt_other2

Show the field ONLY if:[hcq_d1_hospital_dnt_why2(6)]= "1" and [rehospitalization] ="0"


395 hcq_o2_status_hos_48h2





4 Nasal canulla

5 Room air





Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_o2_status_hos_48h2] = "1" or [hcq_o2_status_hos_48h2] ="3" and [rehospitalization] ="0"




Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_o2_status_hos_48h2] = "4" and [rehospitalization] = "0"








4 Nasal canulla

5 Room air



Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_o2_status_hos_72h2] = "1" or [hcq_o2_status_hos_72h2] ="3" and [rehospitalization] ="0"



400 hcq_o2_status_hos_h_72o22

Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_o2_status_hos_72h2] = "4" and [rehospitalization] = "0"








4 Nasal canulla

5 Room air



Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_o2_status_hos_120h2] = "1"or [hcq_o2_status_hos_120h2]= "3" and [rehospitalization] ="0"




Show the field ONLY if:[hcq_d1_hospital2] = "0" and [hcq_o2_status_hos_120h2] = "4"and [rehospitalization] = "0"



404 az_d1_hospital2


AZITHROMYCIN dropdown0 Yes

1 No

405 az_d1_hospital_dose2

Show the field ONLY if:[az_d1_hospital2] = "0" and [rehospitalization] = "0"





406 az_d1_hospital_dose_freq2



2 BID

3 TID

4 QID

5 Other


407 az_d1_hospital_dose_freq_other2

Show the field ONLY if:[az_d1_hospital2] = "0" and [az_d1_hospital_dose_freq2] = "5"and [rehospitalization] = "0"



408 az_d1_hospital_route2



1 IV

2 Other


409 az_d1_hospital_route_other2

Show the field ONLY if:[az_d1_hospital2] = "0" and [az_d1_hospital_route2] = "2" and[rehospitalization] = "0"


410 az_d1_hospital_sdate2



text (date_mdy)

411 az_d1_hospital_edate2

Show the field ONLY if:[az_d1_hospital2] = "0" and [az_d1_hospital_sdate2] "" and[rehospitalization] = "0"


text (date_mdy)

412 az_d1_hospital_ddl2

Show the field ONLY if:[az_d1_hospital2] = "0" and [az_d1_hospital_sdate2] "" and[az_d1_hospital_edate2] ""and [rehospitalization] = "0"


calcCalculation: round(datediff([az_d1_hospital_sdate2],[az_d1_hospital_edate2],'d','mdy'),0)

413 az_d1_hospital_to_admit2

Show the field ONLY if:[az_d1_hospital2] = "0" and [admission_date2] "" and [az_d1_hospital_sdate2] "" and [rehospitalization] = "0"

Time from hospital readmission to first dose of AZITHROMYCINNumber of days

calcCalculation: round(datediff([admission_date2],[az_d1_hospital_sdate2],'d','mdy'),0)

414 az_d1_hospital_dnt_why2

Show the field ONLY if:[az_d1_hospital2] "" and [rehospitalization] = "0"


checkbox1 az_d1_hospital_dnt_why2___1 Died within 24

hours

2 az_d1_hospital_dnt_why2___2 Went to hospicewithin 24 hours

3 az_d1_hospital_dnt_why2___3 Physician notedcontraindication

4 az_d1_hospital_dnt_why2___4 Known arrhythmia

5 az_d1_hospital_dnt_why2___5 QTc problem

6 az_d1_hospital_dnt_why2___6 Other



415 az_d1_hospital_dnt_other2

Show the field ONLY if:[az_d1_hospital_dnt_why2(6)] ="1" and [rehospitalization] ="0"


416 hcq_az_hos_other_anti2

Show the field ONLY if:[hcq_d1_hospital2] = "0" or [az_d1_hospital2] = "0" and [rehospitalization] = "0"


checkbox0 hcq_az_hos_other_anti2___0 Doxycycline

1 hcq_az_hos_other_anti2___1 Other antibiotics

417 hcq_az_hos_other_anti_txt2

Show the field ONLY if:[hcq_d1_hospital2] = "0" or [az_d1_hospital2] = "0" and [hcq_az_hos_other_anti2(1)] = "1" and[rehospitalization] = "0"


418 az_o2_status_hos_48h2



dropdown1 Intubated



4 Nasal canulla

5 Room air



Show the field ONLY if:[az_d1_hospital2] = "0" and [az_o2_status_hos_48h2] = "1" or[az_o2_status_hos_48h2] = "3"and [rehospitalization] = "0"




Show the field ONLY if:[az_d1_hospital2] = "0" and [az_o2_status_hos_48h2] = "4" and [rehospitalization] = "0"






dropdown1 Intubated



4 Nasal canulla

5 Room air















dropdown1 Intubated



4 Nasal canulla

5 Room air










427 hcq_az_hos_comp_se2

Show the field ONLY if:[hcq_d1_hospital2] = "0" or [az_d1_hospital2] = "0" and [rehospitalization] = "0"


checkbox1 hcq_az_hos_comp_se2___1 Arrhythmia

2 hcq_az_hos_comp_se2___2 QTc prolongation (ifknown)

3 hcq_az_hos_comp_se2___3 Hepatic failure(azithromycin)

428 rem_d1_hospital2


REMDESIVIR dropdown0 Yes

1 No

429 rem_d1_hospital_sdate2

Show the field ONLY if:[rem_d1_hospital2] = "0" and [rehospitalization] = "0"


text (date_mdy)

430 rem_d1_hospital_edate2

Show the field ONLY if:[rem_d1_hospital2] = "0" and [rem_d1_hospital_sdate2] ""and [rehospitalization] = "0"


text (date_mdy)

431 rem_d1_hospital_ddl2

Show the field ONLY if:[rem_d1_hospital2] = "0" and [rem_d1_hospital_sdate2] ""and [rem_d1_hospital_edate2] "" and [rehospitalization] ="0"


calcCalculation: round(datediff([rem_d1_hospital_sdate2],[rem_d1_hospital_edate2],'d','mdy'),0)

432 rem_d1_hospital_to_admit2

Show the field ONLY if:[rem_d1_hospital2] = "0" and [rem_d1_hospital_sdate2] ""and [admission_date2] "" and [rehospitalization] = "0"

Time from hospital readmission to first does of REMDESIVIRNumber of days

calcCalculation: round(datediff([admission_date2],[rem_d1_hospital_sdate2],'d','mdy'),0)

433 tosi_used_d1_hospital2


TOCILIZUMAB dropdown0 Yes

1 No

434 tosi_d1_hospital_sdate2

Show the field ONLY if:[tosi_used_d1_hospital2] = "0"and [rehospitalization] = "0"


text (date_mdy)



435 tosi_d1_hospital_edate2



text (date_mdy)

436 tosi_d1_hospital_ddl2

Show the field ONLY if:[tosi_used_d1_hospital2] = "0"and [tosi_d1_hospital_sdate2] <> "" and [tosi_d1_hospital_edate2] "" and [rehospitalization] = "0"


calcCalculation: round(datediff([tosi_d1_hospital_sdate2],[tosi_d1_hospital_edate2],'d','mdy'),0)

437 tosi_d1_hospital_to_admit2

Show the field ONLY if:[tosi_used_d1_hospital2] = "0"and [tosi_d1_hospital_sdate2] <> "" and [admission_date2] "" and [rehospitalization] = "0"

Time from hospital readmission to first does of TOCILIZUMABNumber of days

calcCalculation: round(datediff([admission_date2],[tosi_d1_hospital_sdate2],'d','mdy'),0)

438 tosi_pf_24hp_hos2




439 tosi_pf_6_12a_hos2

Show the field ONLY if:[tos

data dictionar y codebook hackensack mer idian health ... · data dictionar y codebook 04/10/2020...

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