Data Dictionary Demo - Stroke

Patient-reported, clinical, or administrative Form

Please complete all required fields marked with an asterisk (*)

Prior to this hospitalization, have you ever been told by a doctor that you have had a stroke? Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.
Have you ever been told by a doctor that you have had a transient ischemic attack (this is sometimes called a TIA or mini-stroke)? Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.
Have you ever been told by your doctor that you've had a heart attack (this is sometimes called a myocardial infarction, or MI)? Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.
Have you ever been told by your doctor that you have coronary artery disease? Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.
Have you ever been told by your doctor that you have atrial fibrillation? Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.
Have you ever been told by your doctor that you have diabetes? Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.
Have you ever been told by a doctor that you have high blood pressure (this is sometimes called hypertension)? Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.
Have you ever been told by your doctor that you have high cholesterol (this is sometimes called hyperlipidemia or dyslipidemia)? Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.
Do you drink more than one alcoholic drink a day? One standard alcoholic drink is: 12 ounces of regular beer (about 5% alcohol) 5 ounces of wine (about 12% alcohol) 1.5 ounces of distilled spirits (about 40% alcohol) Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.