Variable IDVariable TitleForm Type
01 VERSION OF FORM I BEING ENTERED I
02 VERSION OF FORM II BEING ENTERED II
20Aa LIVING STATUS OF PERSON WITH BRAIN INJURY II
20Ab METHOD OF INTERVIEW DATA COLLECTION - PERSON WITH BRAIN INJURY II
20Ac METHOD OF INTERVIEW DATA COLLECTION - SIGNIFICANT OTHER II
20Ad REASON PERSON WITH BRAIN INJURY NOT PROVIDING DATA II
20Ae IDENTITY OF SIGNIFICANT OTHER II
100 SYSTEM/SUBJECT ID I
101a DATES (AND TIMES) I
102 SHORT TERM REHABILITATION INTERRUPTION I
103 PATIENT BIRTHDATE I
104 SEX I
105 RACE I
107 MARITAL STATUS I
108 PRIMARY PERSON LIVING WITH I
109 RESIDENCE I
109a ZIP CODE I
110a YEARS OF EDUCATION I
110b GED I
111a EMPLOYMENT STATUS I
111b HOURS OF PAID COMPETITIVE EMPLOYMENT I
111d JOB STABILITY: WEEKS EMPLOYED I
111i ANNUAL EARNINGS I
112 CENSUS OCCUPATIONAL CATEGORY I
121 HISTORY OF TBI I
122 PREMORBID CONDITIONS I
123 PREMORBID LIMITATIONS I
130a DATE ABLE TO FOLLOW COMMANDS I
131h ASSOCIATED INJURY - Spinal Cord Injury I
133a CAUSE OF INJURY I
133b ICD-9-CM EXTERNAL CAUSE OF INJURY CODE I
134 ETOH BLOOD LEVEL AT INJURY I
135 INTRACRANIAL CT DIAGNOSIS I
137 ICD-9-CM Diagnosis codes for brain injury I
139 GLASGOW COMA SCALE I
140 REVISED TRAUMA SCORE I
144a DATE EMERGED FROM PTA I
144b METHOD OF PTA DETERMINATION I
146 CAUSE(S) OF DEATH I
148h CRANIAL COMPLICATIONS - Intracranial Hypertension I
151 DISABILITY RATING SCALE I
152 FUNCTIONAL INDEPENDENCE MEASURE (FIM) I
170m1 CRANIAL SURGERY - CRANIOTOMY/CRANIECTOMY I
176 CHARGES I
178 PAYOR SOURCE I
192a1 PREMORBID DRUG USE I
192a2 PREMORBID ALCOHOL USE I
192h PREMORBID HISTORY OF PENAL INCARCERATIONS WITH CONVICTION FOR FELONY I
192i PREMORBID HISTORY OF LEARNING AND/OR BEHAVIOR PROBLEMS IN SCHOOL I
200 SYSTEM/SUBJECT/FOLLOW-UP ID II
201 DATE OF FOLLOW-UP II
207 MARITAL STATUS II
208 PRIMARY PERSON LIVING WITH II
209 RESIDENCE II
209a ZIP CODE II
210a YEARS OF EDUCATION II
210b GED II
211a EMPLOYMENT STATUS II
211b HOURS OF PAID COMPETITIVE EMPLOYMENT II
211c DATE OF FIRST COMPETITIVE EMPLOYMENT II
211d JOB STABILITY: WEEKS EMPLOYED II
211i ANNUAL EARNINGS II
212 CENSUS OCCUPATIONAL CATEGORY II
221 SUBSEQUENT TRAUMATIC BRAIN INJURY II
251 DISABILITY RATING SCALE II
252 FUNCTIONAL INDEPENDENCE MEASURE (FIM) II
273 REHOSPITALIZATION II
292a1 DRUG USE II
292a2 ALCOHOL USE II
292b MOTORIZED TRANSPORTATION II
292c INCOME AND SOURCE II
292e ARRESTS II
292f PSYCHIATRIC PROBLEMS II
292g SATISFACTION WITH LIFE SCALE (SWLS) - FOR PERSON WITH BRAIN INJURY II
296 GLASGOW OUTCOME SCALE - EXTENDED II
297 SUPERVISION RATING SCALE (SRS) II

Traumatic Brain Injury Model System National Database Live Syllabus V10.3
Wednesday, August 16, 2006 12:54pm  .   comments/questions?
© 2003- 2006, All rights reserved ||
. KMRREC