DREAM Forms

dic type	ctrl type	order	column name	description	view condition	bgcolor
String	Linea di divisione	1		GENERAL INFORMATION AND MEDICAL HISTORY
Numeric	Text box	2	vn1	Age of onset of seizures
Boolean (Yes/No)	Select	3	vb1	The description of the seizures was collected from the patient ?
Boolean (Yes/No)	Select	4	vb2	The description of the seizures was collected from the guardian/companion?
String	Linea di divisione	5		Consciousness: meaning of the term and explanatory notes
String	Linea di divisione	6		* Patient with total loss of consciousness:
String	Linea di divisione	7		- is unable to remember what happens in this phase
String	Linea di divisione	8		* Patient with reduced/altered consciousness:
String	Linea di divisione	9		- is unable to correctly remember everything that happens during this phase. Or:
String	Linea di divisione	10		- The patient only partially remembers what happens during this phase.
String	Linea di divisione	11		* Patient with normal consciousness:
String	Linea di divisione	12		- remember well everything that happens during this phase: therefore there is no loss of consciousness
String	Linea di divisione	13		Crisis information and description
Boolean (Yes/No)	Select	14	vb30	Is there a total loss of consciousness?		0xFFF28282
Boolean (Yes/No)	Select	15	vb29	Is there a partial loss or alteration of consciousness?	!vb30	0xFFF28282
String	Linea di divisione	16		Before total loss of consciousness
Boolean (Yes/No)	Select	17	vb6	Sudden and unexplained change in behavior	vb30
Boolean (Yes/No)	Select	18	vb7	Does the patient suddenly exhibit aggressive behavior?	vb6
Boolean (Yes/No)	Select	19	vb13	Does the patient experience inexplicable emotions, such as fear or sensations of dreaming?	vb30
String	Select	20	vt1	Involuntary movements such as jerking/twitching of the limbs?	vb30
String	Select	21	vt9	Does the patient experience pins and needles sensations or abnormal sensitivity in one or more parts of the body?	vb30
Boolean (Yes/No)	Select	22	vb4	Loud scream	vb30
Boolean (Yes/No)	Select	23	vb5	Headache	vb30
Boolean (Yes/No)	Select	24	vb8	The patient has visual hallucinations (sees images that are not there)?	vb30
Boolean (Yes/No)	Select	25	vb9	The patient has auditory hallucinations (hears sounds/voices that are not there)?	vb30
Boolean (Yes/No)	Select	26	vb10	The patient has olfactory hallucinations (smells things that are not there)?	vb30
Boolean (Yes/No)	Select	27	vb11	The patient has abdominal pain, stomach sensation and/or discomfort?	vb30
Boolean (Yes/No)	Select	28	vb12	The patient has palpitations?	vb30
Boolean (Yes/No)	Select	29	vb14	The patient speaks involuntarily and/or speaks strange words?	vb30
Boolean (Yes/No)	Select	30	vb15	Does the patient fall to the ground before losing consciousness? (If YES, the patient can remember falling)	vb30
String	Text area	31	vt7	Other	vb30
String	Linea di divisione	32		During total loss of consciousness
String	Select	33	vt2	How long does the loss of consciousness last?	vb30
Boolean (Yes/No)	Select	34	vb16	Does the patient falls ? (If YES: the patient is NOT able to remember falling)	vb30
String	Select	35	vt3	Involuntary movements such as jerking/twitching of the limbs?	vb30
Boolean (Yes/No)	Select	36	vb17	Whole body stiffness?	vb30
Boolean (Yes/No)	Select	37	vb18	Salivation?	vb30
Boolean (Yes/No)	Select	38	vb19	Tongue bite?	vb30
Boolean (Yes/No)	Select	39	vb20	Blood in the mouth?	vb30
Boolean (Yes/No)	Select	40	vb21	Loss of urine?	vb30
Boolean (Yes/No)	Select	41	vb22	Loss of feces?	vb30
String	Text area	42	vt8	Other	vb30
String	Linea di divisione	43		Reduced consciousness or altered consciousness
Boolean (Yes/No)	Select	44	vb24	Sudden and unexplained change in behavior?	vb29
Boolean (Yes/No)	Select	45	vb25	Does the patient suddenly exhibit aggressive behavior?	vb24
Boolean (Yes/No)	Select	46	vb26	Does the patient experience inexplicable emotions, such as fear or sensations of dreaming?	vb29
String	Select	47	vt6	Involuntary movements such as jerking/twitching of the limbs?	vb29
String	Select	48	vt10	Does the patient experience pins and needles sensations or abnormal sensitivity in one or more parts of the body?	vb29
Boolean (Yes/No)	Select	49	vb27	Headache	vb29
Boolean (Yes/No)	Select	50	vb28	The patient has visual hallucinations (sees images that are not there)?	vb29

id dictionary	EVN_CHR_EPI
description	Epilepsy
is single ?
domain	ANAG_EVENT
order	90
used
hide in forms
filter hivpos	ALL
filter gender	ALL
filter agemin	0
filter agemax	150

Form fields (d_events)