NACC Uniform Data Set (UDS) DATA TEMPLATE for Initial Visit Packet (IVP)

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Jasmin Francis
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Department of Epidemiology, School of Public Health, University of Washington 4311 11 th Avenue NE #300 Seattle, WA 98105 phone: (206) 543-8637; fax: (206) 616-5927 e-mail: naccmail@u.washington.

1 Department of Epidemiology, School of Public Health, University of Washington th Avenue NE #300 Seattle, WA phone: (206) ; fax: (206) website: NACC Uniform Data Set (UDS) DATA TEMPLATE for Initial Visit Packet (IVP) (Version 2.0, February 2008) Copyright 2011 University of Washington This publication was funded by the National Institute of Health through the National Institute on Aging (Cooperative Agreement U01 AG016976)

2 Data Template Uniform Data Set (UDS) Initial Visit Packet (IVP) This template is designed to assist the Centers data cores in developing software to submit UDS data to NACC. The template details the data element names, type of data element, columns for ASCII file submission, and item number. This template is only needed for ASCII batch file submissions. Centers using web data entry will not need this template. A more detailed description of each data element is found in the data element dictionary. Data elements are listed by form and within form by item number. 1. The first 10 data elements are the same for each template, for each form. They are required and are shaded on the template. They must have legal values or the form cannot be processed. 2. There is exactly one blank space required between the data fields of adjacent variables. Although a data field may in some cases contain one or more blanks, the required separator blank must still be included. Column assignments and column alignment must be maintained. 3. In some cases, the item number in the template does not appear on the form. This is true for most Other (specify) text items and dates. 4. Now that there will be more than one version of a form in current use, make sure you are using the appropriate template. NACC UDS Data Template IVP (version 2.0, February 2008) i

3 FORM HEADER CODING (first 10 data elements) PACKET FORMID = I (For the Initial Visit Packet.) = Form ID (i.e., Z1, A1, B4, etc.) FORMVER = 2 (For this second version of all forms.) ADCID PTID = Center ID (Same number used in the MDS and NP data for your Center; see the UDS Data Element Dictionary for a list of Center IDs.) = Patient ID (Follow your Center s Patient ID scheme. Patient ID must be unique within the data set from your Center no duplicates. PTID for each subject must be the same for each visit in the UDS and the same PTID used for that subject in the MDS and NP databases. PTID cannot change once it has been assigned by your Center. Since this is a character field, be sure to include/exclude leading zeroes to match ID numbers in all data sets.) VISITMO VISITDAY = Actual date of the interview VISITYR (Cannot precede 09/01/2005.) VISITNUM INITIALS = Visit ID (Assigned by your Center, need not start with 1.) = Examiner initials (Initials of the person conducting the interview.) NACC UDS Data Template IVP (version 2.0, February 2008) ii

4 Packet I, Form Z1: FORM CHECKLIST (Version 2) 1 45 A2SUB N A2NOT N 1A A2COMM C 1B A3SUB N A3NOT N 2A A3COMM C 2B A4SUB N A4NOT N 3A A4COMM C 3B B1SUB N B1NOT N 4A B1COMM C 4B B2SUB N B2NOT N 5A B2COMM C 5B B3SUB N B3NOT N 6A B3COMM C 6B B5SUB N B5NOT N 7A B5COMM C 7B B6SUB N B6NOT N 8A B6COMM C 8B B7SUB N B7NOT N 9A B7COMM C 9B NACC UDS Data Template IVP (version 2.0, February 2008) Form Z1: page 1

5 Packet I, Form Z1: FORM CHECKLIST (Version 2) B8SUB N B8NOT N 10A B8COMM C 10B NACC UDS Data Template IVP (version 2.0, February 2008) Form Z1: page 2

6 Packet I, Form A1: SUBJECT DEMOGRAPHICS (Version 2) 1 45 INMDS N REASON N REASONX C 2A REFER N REFERX C 3A PRESTAT N PRESPART N SOURCE N BIRTHMO N 7A BIRTHYR N 7B SEX N HISPANIC N HISPOR N 9A HISPORX C 9A RACE N RACEX C 10A RACESEC N RACESECX C 11A RACETER N RACETERX C 12A PRIMLANG N PRIMLANX C 13A EDUC N LIVSIT N LIVSITX C 15A INDEPEND N RESIDENC N 17 NACC UDS Data Template IVP (version 2.0, February 2008) Form A1: page 3

7 Packet I, Form A1: SUBJECT DEMOGRAPHICS (Version 2) RESIDENX C 17A ZIP C MARISTAT N MARISTAX C 19A HANDED N 20 NACC UDS Data Template IVP (version 2.0, February 2008) Form A1: page 4

8 Packet I, Form A2: INFORMANT DEMOGRAPHICS (Version 2) INBIRMO N 1A INBIRYR N 1B 1 53 INSEX N INHISP N INHISPOR N 3A INHISPOX C 3A INRACE N INRACEX C 4A INRASEC N INRASECX C 5A INRATER N INRATERX C 6A INEDUC N INRELTO N INRELTOX C 8A INLIVWTH N INVISITS N 9A INCALLS N 9B INRELY N 10 NACC UDS Data Template IVP (version 2.0, February 2008) Form A2: page 5

9 Packet I, Form A3: SUBJECT FAMILY HISTORY (Version 2) MOMYOB N 1A 1 50 MOMLIV N 1B MOMYOD N 1C 1 57 MOMDEM N 1D MOMONSET N 1E DADYOB N 2A 1 68 DADLIV N 2B DADYOD N 2C 1 75 DADDEM N 2D DADONSET N 2E 1 81 TWIN N TWINTYPE N 3A SIBS N SIB1YOB N 5A SIB1LIV N 5B SIB1YOD N 5C SIB1DEM N 5D SIB1ONS N 5E SIB2YOB N 5A SIB2LIV N 5B SIB2YOD N 5C SIB2DEM N 5D SIB2ONS N 5E SIB3YOB N 5A SIB3LIV N 5B SIB3YOD N 5C SIB3DEM N 5D3 NACC UDS Data Template IVP (version 2.0, February 2008) Form A3: page 6

10 Packet I, Form A3: SUBJECT FAMILY HISTORY (Version 2) SIB3ONS N 5E SIB4YOB N 5A SIB4LIV N 5B SIB4YOD N 5C SIB4DEM N 5D SIB4ONS N 5E SIB5YOB N 5A SIB5LIV N 5B SIB5YOD N 5C SIB5DEM N 5D SIB5ONS N 5E SIB6YOB N 5A SIB6LIV N 5B SIB6YOD N 5C SIB6DEM N 5D SIB6ONS N 5E SIB7YOB N 5A SIB7LIV N 5B SIB7YOD N 5C SIB7DEM N 5D SIB7ONS N 5E SIB8YOB N 5A SIB8LIV N 5B SIB8YOD N 5C SIB8DEM N 5D SIB8ONS N 5E SIB9YOB N 5A SIB9LIV N 5B SIB9YOD N 5C SIB9DEM N 5D SIB9ONS N 5E SIB10YOB N 5A SIB10LIV N 5B SIB10YOD N 5C SIB10DEM N 5D SIB10ONS N 5E10 NACC UDS Data Template IVP (version 2.0, February 2008) Form A3: page 7

11 Packet I, Form A3: SUBJECT FAMILY HISTORY (Version 2) SIB11YOB N 5A SIB11LIV N 5B SIB11YOD N 5C SIB11DEM N 5D SIB11ONS N 5E SIB12YOB N 5A SIB12LIV N 5B SIB12YOD N 5C SIB12DEM N 5D SIB12ONS N 5E SIB13YOB N 5A SIB13LIV N 5B SIB13YOD N 5C SIB13DEM N 5D SIB13ONS N 5E SIB14YOB N 5A SIB14LIV N 5B SIB14YOD N 5C SIB14DEM N 5D SIB14ONS N 5E SIB15YOB N 5A SIB15LIV N 5B SIB15YOD N 5C SIB15DEM N 5D SIB15ONS N 5E SIB16YOB N 5A SIB16LIV N 5B SIB16YOD N 5C SIB16DEM N 5D SIB16ONS N 5E SIB17YOB N 5A SIB17LIV N 5B SIB17YOD N 5C SIB17DEM N 5D SIB17ONS N 5E SIB18YOB N 5A18 NACC UDS Data Template IVP (version 2.0, February 2008) Form A3: page 8

12 Packet I, Form A3: SUBJECT FAMILY HISTORY (Version 2) SIB18LIV N 5B SIB18YOD N 5C SIB18DEM N 5D SIB18ONS N 5E SIB19YOB N 5A SIB19LIV N 5B SIB19YOD N 5C SIB19DEM N 5D SIB19ONS N 5E SIB20YOB N 5A SIB20LIV N 5B SIB20YOD N 5C SIB20DEM N 5D SIB20ONS N 5E KIDS N KID1YOB N 7A KID1LIV N 7B KID1YOD N 7C KID1DEM N 7D KID1ONS N 7E KID2YOB N 7A KID2LIV N 7B KID2YOD N 7C KID2DEM N 7D KID2ONS N 7E KID3YOB N 7A KID3LIV N 7B KID3YOD N 7C KID3DEM N 7D KID3ONS N 7E KID4YOB N 7A KID4LIV N 7B KID4YOD N 7C KID4DEM N 7D KID4ONS N 7E KID5YOB N 7A5 NACC UDS Data Template IVP (version 2.0, February 2008) Form A3: page 9

13 Packet I, Form A3: SUBJECT FAMILY HISTORY (Version 2) KID5LIV N 7B KID5YOD N 7C KID5DEM N 7D KID5ONS N 7E KID6YOB N 7A KID6LIV N 7B KID6YOD N 7C KID6DEM N 7D KID6ONS N 7E KID7YOB N 7A KID7LIV N 7B KID7YOD N 7C KID7DEM N 7D KID7ONS N 7E KID8YOB N 7A KID8LIV N 7B KID8YOD N 7C KID8DEM N 7D KID8ONS N 7E KID9YOB N 7A KID9LIV N 7B KID9YOD N 7C KID9DEM N 7D KID9ONS N 7E KID10YOB N 7A KID10LIV N 7B KID10YOD N 7C KID10DEM N 7D KID10ONS N 7E KID11YOB N 7A KID11LIV N 7B KID11YOD N 7C KID11DEM N 7D KID11ONS N 7E KID12YOB N 7A KID12LIV N 7B12 NACC UDS Data Template IVP (version 2.0, February 2008) Form A3: page 10

14 Packet I, Form A3: SUBJECT FAMILY HISTORY (Version 2) KID12YOD N 7C KID12DEM N 7D KID12ONS N 7E KID13YOB N 7A KID13LIV N 7B KID13YOD N 7C KID13DEM N 7D KID13ONS N 7E KID14YOB N 7A KID14LIV N 7B KID14YOD N 7C KID14DEM N 7D KID14ONS N 7E KID15YOB N 7A KID15LIV N 7B KID15YOD N 7C KID15DEM N 7D KID15ONS N 7E RELSDEM N REL1YOB N 9A REL1LIV N 9B REL1YOD N 9C REL1ONS N 9D REL2YOB N 9A REL2LIV N 9B REL2YOD N 9C REL2ONS N 9D REL3YOB N 9A REL3LIV N 9B REL3YOD N 9C REL3ONS N 9D REL4YOB N 9A REL4LIV N 9B REL4YOD N 9C REL4ONS N 9D REL5YOB N 9A5 NACC UDS Data Template IVP (version 2.0, February 2008) Form A3: page 11

15 Packet I, Form A3: SUBJECT FAMILY HISTORY (Version 2) REL5LIV N 9B REL5YOD N 9C REL5ONS N 9D REL6YOB N 9A REL6LIV N 9B REL6YOD N 9C REL6ONS N 9D REL7YOB N 9A REL7LIV N 9B REL7YOD N 9C REL7ONS N 9D REL8YOB N 9A REL8LIV N 9B REL8YOD N 9C REL8ONS N 9D REL9YOB N 9A REL9LIV N 9B REL9YOD N 9C REL9ONS N 9D REL10YOB N 9A REL10LIV N 9B REL10YOD N 9C REL10ONS N 9D REL11YOB N 9A REL11LIV N 9B REL11YOD N 9C REL11ONS N 9D REL12YOB N 9A REL12LIV N 9B REL12YOD N 9C REL12ONS N 9D REL13YOB N 9A REL13LIV N 9B REL13YOD N 9C REL13ONS N 9D REL14YOB N 9A14 NACC UDS Data Template IVP (version 2.0, February 2008) Form A3: page 12

16 Packet I, Form A3: SUBJECT FAMILY HISTORY (Version 2) REL14LIV N 9B REL14YOD N 9C REL14ONS N 9D REL15YOB N 9A REL15LIV N 9B REL15YOD N 9C REL15ONS N 9D15 NACC UDS Data Template IVP (version 2.0, February 2008) Form A3: page 13

17 Packet I, Form A4G: SUBJECT MEDICATIONS (general) (Version 2) 1 45 ANYMEDS N 1 NACC UDS Data Template IVP (version 2.0, February 2008) Form A4G: page 14

18 Packet I, Form A4D: SUBJECT MEDICATIONS (details) (Version 2) DRUGID C 1 NACC UDS Data Template IVP (version 2.0, February 2008) Form A4D: page 15

19 Packet I, Form A5: SUBJECT HEALTH HISTORY (Version 2) 1 45 CVHATT N 1A 1 47 CVAFIB N 1B 1 49 CVANGIO N 1C 1 51 CVBYPASS N 1D 1 53 CVPACE N 1E 1 55 CVCHF N 1F 1 57 CVOTHR N 1G CVOTHRX C 1G CBSTROKE N 2A STROK1YR N 2A STROK2YR N 2A STROK3YR N 2A STROK4YR N 2A STROK5YR N 2A STROK6YR N 2A CBTIA N 2B TIA1YR N 2B TIA2YR N 2B TIA3YR N 2B TIA4YR N 2B TIA5YR N 2B TIA6YR N 2B CBOTHR N 2C CBOTHRX C 2C PD N 3A PDYR N 3A PDOTHR N 3B NACC UDS Data Template IVP (version 2.0, February 2008) Form A5: page 16

20 Packet I, Form A5: SUBJECT HEALTH HISTORY (Version 2) PDOTHRYR N 3B SEIZURES N 4A TRAUMBRF N 4B TRAUMEXT N 4B TRAUMCHR N 4B NCOTHR N 4C NCOTHRX C 4C HYPERTEN N 5A HYPERCHO N 5B DIABETES N 5C B12DEF N 5D THYROID N 5E INCONTU N 5F INCONTF N 5G DEP2YRS N 6A DEPOTHR N 6B ALCOHOL N 7A TOBAC30 N 7B TOBAC100 N 7B SMOKYRS N 7B PACKSPER N 7B QUITSMOK N 7B ABUSOTHR N 7C ABUSX C 7C PSYCDIS N 7D PSYCDISX C 7D1 NACC UDS Data Template IVP (version 2.0, February 2008) Form A5: page 17

21 Packet I, Form B1: EVALUATION FORM PHYSICAL (Version 2) HEIGHT N WEIGHT N BPSYS N 3A BPDIAS N 3B HRATE N VISION N VISCORR N VISWCORR N 6A 1 72 HEARING N HEARAID N HEARWAID N 8A NACC UDS Data Template IVP (version 2.0, February 2008) Form B1: page 18

22 Packet I, Form B2: EVALUATION FORM HIS and CVD (Version 2) 1 45 ABRUPT N STEPWISE N SOMATIC N EMOT N HXHYPER N HXSTROKE N FOCLSYM N FOCLSIGN N HACHIN N CVDCOG N STROKCOG N CVDIMAG N CVDIMAG1 N 12A CVDIMAG2 N 12A CVDIMAG3 N 12A CVDIMAG4 N 12A CVDIMAGX C 12A5 NACC UDS Data Template IVP (version 2.0, February 2008) Form B2: page 19

23 Packet I, Form B3: EVALUATION FORM UPDRS (Version 2) 1 45 PDNORMAL N G SPEECH N SPEECHX C 1A FACEXP N FACEXPX C 2A TRESTFAC N 3A TRESTFAX C 3A TRESTRHD N 3B TRESTRHX C 3B TRESTLHD N 3C TRESTLHX C 3C TRESTRFT N 3D TRESTRFX C 3D TRESTLFT N 3E TRESTLFX C 3E TRACTRHD N 4A TRACTRHX C 4A TRACTLHD N 4B TRACTLHX C 4B RIGDNECK N 5A RIGDNEX C 5A RIGDUPRT N 5B RIGDUPRX C 5B RIGDUPLF N 5C RIGDUPLX C 5C RIGDLORT N 5D RIGDLORX C 5D1 NACC UDS Data Template IVP (version 2.0, February 2008) Form B3: page 20

24 Packet I, Form B3: EVALUATION FORM UPDRS (Version 2) RIGDLOLF N 5E RIGDLOLX C 5E TAPSRT N 6A TAPSRTX C 6A TAPSLF N 6B TAPSLFX C 6B HANDMOVR N 7A HANDMVRX C 7A HANDMOVL N 7B HANDMVLX C 7B HANDALTR N 8A HANDATRX C 8A HANDALTL N 8B HANDATLX C 8B LEGRT N 9A LEGRTX C 9A LEGLF N 9B LEGLFX C 9B ARISING N ARISINGX C 10A POSTURE N POSTUREX C 11A GAIT N GAITX C 12A POSSTAB N POSSTABX C 13A BRADYKIN N BRADYKIX C 14A NACC UDS Data Template IVP (version 2.0, February 2008) Form B3: page 21

25 Packet I, Form B4: GLOBAL STAGING CDR: STANDARD and SUPPLEMENTAL (Version 2) MEMORY N ORIENT N JUDGMENT N COMMUN N HOMEHOBB N PERSCARE N CDRSUM N CDRGLOB N COMPORT N CDRLANG N 10 NACC UDS Data Template IVP (version 2.0, February 2008) Form B4: page 22

26 Packet I, Form B5: BEHAVIORAL ASSESSMENT NPI-Q (Version 2) 1 45 NPIQINF N NPIQINFX C 1A DEL N 2A DELSEV N 2B HALL N 3A HALLSEV N 3B AGIT N 4A AGITSEV N 4B DEPD N 5A DEPDSEV N 5B ANX N 6A ANXSEV N 6B ELAT N 7A ELATSEV N 7B APA N 8A APASEV N 8B DISN N 9A DISNSEV N 9B IRR N 10A IRRSEV N 10B MOT N 11A MOTSEV N 11B NITE N 12A NITESEV N 12B APP N 13A APPSEV N 13B NACC UDS Data Template IVP (version 2.0, February 2008) Form B5: page 23

27 Packet I, Form B6: BEHAVIORAL ASSESSMENT GDS (Version 2) 1 45 NOGDS N G SATIS N DROPACT N EMPTY N BORED N SPIRITS N AFRAID N HAPPY N HELPLESS N STAYHOME N MEMPROB N WONDRFUL N WRTHLESS N ENERGY N HOPELESS N BETTER N GDS N 16 NACC UDS Data Template IVP (version 2.0, February 2008) Form B6: page 24

28 Packet I, Form B7: FUNCTIONAL ASSESSMENT FAQ (Version 2) 1 45 BILLS N TAXES N SHOPPING N GAMES N STOVE N MEALPREP N EVENTS N PAYATTN N REMDATES N TRAVEL N 10 NACC UDS Data Template IVP (version 2.0, February 2008) Form B7: page 25

29 Packet I, Form B8: EVALUATION PHYSICAL/NEUROLOGICAL EXAM FINDINGS (Version 2) 1 45 NORMAL N FOCLDEF N GAITDIS N EYEMOVE N 4 NACC UDS Data Template IVP (version 2.0, February 2008) Form B8: page 26

30 Packet I, Form B9: CLINICIAN JUDGMENT OF SYMPTOMS ONSET (Version 2) 1 45 DECSUB N DECIN N DECCLIN N 3A DECAGE N 3B 1 55 COGMEM N 4A 1 57 COGJUDG N 4B 1 59 COGLANG N 4C 1 61 COGVIS N 4D 1 63 COGATTN N 4E 1 65 COGFLUC N 4F 1 67 COGOTHR N 4G COGOTHRX C 4G COGFRST N COGFRSTX C 5A COGMODE N COGMODEX C 6A BEAPATHY N 7A BEDEP N 7B BEVHALL N 7C BEVWELL N 7C1A BEAHALL N 7C BEDEL N 7C BEDISIN N 7D BEIRRIT N 7E BEAGIT N 7F BEPERCH N 7G BEREM N 7H NACC UDS Data Template IVP (version 2.0, February 2008) Form B9: page 27

31 Packet I, Form B9: CLINICIAN JUDGMENT OF SYMPTOMS ONSET (Version 2) BEOTHR N 7I BEOTHRX C 7I BEFRST N BEFRSTX C 8A BEMODE N BEMODEX C 9A MOGAIT N 10A MOFALLS N 10B MOTREM N 10C MOSLOW N 10D MOFRST N MOMODE N MOMODEX C 12X MOMOPARK N 12A COURSE N FRSTCHG N 14 NACC UDS Data Template IVP (version 2.0, February 2008) Form B9: page 28

32 Packet I, Form C1: MMSE AND NEUROPSYCHOLOGICAL BATTERY (Version 2) 1 45 MMSELOC N 1A 1 47 MMSELAN N 1A MMSELANX C 1A MMSEORDA N 1B MMSEORLO N 1B PENTAGON N 1C MMSE N 1D NPSYCLOC N NPSYLAN N 2A NPSYLANX C 2A LOGIMO N 3AMO LOGIDAY N 3ADY LOGIYR N 3AYR LOGIPREV N 3A LOGIMEM N 3B DIGIF N 4A DIGIFLEN N 4B DIGIB N 5A DIGIBLEN N 5B ANIMALS N 6A VEG N 6B TRAILA N 7A TRAILARR N 7A TRAILALI N 7A TRAILB N 7B TRAILBRR N 7B TRAILBLI N 7B2 NACC UDS Data Template IVP (version 2.0, February 2008) Form C1: page 29

33 Packet I, Form C1: MMSE AND NEUROPSYCHOLOGICAL BATTERY (Version 2) WAIS N 8A MEMUNITS N 9A MEMTIME N 9B BOSTON N 10A COGSTAT N 11A NACC UDS Data Template IVP (version 2.0, February 2008) Form C1: page 30

34 Packet I, Form D1: CLINICIAN DIAGNOSIS COGNITIVE STATUS AND DEMENTIA (Version 2) 1 45 WHODIDDX N NORMCOG N DEMENTED N MCIAMEM N 4A 1 53 MCIAPLUS N 4B 1 55 MCIAPLAN N 4B MCIAPATT N 4B MCIAPEX N 4B MCIAPVIS N 4B MCINON1 N 4C 1 65 MCIN1LAN N 4C MCIN1ATT N 4C MCIN1EX N 4C MCIN1VIS N 4C MCINON2 N 4D 1 75 MCIN2LAN N 4D MCIN2ATT N 4D MCIN2EX N 4D MCIN2VIS N 4D IMPNOMCI N 4E 1 85 PROBAD N PROBADIF N 5A 1 89 POSSAD N POSSADIF N 6A 1 93 DLB N DLBIF N 7A 1 97 VASC N 8 NACC UDS Data Template IVP (version 2.0, February 2008) Form D1: page 31

35 Packet I, Form D1: CLINICIAN DIAGNOSIS COGNITIVE STATUS AND DEMENTIA (Version 2) 1 99 VASCIF N 8A VASCPS N VASCPSIF N 9A ALCDEM N ALCDEMIF N 10A DEMUN N DEMUNIF N 11A FTD N FTDIF N 12A PPAPH N PPAPHIF N 13A PNAPH N 13A SEMDEMAN N 13A SEMDEMAG N 13A PPAOTHR N 13A PSP N PSPIF N 14A CORT N CORTIF N 15A HUNT N HUNTIF N 16A PRION N PRIONIF N 17A MEDS N MEDSIF N 18A DYSILL N DYSILLIF N 19A DEP N DEPIF N 20A OTHPSY N OTHPSYIF N 21A DOWNS N DOWNSIF N 22A PARK N PARKIF N 23A NACC UDS Data Template IVP (version 2.0, February 2008) Form D1: page 32

36 Packet I, Form D1: CLINICIAN DIAGNOSIS COGNITIVE STATUS AND DEMENTIA (Version 2) STROKE N STROKIF N 24A HYCEPH N HYCEPHIF N 25A BRNINJ N BRNINJIF N 26A NEOP N NEOPIF N 27A COGOTH N COGOTHIF N 28A COGOTHX C 28B COGOTH2 N COGOTH2F N 29A COGOTH2X C 29B COGOTH3 N COGOTH3F N 30A COGOTH3X C 30B NACC UDS Data Template IVP (version 2.0, February 2008) Form D1: page 33

37 Packet I, Form E1: IMAGING/LABS (Version 2) 1 45 CTFLM N 1A 1 47 CTDIG N 1B 1 49 MRI1FLM N 2A 1 51 MRI1DIG N 2B 1 53 MRI2FLM N 3A 1 55 MRI2DIG N 3B 1 57 MRI3FLM N 4A 1 59 MRI3DIG N 4B 1 61 MRISPFLM N 5A 1 63 MRISPDIG N 5B 1 65 SPECTFLM N 6A 1 67 SPECTDIG N 6B 1 69 PETFLM N 7A 1 71 PETDIG N 7B 1 73 DNA N CSFANTEM N SERUM N APOE N 11 NACC UDS Data Template IVP (version 2.0, February 2008) Form E1: page 34

Data Template For Initial Visit Packet

NACC Uniform Data Set Data Template For Initial Visit Packet Version 3.0, March 2015 Copyright 2006, 2008, 2015, 2017 University of Washington. Created and published by the ADC Clinical Task Force (John