NACC Uniform Data Set (UDS) FTLD Module Data Template For Initial Visit Packet Version 2.0, January 2012 Copyright 2013 University of Washington Created and published by the FTLD work group of the ADC Program (David Knopman, MD, Chair) and the National Alzheimer s Coordinating Center (Walter A. Kukull, PhD, Director). All rights reserved. This publication was funded by the National Institutes of Health through the National Institute on Aging (Cooperative Agreement U01 AG016976). NOTE: Version 2 is NOT the most current version of the FTLD Moudle forms and is no longer used for data submission. For the most current version, please visit http:// www.alz.washington.edu. This Data Template last modified June 18, 2012.
FTLD Module to the Uniform Data Set Data Template for the Initial Visit Packet Preface This template is designed to help the Data Cores at the Alzheimer s Disease Centers develop software for submitting FTLD data to NACC. In this template, data elements are organized by form and, within the form, by item number. For each data element, the template lists the element name, element type, columns for ASCII file submission, and item number. This template is needed only for file submission. 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 for the FTLD Initial Visit Packet. Please note: The first 10 data elements are the same for each form, and hence for each template. These elements which are required are shaded on the template. For ASCII fixed-format files, exactly one blank space is 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. For SAS files, all data elements must be present in the file. For tab-delimited files, all fields must be separated by one tab. For comma-delimited files, all fields must be separated by one comma. Fields containing commas must be contained in quotation marks. In some cases, the item number shown in the template does not appear in the form. This is true for most Other (specify) text items and dates.
Coding for form header (first 10 data elements on each form) PACKET = IF (The letter I, for the Initial Visit FTLD Module) FORMID = Form ID (I.e., Z1F, A3A, A3F, etc.) FORMVER = 2 Although this is the first version of the FTLD forms, the FORMVER is 2 because the FTLD Module was initially created to be used with Version 2 of the UDS. ADCID = Center ID The same number used in the MDS and NP data for your Center; see the Data Element Dictionary for the FTLD Module or the UDS for a list of Center IDs. PTID = Patient ID Follow your Center s patient ID scheme. For each subject, patient ID: must be unique within the data set from your Center no duplicate Patient IDs are permitted; must be the same for each visit in the FTLD Module; and must be the same PTID used for that subject in all the NACC databases (UDS, MDS, and NP). PTID cannot be changed once it has been assigned by your Center. Because this is a character field, you must include or exclude leading zeros to match ID numbers across all data sets. VISITMO VISITDAY = Actual date of the interview; cannot precede 01/01/2012 VISITYR VISITNUM = Visit ID Assigned by your Center; need not start with 1 INITIALS = Examiner s initials (Initials of the person conducting the interview)
Form Z1F Form Checklist 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDA3AFS N 1a 2 47 48 FTDA3AFR N 1b 60 50 109 FTDA3AFC C 1c 1 111 111 FTDA3FS N 2a 2 113 114 FTDA3FR N 2b 60 116 175 FTDA3FC C 2c 1 177 177 FTDC4FS N 3a 2 179 180 FTDC4FR N 3b 60 182 241 FTDC4FC C 3c 1 243 243 FTDC5FS N 4a 2 245 246 FTDC5FR N 4b 60 248 307 FTDC5FC C 4c 1 309 309 FTDC6FS N 5a 2 311 312 FTDC6FR N 5b 60 314 373 FTDC6FC C 5c NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 1
Form A3aF Record of Consent for Biologic Specimen Use 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDRELCO N 1 4 47 50 FTDSIBBY N 1 4 52 55 FTDCHDBY N 1 1 57 57 FTDSTORE N 1a 1 59 59 FTDSLEAR N 1b 1 61 61 FTDCOMME N 1c NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 2
Form A3F Family History: Affected Family Members 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDAFF N 1a 1 47 47 FTDMUTAT N 1b 1 49 49 FTDPMUT N 1c 60 51 110 FTDPMUTX C 1c1 1 112 112 FTDMCLAB N 1d 1 114 114 FTDMRLAB N 1e 1 116 116 FTDMFAMR N 1f 1 118 118 FTDMOTH N 1g 60 120 179 FTDMOTHX C 1g1 1 181 181 FTDMOMN N 2aa 3 183 185 FTDMOMP N 2ab 1 187 187 FTDMOME N 2ac 3 189 191 FTDMOMA N 2ad 1 193 193 FTDDADN N 2ba 3 195 197 FTDDADP N 2bb 1 199 199 FTDDADE N 2bc 3 201 203 FTDDADA N 2bd 2 205 206 FTDBSAM N 3aa 4 208 211 FTDBSA N 3aa 1 213 213 FTDNSA N 3ab 3 215 217 FTDPSA N 3ac NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 3
Form A3F family history: affected family members CONTINUED 1 219 219 FTDMSA N 3ad 3 221 223 FTDASA N 3ae 2 225 226 FTDBSBM N 3ba 4 228 231 FTDBSB N 3ba 1 233 233 FTDNSB N 3bb 3 235 237 FTDPSB N 3bc 1 239 239 FTDMSB N 3bd 3 241 243 FTDASB N 3be 2 245 246 FTDBSCM N 3ca 4 248 251 FTDBSC N 3ca 1 253 253 FTDNSC N 3cb 3 255 257 FTDPSC N 3cc 1 259 259 FTDMSC N 3cd 3 261 263 FTDASC N 3ce 2 265 266 FTDBSDM N 3da 4 268 271 FTDBSD N 3da 1 273 273 FTDNSD N 3db 3 275 277 FTDPSD N 3dc 1 279 279 FTDMSD N 3dd 3 281 283 FTDASD N 3de 2 285 286 FTDBSEM N 3ea 4 288 291 FTDBSE N 3ea 1 293 293 FTDNSE N 3eb 3 295 297 FTDPSE N 3ec 1 299 299 FTDMSE N 3ed 3 301 303 FTDASE N 3ee 2 305 306 FTDBSFM N 3fa 4 308 311 FTDBSF N 3fa 1 313 313 FTDNSF N 3fb 3 315 317 FTDPSF N 3fc 1 319 319 FTDMSF N 3fd 3 321 323 FTDASF N 3fe 2 325 326 FTDBSGM N 3ga 4 328 331 FTDBSG N 3ga 1 333 333 FTDNSG N 3gb NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 4
Form A3F family history: affected family members CONTINUED 3 335 337 FTDPSG N 3gc 1 339 339 FTDMSG N 3gd 3 341 343 FTDASG N 3ge 2 345 346 FTDBSHM N 3ha 4 348 351 FTDBSH N 3ha 1 353 353 FTDNSH N 3hb 3 355 357 FTDPSH N 3hc 1 359 359 FTDMSH N 3hd 3 361 363 FTDASH N 3he 2 365 366 FTDBSIM N 3ia 4 368 371 FTDBSI N 3ia 1 373 373 FTDNSI N 3ib 3 375 377 FTDPSI N 3ic 1 379 379 FTDMSI N 3id 3 381 383 FTDASI N 3ie 2 385 386 FTDBSJM N 3ja 4 388 391 FTDBSJ N 3ja 1 393 393 FTDNSJ N 3jb 3 395 397 FTDPSJ N 3jc 1 399 399 FTDMSJ N 3jd 3 401 403 FTDASJ N 3je 2 405 406 FTDBSKM N 3ka 4 408 411 FTDBSK N 3ka 1 413 413 FTDNSK N 3kb 3 415 417 FTDPSK N 3kc 1 419 419 FTDMSK N 3kd 3 421 423 FTDASK N 3ke 2 425 426 FTDBSLM N 3la 4 428 431 FTDBSL N 3la 1 433 433 FTDNSL N 3lb 3 435 437 FTDPSL N 3lc 1 439 439 FTDMSL N 3ld 3 441 443 FTDASL N 3le 2 445 446 FTDBSMM N 3ma 4 448 451 FTDBSM N 3ma NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 5
Form A3F family history: affected family members CONTINUED 1 453 453 FTDNSM N 3mb 3 455 457 FTDPSM N 3mc 1 459 459 FTDMSM N 3md 3 461 463 FTDASM N 3me 2 465 466 FTDBCAM N 4aa 4 468 471 FTDBCA N 4aa 1 473 473 FTDNCA N 4ab 3 475 477 FTDPCA N 4ac 1 479 479 FTDMCA N 4ad 3 481 483 FTDACA N 4ae 2 485 486 FTDBCBM N 4ba 4 488 491 FTDBCB N 4ba 1 493 493 FTDNCB N 4bb 3 495 497 FTDPCB N 4bc 1 499 499 FTDMCB N 4bd 3 501 503 FTDACB N 4be 2 505 506 FTDBCCM N 4ca 4 508 511 FTDBCC N 4ca 1 513 513 FTDNCC N 4cb 3 515 517 FTDPCC N 4cc 1 519 519 FTDMCC N 4cd 3 521 523 FTDACC N 4ce 2 525 526 FTDBCDM N 4da 4 528 531 FTDBCD N 4da 1 533 533 FTDNCD N 4db 3 535 537 FTDPCD N 4dc 1 539 539 FTDMCD N 4dd 3 541 543 FTDACD N 4de 2 545 546 FTDBCEM N 4ea 4 548 551 FTDBCE N 4ea 1 553 553 FTDNCE N 4eb 3 555 557 FTDPCE N 4ec 1 559 559 FTDMCE N 4ed 3 561 563 FTDACE N 4ee 2 565 566 FTDBCFM N 4fa NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 6
Form A3F family history: affected family members CONTINUED 4 568 571 FTDBCF N 4fa 1 573 573 FTDNCF N 4fb 3 575 577 FTDPCF N 4fc 1 579 579 FTDMCF N 4fd 3 581 583 FTDACF N 4fe 2 585 586 FTDBCGM N 4ga 4 588 591 FTDBCG N 4ga 1 593 593 FTDNCG N 4gb 3 595 597 FTDPCG N 4gc 1 599 599 FTDMCG N 4gd 3 601 603 FTDACG N 4ge 2 605 606 FTDBCHM N 4ha 4 608 611 FTDBCH N 4ha 1 613 613 FTDNCH N 4hb 3 615 617 FTDPCH N 4hc 1 619 619 FTDMCH N 4hd 3 621 623 FTDACH N 4he 2 625 626 FTDBCIM N 4ia 4 628 631 FTDBCI N 4ia 1 633 633 FTDNCI N 4ib 3 635 637 FTDPCI N 4ic 1 639 639 FTDMCI N 4id 3 641 643 FTDACI N 4ie 2 645 646 FTDBCJM N 4ja 4 648 651 FTDBCJ N 4ja 1 653 653 FTDNCJ N 4jb 3 655 657 FTDPCJ N 4jc 1 659 659 FTDMCJ N 4jd 3 661 663 FTDACJ N 4je 2 665 666 FTDBCKM N 4ka 4 668 671 FTDBCK N 4ka 1 673 673 FTDNCK N 4kb 3 675 677 FTDPCK N 4kc 1 679 679 FTDMCK N 4kd 3 681 683 FTDACK N 4ke NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 7
Form A3F family history: affected family members CONTINUED 2 685 686 FTDBCLM N 4la 4 688 691 FTDBCL N 4la 1 693 693 FTDNCL N 4lb 3 695 697 FTDPCL N 4lc 1 699 699 FTDMCL N 4ld 3 701 703 FTDACL N 4le 2 705 706 FTDBCMM N 4ma 4 708 711 FTDBCM N 4ma 1 713 713 FTDNCM N 4mb 3 715 717 FTDPCM N 4mc 1 719 719 FTDMCM N 4md 3 721 723 FTDACM N 4me NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 8
Form B3F Supplemental UPDRS 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDLTFAS N A1 1 47 47 FTDLIMB N A2 1 49 49 FTDBULB N A3 1 51 51 FTDEYE N A4 1 53 53 FTDDYST N A5 1 55 55 FTDIDEO N A6 1 57 57 FTDALIEN N A7 1 59 59 FTDMYOCL N A8 1 61 61 FTDCORTS N A9 1 63 63 FTDGSEV N B1 60 65 124 FTDGSEVX C B1a 1 126 126 FTDGTYP N B2 60 128 187 FTDGTYPG C B2a 60 189 248 FTDGTYPX C B2b NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 9
Form B9F Clinical PPA and bvftd Features 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDPPASL N 1 1 47 47 FTDPPAPO N 2 1 49 49 FTDPPAIW N 3 1 51 51 FTDPPASW N 4 1 53 53 FTDPPAPK N 5 1 55 55 FTDPPAGS N 6 1 57 57 FTDPPAEH N 7 1 59 59 FTDPPACS N 8 1 61 61 FTDPPASS N 9 1 63 63 FTDPPASR N 10 1 65 65 FTDPPASD N 11 1 67 67 FTDCPPA N 12 1 69 69 FTDCPPAS N 13 1 71 71 FTDBVCLN N 14 1 73 73 FTDBVDIS N 15 1 75 75 FTDBVAPA N 16 1 77 77 FTDBVLOS N 17 1 79 79 FTDBVRIT N 18 1 81 81 FTDBVHYP N 19 1 83 83 FTDBVNEU N 20 1 85 85 FTDBVIDL N 21 1 87 87 FTDBVFT N 22 1 89 89 FTDEMGPV N 23 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 10
Form B9F clinical ppa and bvftd features CONTINUED 1 91 91 FTDEMGPY N 24 1 93 93 FTDEMGMN N 25 1 95 95 FTDPABVF N 26 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 11
Form C1F Neuropsychological Battery Summary Scores 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 2 45 46 FTDBENTC N 1a 2 48 49 FTDVERFC N 2a 2 51 52 FTDVERFN N 2b 2 54 55 FTDVERNF N 2c 2 57 58 FTDVERLC N 2d 2 60 61 FTDVERLR N 2e 2 63 64 FTDVERLN N 2f 2 66 67 FTDVERTN N 2g 2 69 70 FTDVERTE N 2h 2 72 73 FTDVERTI N 2i 2 75 76 FTDWORRC N 3a 2 78 79 FTDWORRS N 3b 2 81 82 FTDWORRR N 3c 2 84 85 FTDWORIC N 3d 2 87 88 FTDWORIS N 3e 2 90 91 FTDWORIR N 3f 2 93 94 FTDWORIP N 3g 2 96 97 FTDBENTD N 4a 1 99 99 FTDBENRS N 4b 2 101 102 FTDSEMMT N 5a 2 104 105 FTDSEMAA N 6a 2 107 108 FTDSEMTA N 6b 2 110 111 FTDSEMSU N 6c NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 12
Form c1f neuropsychological battery summary scores CONTINUED 2 113 114 FTDANASW N 7a 2 116 117 FTDANAOW N 7b 2 119 120 FTDANATS N 7c 2 122 123 FTDSENAS N 8a 2 125 126 FTDSENOS N 8b 2 128 129 FTDSENSR N 8c 2 131 132 FTDSENPR N 8d 2 134 135 FTDNOUNC N 9a 2 137 138 FTDVERBC N 9b 5 140 144 FTDRATIO N 9c 2 146 147 FTDREAAS N 10a 2 149 150 FTDREAOS N 10b 2 152 153 FTDREASR N 10c 2 155 156 FTDREAPR N 10d NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 13
Form C2F Social Norms Questionnaire 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 2 45 46 FTDCPC2F N 0 1 48 48 FTDHAIRD N 1 1 50 50 FTDSPIT N 2 1 52 52 FTDNOSE N 3 1 54 54 FTDCOAGE N 4 1 56 56 FTDCRY N 5 1 58 58 FTDCUT N 6 1 60 60 FTDYTRIP N 7 1 62 62 FTDEATP N 8 1 64 64 FTDTELLA N 9 1 66 66 FTDOPIN N 10 1 68 68 FTDLAUGH N 11 1 70 70 FTDSHIRT N 12 1 72 72 FTDKEEPM N 13 1 74 74 FTDPICKN N 14 1 76 76 FTDOVER N 15 1 78 78 FTDEATR N 16 1 80 80 FTDHAIRL N 17 1 82 82 FTDSHIRW N 18 1 84 84 FTDMOVE N 19 1 86 86 FTDHUGS N 20 1 88 88 FTDLOUD N 21 1 90 90 FTDLOST N 22 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 14
Form C2F social norms questionnaire CONTINUED 2 92 93 FTDSNTOT N 23 2 95 96 FTDSNTBS N 24 2 98 99 FTDSNTOS N 25 5 101 105 FTDSNRAT N 26 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 15
Form C3F Social Behavior Observer Checklist 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDSELF N 1 1 47 47 FTDBADLY N 1a 1 49 49 FTDDEPR N 1b 1 51 51 FTDEMOTD N 1c 1 53 53 FTDLSELF N 2 1 55 55 FTDDISR N 2a 1 57 57 FTDBELCH N 2b 1 59 59 FTDGIGG N 2c 1 61 61 FTDPRIV N 3 1 63 63 FTDNEGAT N 3a 1 65 65 FTDECOMM N 3b 1 67 67 FTDINAPJ N 3c 1 69 69 FTDFAILA N 4 1 71 71 FTDRESIS N 4a 1 73 73 FTDINTER N 4b 1 75 75 FTDVERBA N 4c 1 77 77 FTDPHYSI N 4d 1 79 79 FTDTOPIC N 4e 1 81 81 FTDPROTO N 4f 1 83 83 FTDPREO N 5 1 85 85 FTDFINI N 5a NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 16
Form C3F social behavior observer checklist CONTINUED 1 87 87 FTDACTED N 6 1 89 89 FTDABS N 6a 1 91 91 FTDFEEDB N 6b 1 93 93 FTDFRUST N 6c 1 95 95 FTDANXI N 7 1 97 97 FTDNERVO N 7a 1 99 99 FTDNDIAG N 7b 1 101 101 FTDSTIMB N 8 1 103 103 FTDSTIME N 8a 1 105 105 FTDOBJEC N 8b 1 107 107 FTDCIRCU N 8c 1 109 109 FTDPERSE N 9 1 111 111 FTDREPEA N 9a 1 113 113 FTDANECD N 9b 1 115 115 FTDDINIT N 10 1 117 117 FTDDELAY N 10a 1 119 119 FTDADDVE N 10b 1 121 121 FTDFLUCT N 11 1 123 123 FTDLOSTT N 11a 1 125 125 FTDREPRU N 11b 1 127 127 FTDTRAIN N 11c 1 129 129 FTDDISCL N 12 1 131 131 FTDSPONT N 12a 1 133 133 FTDSPONR N 12b 1 135 135 FTDSTOOD N 12c 1 137 137 FTDTOUCH N 12d 1 139 139 FTDDSOCI N 13 1 141 141 FTDEXAGG N 14 2 143 144 FTDSBTOT N 15 3 146 148 FTDSBCTO N 16 3 150 152 FTDLENGT N 17 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 17
Form C4F Behavioral Inhibition Scale 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDCPC4F N 0 1 47 47 FTDWORKU N 1 1 49 49 FTDMIST N 2 1 51 51 FTDCRIT N 3 1 53 53 FTDWORR N 4 1 55 55 FTDBAD N 5 1 57 57 FTDPOOR N 6 1 59 59 FTDFFEAR N 7 2 61 62 FTDBIST N 8 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 18
Form C5F Interpersonal Reactivity Index 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDCPC5F N 0 1 47 47 FTDINSEX N 0a 2 49 50 FTDINFMO N 0b 4 52 55 FTDINFYR N 0b 1 57 57 FTDINFRE N 0c 1 59 59 FTDFEEL N 1 1 61 61 FTDDIFF N 2 1 63 63 FTDSORR N 3 1 65 65 FTDSIDE N 4 1 67 67 FTDADVAN N 5 1 69 69 FTDIMAG N 6 1 71 71 FTDMISF N 7 1 73 73 FTDWASTE N 8 1 75 75 FTDPITY N 9 1 77 77 FTDQTOUC N 10 1 79 79 FTDSIDES N 11 1 81 81 FTDSOFTH N 12 1 83 83 FTDUPSET N 13 1 85 85 FTDCRITI N 14 2 87 88 FTDIRIEC N 15 2 90 91 FTDIRIPT N 16 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 19
Form C6F Revised Self-monitoring Scale 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDCPC6F N 0 1 47 47 FTDALTER N 1 1 49 49 FTDEMOT N 2 1 51 51 FTDACROS N 3 1 53 53 FTDCONV N 4 1 55 55 FTDINTUI N 5 1 57 57 FTDJOKE N 6 1 59 59 FTDIMAGP N 7 1 61 61 FTDINAPP N 8 1 63 63 FTDCHBEH N 9 1 65 65 FTDADBEH N 10 1 67 67 FTDLYING N 11 1 69 69 FTDGOODF N 12 1 71 71 FTDREGUL N 13 2 73 74 FTDSMSCR N 14 2 76 77 FTDSPSCR N 15 2 79 80 FTDRSMST N 16 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 20
Form E2F Imaging Available 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDSMRI N 1 2 47 48 FTDSMMO N 1a 2 50 51 FTDSMDY N 1a 4 53 56 FTDSMYR N 1a 1 58 58 FTDSMDIC N 1b 60 60 119 FTDSMDIS C 1b1 1 121 121 FTDSMADN N 1c 60 123 182 FTDSMADV C 1c1 1 184 184 FTDSMMAN N 1d 60 186 245 FTDSMMAO C 1d0 60 247 306 FTDSMMAM C 1d1 1 308 308 FTDSMFS N 1e 60 310 369 FTDSMFSO C 1e1 1 371 371 FTDSMQU N 1f 1 373 373 FTDFDGPT N 2 2 375 376 FTDFPMO N 2a 2 378 379 FTDFPDY N 2a 4 381 384 FTDFPYR N 2a 1 386 386 FTDFDDIC N 2b 60 388 447 FTDFDDID C 2b1 1 449 449 FTDFDADN N 2c 60 451 510 FTDFDADV C 2c1 1 512 512 FTDFDMAN N 2d NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 21
Form E2F IMAGING available CONTINUED 60 514 573 FTDFDMAO C 2d0 60 575 634 FTDFDMAM C 2d1 1 636 636 FTDFDQU N 2e 1 638 638 FTDAMYPT N 3 2 640 641 FTDAMMO N 3a 2 643 644 FTDAMDY N 3a 4 646 649 FTDAMYR N 3a 1 651 651 FTDAMDIC N 3b 60 653 712 FTDAMDID C 3b1 1 714 714 FTDAMLIG N 3c 60 716 775 FTDAMLIO C 3c1 1 777 777 FTDAMADN N 3d 60 779 838 FTDAMADV C 3d1 1 840 840 FTDAMMAN N 3e 60 842 901 FTDAMMAO C 3e0 60 903 962 FTDAMMAM C 3e1 1 964 964 FTDAMQU N 3f 1 966 966 FTDOTHER N 4 1 968 968 FTDOTDOP N 4a 1 970 970 FTDOTSER N 4b 1 972 972 FTDOTCHO N 4c 1 974 974 FTDOTANO N 4d 60 976 1035 FTDOTANS C 4d1 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 22
Form E3F Imaging in Diagnosis 2 1 2 PACKET C 3 4 6 FORMID C 3 8 10 FORMVER N 2 12 13 ADCID N 10 15 24 PTID C 2 26 27 VISITMO N 2 29 30 VISITDAY N 4 32 35 VISITYR N 3 37 39 VISITNUM C 3 41 43 INITIALS C 1 45 45 FTDIDIAG N 1 1 47 47 FTDSMRIO N 2 1 49 49 FTDMRIFA N 2a 1 51 51 FTDMRIRF N 2a1 1 53 53 FTDMRILF N 2a2 1 55 55 FTDMRIRT N 2a3 1 57 57 FTDMRILT N 2a4 1 59 59 FTDMRIRM N 2a5 1 61 61 FTDMRILM N 2a6 1 63 63 FTDMRIRP N 2a7 1 65 65 FTDMRILP N 2a8 1 67 67 FTDMRIRB N 2a9 1 69 69 FTDMRILB N 2a10 1 71 71 FTDMRIOB N 2a11 60 73 132 FTDMRIOS C 2a11a 1 134 134 FTDFDGPE N 3 1 136 136 FTDFDGFH N 3a 1 138 138 FTDFDGRF N 3a1 1 140 140 FTDFDGLF N 3a2 1 142 142 FTDFDGRT N 3a3 1 144 144 FTDFDGLT N 3a4 1 146 146 FTDFDGRM N 3a5 1 148 148 FTDFDGLM N 3a6 1 150 150 FTDFDGRP N 3a7 NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 23
Form E3F IMAGING in diagnosis CONTINUED 1 152 152 FTDFDGLP N 3a8 1 154 154 FTDFDGRB N 3a9 1 156 156 FTDFDGLB N 3a10 1 158 158 FTDFDGOA N 3a11 60 160 219 FTDFDGOS C 3a11a 1 221 221 FTDAMYP N 4 1 223 223 FTDAMYVI N 4a 1 225 225 FTDAMYRF N 4a1 1 227 227 FTDAMYLF N 4a2 1 229 229 FTDAMYRT N 4a3 1 231 231 FTDAMYLT N 4a4 1 233 233 FTDAMYRM N 4a5 1 235 235 FTDAMYLM N 4a6 1 237 237 FTDAMYRP N 4a7 1 239 239 FTDAMYLP N 4a8 1 241 241 FTDAMYRB N 4a9 1 243 243 FTDAMYLB N 4a10 1 245 245 FTDAMYOA N 4a11 60 247 306 FTDAMYOS C 4a11a 1 308 308 FTDCBFSP N 5 1 310 310 FTDCBFVI N 5a 1 312 312 FTDCBFRF N 5a1 1 314 314 FTDCBFLF N 5a2 1 316 316 FTDCBFRT N 5a3 1 318 318 FTDCBFLT N 5a4 1 320 320 FTDCBFRM N 5a5 1 322 322 FTDCBFLM N 5a6 1 324 324 FTDCBFRP N 5a7 1 326 326 FTDCBFLP N 5a8 1 328 328 FTDCBFRB N 5a9 1 330 330 FTDCBFLB N 5a10 1 332 332 FTDCBFOA N 5a11 60 334 393 FTDCBFOS C 5a11a 1 395 395 FTDOTHI N 6 60 397 456 FTDOTHIS C 6a NACC UDS FTLD Data Template IVP (Version 2, January 2012) Page 24