ID

18731

Descripción

ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Medical History (General). Case Report Form (CRF)/Source Document templates were created for University of Wisconsin-Madison researchers. These templates are consistent with the FDA's CDASH (Clinical Data Acquisition Standards Harmonization) standards. The CDASH standards identify those elements that should be captured on a Case Report Form (CRF). The forms serve only as templates, and must be edited to meet the study data collection needs as described in the protocol.

Link

https://ictr.wisc.edu/CaseReptTempt

Palabras clave

Versiones (2)
  1. 22/7/16 22/7/16 -
  2. 17/11/16 17/11/16 -
Subido en

17 de noviembre de 2016

DOI

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Licencia

Creative Commons BY-NC 3.0
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Medical History (General): CRF Wisconsin Madison

Inglés

Medical History (General): CRF Wisconsin Madison

1 formularios  
Header
Descripción

Header

PI Name
Descripción

PI Name

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0027365
UMLS CUI [1,2]
C1521895
Protocol or IRB Number
Descripción

Protocol or IRB Number

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348563
Protocol Short Title
Descripción

Protocol Short Title

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2348563
UMLS CUI [1,2]
C1705824
Subject Initials
Descripción

Subject Initials

Tipo de datos

text

Alias
UMLS CUI [1]
C2986440
Subject ID
Descripción

Subject ID

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348585
Date
Descripción

Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
Medical History (General)
Descripción

Medical History (General)

Insert body system being inquired about
Descripción

Body System

Tipo de datos

text

Alias
UMLS CUI [1]
C0460002
Diagnosed condition
Descripción

Diagnosed condition

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0011900
Diagnosis/Condition/Surgery
Descripción

Diagnosis/Condition/Surgery

Tipo de datos

text

Alias
UMLS CUI [1]
C0011900
UMLS CUI [2]
C0543467
Onset Date or Year
Descripción

Onset Date or Year

Tipo de datos

integer

Alias
UMLS CUI [1]
C0574845
UMLS CUI [2]
C3274945
Current Problem
Descripción

Current Problem

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0033213
UMLS CUI [1,2]
C0521116
Other (specify)
Descripción

Other (specify)

Diagnosed condition
Descripción

Diagnosed condition

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0011900
Diagnosis/Condition/Surgery
Descripción

Diagnosis/Condition/Surgery

Tipo de datos

text

Alias
UMLS CUI [1]
C0011900
UMLS CUI [2]
C0543467
Onset Date Or Year
Descripción

Onset Date Or Year

Tipo de datos

integer

Alias
UMLS CUI [1]
C0574845
UMLS CUI [2]
C3274945
Current Problem
Descripción

Current Problem

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0033213
UMLS CUI [1,2]
C0521116
Additional Notes
Descripción

Additional Notes

Tipo de datos

text

Alias
UMLS CUI [1]
C0947611
Medical History Not Obtained
Descripción

Medical History Not Obtained

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C1882120
Medical History Obtained By
Descripción

Medical History Obtained By

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C1301820
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Similar models

Medical History (General): CRF Wisconsin Madison

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header
PI Name
Item
PI Name
text
C0027365 (UMLS CUI [1,1])
C1521895 (UMLS CUI [1,2])
Protocol or IRB Number
Item
Protocol or IRB Number
integer
C2348563 (UMLS CUI [1])
Protocol Short Title
Item
Protocol Short Title
text
C2348563 (UMLS CUI [1,1])
C1705824 (UMLS CUI [1,2])
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Subject ID
Item
Subject ID
integer
C2348585 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Item Group
Medical History (General)
Body System
Item
Insert body system being inquired about
text
C0460002 (UMLS CUI [1])
Diagnosed condition
Item
Diagnosed condition
boolean
C0011900 (UMLS CUI [1])
Diagnosis/Condition/Surgery
Item
Diagnosis/Condition/Surgery
text
C0011900 (UMLS CUI [1])
C0543467 (UMLS CUI [2])
Onset Date or Year
Item
Onset Date or Year
integer
C0574845 (UMLS CUI [1])
C3274945 (UMLS CUI [2])
Current Problem
Item
Current Problem
boolean
C0033213 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Item Group
Other (specify)
Diagnosed condition
Item
Diagnosed condition
boolean
C0011900 (UMLS CUI [1])
Diagnosis/Condition/Surgery
Item
Diagnosis/Condition/Surgery
text
C0011900 (UMLS CUI [1])
C0543467 (UMLS CUI [2])
Onset Date Or Year
Item
Onset Date Or Year
integer
C0574845 (UMLS CUI [1])
C3274945 (UMLS CUI [2])
Current Problem
Item
Current Problem
boolean
C0033213 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Additional Notes
Item
Additional Notes
text
C0947611 (UMLS CUI [1])
Medical History Not Obtained
Item
Medical History Not Obtained
boolean
C0262926 (UMLS CUI [1,1])
C1882120 (UMLS CUI [1,2])
Medical History Obtained By
Item
Medical History Obtained By
text
C0262926 (UMLS CUI [1,1])
C1301820 (UMLS CUI [1,2])
Volver a la parte superior de la página 

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