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ACCIDENT REPORt FORM

1 forms  
  1. StudyEvent: ODM
    1. ACCIDENT REPORt FORM
Patienten Informationen
Description

Patienten Informationen

Name
Description

Patient name

Data type

integer

Alias
UMLS CUI [1]
C1299487
Geburtsdatum
Description

Patient date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Geschlecht
Description

Gender

Data type

integer

Alias
UMLS CUI [1]
C0079399
Anschrift
Description

Patient address

Data type

integer

Alias
UMLS CUI [1]
C0421449
Telefon
Description

Telephone

Data type

integer

Alias
UMLS CUI [1]
C1515258
Staatsangehörigkeit
Description

Nationality

Data type

integer

Alias
UMLS CUI [1]
C0027473
Beschäftigt als
Description

Occupation

Data type

integer

Alias
UMLS CUI [1]
C0028811
Krankenversicherung
Description

Health insurance

Data type

integer

Alias
UMLS CUI [1]
C0021682
Unfallbogen
Description

Unfallbogen

Unfallbetrieb (Schule, Kindergarten, KITA etc.)
Description

bitte mit genauer Anschrift:

Data type

integer

Alias
UMLS CUI [1]
C0337069
Unfalldatum
Description

Accident date

Data type

integer

Alias
UMLS CUI [1]
C0000924
Unfallzeit
Description

Accident time

Data type

integer

Alias
UMLS CUI [1,1]
C0000924
UMLS CUI [1,2]
C0011008
Beginn der Schul-, Kindergartenzeit
Description

School begin

Data type

integer

Alias
UMLS CUI [1]
C0680097
Ende der Schul-, Kindergartenzeit
Description

End school

Data type

integer

Alias
UMLS CUI [1]
C0680097
Wie und wo ist der Unfall geschehen
Description

Place of occurrence of accident

Data type

integer

Alias
UMLS CUI [1]
C0431140
Verhalten des Kindes nach dem Unfall
Description

Behaviour after the accident

Data type

integer

Alias
UMLS CUI [1,1]
C0004927
UMLS CUI [1,2]
C0000924
Erstmalig behandelt am
Description

First treatment

Data type

date

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0205435
UMLS CUI [1,3]
C0011008
behandelnder Arzt
Description

Attending physician

Data type

integer

Alias
UMLS CUI [1]
C1320929
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Similar models

ACCIDENT REPORt FORM

1 forms
  1. StudyEvent: ODM
    1. ACCIDENT REPORt FORM
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patienten Informationen
Patient name
Item
Name
integer
C1299487 (UMLS CUI [1])
Patient date of birth
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Item
Geschlecht
integer
C0079399 (UMLS CUI [1])
Gender
Code List
Geschlecht
CL Item
Junge (1)
C0086582 (UMLS CUI-1)
CL Item
Mädchen (2)
C0086287 (UMLS CUI-1)
Patient address
Item
Anschrift
integer
C0421449 (UMLS CUI [1])
Telephone
Item
Telefon
integer
C1515258 (UMLS CUI [1])
Nationality
Item
Staatsangehörigkeit
integer
C0027473 (UMLS CUI [1])
Item
Beschäftigt als
integer
C0028811 (UMLS CUI [1])
Occupation
Code List
Beschäftigt als
CL Item
Schüler (1)
C0260267 (UMLS CUI-1)
CL Item
Kindergarten (2)
C0681405 (UMLS CUI-1)
Health insurance
Item
Krankenversicherung
integer
C0021682 (UMLS CUI [1])
Item Group
Unfallbogen
Accident site
Item
Unfallbetrieb (Schule, Kindergarten, KITA etc.)
integer
C0337069 (UMLS CUI [1])
Accident date
Item
Unfalldatum
integer
C0000924 (UMLS CUI [1])
Accident time
Item
Unfallzeit
integer
C0000924 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
School begin
Item
Beginn der Schul-, Kindergartenzeit
integer
C0680097 (UMLS CUI [1])
End school
Item
Ende der Schul-, Kindergartenzeit
integer
C0680097 (UMLS CUI [1])
Place of occurrence of accident
Item
Wie und wo ist der Unfall geschehen
integer
C0431140 (UMLS CUI [1])
Behaviour after the accident
Item
Verhalten des Kindes nach dem Unfall
integer
C0004927 (UMLS CUI [1,1])
C0000924 (UMLS CUI [1,2])
First treatment
Item
Erstmalig behandelt am
date
C0087111 (UMLS CUI [1,1])
C0205435 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Attending physician
Item
behandelnder Arzt
integer
C1320929 (UMLS CUI [1])
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