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ID
20887
Beschrijving
Patient questionnaire to ODM format. Routine documentation of University Hospital of Münster. Publication granted by: Univ.-Prof. Dr. Dr.med. Gereon Heuft Klinik für Psychosomatik und Psychotherapie Universitätsklinikum Münster Domagkstr.22 48149 Münster
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Versies (2)
- 24-03-17 24-03-17 -
- 17-09-21 17-09-21 -
Geüploaded op
24 maart 2017
DOI
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Licentie
Creative Commons BY-NC 3.0
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Patient questionnaire Psychosomatic medicine UKM
Patient questionnaire
- StudyEvent: ODM
Similar models
Patient questionnaire
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Patient name
Item
Patient name
text
C1299487 (UMLS CUI [1])
Address
Item
Address
integer
C0421449 (UMLS CUI [1])
Telephone
Item
Telephone
integer
C1515258 (UMLS CUI [1])
Religion
Item
Relegion
text
C0035039 (UMLS CUI [1])
CL Item
male (1)
C1706180 (UMLS CUI-1)
CL Item
female (2)
C0015780 (UMLS CUI-1)
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
CL Item
German (1)
C1556085 (UMLS CUI-1)
CL Item
Other nationality (2)
C0027473 (UMLS CUI-1)
CL Item
late repatriate (3)
CL Item
single (1)
C0037179 (UMLS CUI-1)
CL Item
married (2)
C0555047 (UMLS CUI-1)
CL Item
separated (3)
C0086972 (UMLS CUI-1)
CL Item
divorced (4)
C0086170 (UMLS CUI-1)
CL Item
widowed (5)
C0206275 (UMLS CUI-1)
CL Item
re-married (6)
C2114520 (UMLS CUI-1)
CL Item
no partner (1)
C0420841 (UMLS CUI-1)
CL Item
steady partnership (2)
C1711206 (UMLS CUI-1)
CL Item
promiscuous (3)
C0562558 (UMLS CUI-1)
CL Item
spouse (4)
C3842295 (UMLS CUI-1)
CL Item
Date of birth of partner (1)
C0803906 (UMLS CUI-1)
CL Item
Job of partner (2)
C0028811 (UMLS CUI-1)
CL Item
Symptoms since when? (1)
C3175529 (UMLS CUI-1)
GP
Item
Name of GP
text
C0017319 (UMLS CUI [1])
Address
Item
Address
integer
C0421449 (UMLS CUI [1])
Telephone
Item
Telephone
integer
Item
Who has advised you to come to the outpatient department?
integer
C0557824 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0566251 (UMLS CUI [1,2])
CL Item
GP (1)
C0017319 (UMLS CUI-1)
CL Item
Hospital (2)
C0019994 (UMLS CUI-1)
CL Item
consultant (3)
C0545082 (UMLS CUI-1)
C0009817 (UMLS CUI-2)
C0009817 (UMLS CUI-2)
CL Item
Psychotherapist (4)
C0557555 (UMLS CUI-1)
CL Item
Advice center (5)
CL Item
Partner/ relative / friends (6)
C3887537 (UMLS CUI-1)
CL Item
Myself (7)
CL Item
Other (8)
C0205394 (UMLS CUI-1)
CL Item
Flat or house (1)
C0457933 (UMLS CUI-1)
CL Item
home for the elderly (2)
C0019870 (UMLS CUI-1)
CL Item
no degree (1)
CL Item
Vocational qualification (1)
C1709790 (UMLS CUI-1)
CL Item
University degree (2)
C0041740 (UMLS CUI-1)
CL Item
no qualification (3)
C0007836 (UMLS CUI-1)
CL Item
other (4)
C0205394 (UMLS CUI-1)
CL Item
worker (1)
C1306056 (UMLS CUI-1)
CL Item
employee (2)
C0599987 (UMLS CUI-1)
CL Item
civil servant (3)
C0401892 (UMLS CUI-1)
CL Item
self-employed (4)
C0425092 (UMLS CUI-1)
CL Item
unemployed (5)
C0041674 (UMLS CUI-1)
CL Item
I live alone (1)
CL Item
worker (2)
C1306056 (UMLS CUI-1)
CL Item
craftsman (3)
CL Item
employee (4)
C0599987 (UMLS CUI-1)
CL Item
civil servant (5)
C0401892 (UMLS CUI-1)
Employable
Item
Employable
boolean
CL Item
no (1)
C1298908 (UMLS CUI-1)
CL Item
pension application (2)
C0185125 (UMLS CUI-1)
CL Item
no (1)
C1298908 (UMLS CUI-1)
CL Item
yes (2)
C1705108 (UMLS CUI-1)
CL Item
degree (3)
C0449438 (UMLS CUI-1)
C0439792 (UMLS CUI-2)
C0439792 (UMLS CUI-2)
CL Item
application (4)
C0185125 (UMLS CUI-1)
Work Capacity Evaluation
Item
Work Capacity Evaluation
boolean
C0043228 (UMLS CUI [1])
Children
Item
Do you have any children?
boolean
C0008059 (UMLS CUI [1])
CL Item
First name (1)
C1443235 (UMLS CUI-1)
CL Item
Gender (2)
C0079399 (UMLS CUI-1)
CL Item
Date of birth (3)
C0421451 (UMLS CUI-1)
CL Item
In case of death: Cause of death (4)
C0007465 (UMLS CUI-1)
Siblings
Item
Siblings
boolean
C0037047 (UMLS CUI [1])
CL Item
date of birth (1)
C0421451 (UMLS CUI-1)
CL Item
date of death (2)
C1148348 (UMLS CUI-1)
CL Item
job (3)
C0028811 (UMLS CUI-1)
CL Item
date of birth (1)
C0421451 (UMLS CUI-1)
CL Item
date of death (2)
C1148348 (UMLS CUI-1)
CL Item
job (3)
C0028811 (UMLS CUI-1)