Check up form

  1. StudyEvent: ODM
    1. Check up form
Patient demographics
Description

Patient demographics

Patient name
Description

Patient name

Data type

text

Alias
UMLS CUI [1]
C1299487
Clinic
Description

Clinic

Data type

integer

Alias
UMLS CUI [1]
C0442592
Name of attending physician
Description

Attending physician

Data type

text

Alias
UMLS CUI [1]
C1320929
Date
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Informed consent
Description

Informed consent

Data type

boolean

Alias
UMLS CUI [1]
C0021430
Clinic
Description

Clinic

Data type

integer

Alias
UMLS CUI [1]
C0442592
Hypersensitivities
Description

Hypersensitivities

Data type

integer

Alias
UMLS CUI [1]
C0020517
Check up
Description

Check up

Fluid balance
Description

Fluid balance

Data type

integer

Alias
UMLS CUI [1]
C0016284
Body weight
Description

Body weight

Data type

integer

Alias
UMLS CUI [1]
C0005910
Diuresis
Description

Diuresis

Data type

integer

Alias
UMLS CUI [1]
C0012797
Medication
Description

Medication

Data type

integer

Alias
UMLS CUI [1]
C0013227
Catheter
Description

Catheter

Data type

integer

Alias
UMLS CUI [1]
C0179802
Blood sugar
Description

Blood sugar

Data type

integer

Alias
UMLS CUI [1]
C0392201
Chemotherapy
Description

Chemotherapy

Data type

integer

Alias
UMLS CUI [1]
C0392920
Oxygen
Description

Oxygen

Data type

boolean

Alias
UMLS CUI [1]
C0030054
Vital signs
Description

Vital signs

Data type

integer

Alias
UMLS CUI [1]
C0518766
Blood product
Description

Blood product

Data type

integer

Alias
UMLS CUI [1]
C0456388
PRN medication
Description

PRN medication

Data type

integer

Alias
UMLS CUI [1]
C3166225
Medical order
Description

Medical order

Data type

text

Alias
UMLS CUI [1]
C1563825
Blood Constituents
Description

Blood Constituents

Data type

integer

Alias
UMLS CUI [1]
C0729650
Fecal occult blood test
Description

Fecal occult blood test

Data type

boolean

Alias
UMLS CUI [1]
C0201811
Pain scale
Description

Pain scale

Data type

integer

Alias
UMLS CUI [1]
C1504479

Similar models

Check up form

  1. StudyEvent: ODM
    1. Check up form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient demographics
Patient name
Item
Patient name
text
C1299487 (UMLS CUI [1])
Clinic
Item
Clinic
integer
C0442592 (UMLS CUI [1])
Attending physician
Item
Name of attending physician
text
C1320929 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Informed consent
Item
Informed consent
boolean
C0021430 (UMLS CUI [1])
Item
Clinic
integer
C0442592 (UMLS CUI [1])
Code List
Clinic
CL Item
gynecology (1)
C0018417 (UMLS CUI-1)
CL Item
hematology (2)
C0474523 (UMLS CUI-1)
CL Item
urology (3)
C0042077 (UMLS CUI-1)
Hypersensitivities
Item
Hypersensitivities
integer
C0020517 (UMLS CUI [1])
Item Group
Check up
Fluid balance
Item
Fluid balance
integer
C0016284 (UMLS CUI [1])
Body weight
Item
Body weight
integer
C0005910 (UMLS CUI [1])
Diuresis
Item
Diuresis
integer
C0012797 (UMLS CUI [1])
Medication
Item
Medication
integer
C0013227 (UMLS CUI [1])
Catheter
Item
Catheter
integer
C0179802 (UMLS CUI [1])
Blood sugar
Item
Blood sugar
integer
C0392201 (UMLS CUI [1])
Chemotherapy
Item
Chemotherapy
integer
C0392920 (UMLS CUI [1])
Oxygen
Item
Oxygen
boolean
C0030054 (UMLS CUI [1])
Item
Vital signs
integer
C0518766 (UMLS CUI [1])
Code List
Vital signs
CL Item
blood pressure (1)
C0005823 (UMLS CUI-1)
CL Item
temperature (2)
C0039476 (UMLS CUI-1)
CL Item
pulse (3)
C0232117 (UMLS CUI-1)
CL Item
respiratory rate (4)
C0231832 (UMLS CUI-1)
Blood product
Item
Blood product
integer
C0456388 (UMLS CUI [1])
PRN medication
Item
PRN medication
integer
C3166225 (UMLS CUI [1])
Medical order
Item
Medical order
text
C1563825 (UMLS CUI [1])
Blood Constituents
Item
Blood Constituents
integer
C0729650 (UMLS CUI [1])
Fecal occult blood test
Item
Fecal occult blood test
boolean
C0201811 (UMLS CUI [1])
Item
Pain scale
integer
C1504479 (UMLS CUI [1])
Code List
Pain scale
CL Item
0 no pain at all (0)
CL Item
1 (1)
CL Item
10 unbearable pain (10)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)