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Accident Report form

1 forms  
  1. StudyEvent: ODM
    1. Accident Report form
Patient demographics
Description

Patient demographics

Patient name
Description

Patient name

Data type

integer

Alias
UMLS CUI [1]
C1299487
Date of birth
Description

Patient date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Gender
Description

Gender

Data type

integer

Alias
UMLS CUI [1]
C0079399
Patient address
Description

Patient address

Data type

integer

Alias
UMLS CUI [1]
C0421449
Telephone
Description

Telephone

Data type

integer

Alias
UMLS CUI [1]
C1515258
Nationality
Description

Nationality

Data type

integer

Alias
UMLS CUI [1]
C0027473
Occupation
Description

Occupation

Data type

integer

Alias
UMLS CUI [1]
C0028811
Health insurance
Description

Health insurance

Data type

integer

Alias
UMLS CUI [1]
C0021682
Accident form
Description

Accident form

Accident site
Description

Please note address of accident site.

Data type

integer

Alias
UMLS CUI [1]
C0337069
Accident date
Description

Accident date

Data type

integer

Alias
UMLS CUI [1]
C0000924
Accident time
Description

Accident time

Data type

integer

Alias
UMLS CUI [1,1]
C0000924
UMLS CUI [1,2]
C0011008
School begin
Description

School begin

Data type

integer

Alias
UMLS CUI [1]
C0680097
End school
Description

End school

Data type

integer

Alias
UMLS CUI [1]
C0680097
Place of occurrence of accident
Description

Place of occurrence of accident

Data type

integer

Alias
UMLS CUI [1]
C0431140
Behaviour after the accident
Description

Behaviour after the accident

Data type

integer

Alias
UMLS CUI [1,1]
C0004927
UMLS CUI [1,2]
C0000924
First treatment
Description

First treatment

Data type

date

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0205435
UMLS CUI [1,3]
C0011008
Attending physician
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
Patient demographics
Patient name
Item
Patient name
integer
C1299487 (UMLS CUI [1])
Patient date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Gender
integer
C0079399 (UMLS CUI [1])
Gender
Code List
Gender
CL Item
male (1)
C0086582 (UMLS CUI-1)
CL Item
female (2)
C0086287 (UMLS CUI-1)
Patient address
Item
Patient address
integer
C0421449 (UMLS CUI [1])
Telephone
Item
Telephone
integer
C1515258 (UMLS CUI [1])
Nationality
Item
Nationality
integer
C0027473 (UMLS CUI [1])
Item
Occupation
integer
C0028811 (UMLS CUI [1])
Occupation
Code List
Occupation
CL Item
Student (1)
C0260267 (UMLS CUI-1)
CL Item
Kindergarden (2)
C0681405 (UMLS CUI-1)
Health insurance
Item
Health insurance
integer
C0021682 (UMLS CUI [1])
Item Group
Accident form
Accident site
Item
Accident site
integer
C0337069 (UMLS CUI [1])
Accident date
Item
Accident date
integer
C0000924 (UMLS CUI [1])
Accident time
Item
Accident time
integer
C0000924 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
School begin
Item
School begin
integer
C0680097 (UMLS CUI [1])
End school
Item
End school
integer
C0680097 (UMLS CUI [1])
Place of occurrence of accident
Item
Place of occurrence of accident
integer
C0431140 (UMLS CUI [1])
Behaviour after the accident
Item
Behaviour after the accident
integer
C0004927 (UMLS CUI [1,1])
C0000924 (UMLS CUI [1,2])
First treatment
Item
First treatment
date
C0087111 (UMLS CUI [1,1])
C0205435 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Attending physician
Item
Attending physician
integer
C1320929 (UMLS CUI [1])
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