ID

24392

Beschreibung

Routine documentation in German hospitals. Source file name: SD070109_Geburtenbogen. Examplary forms provided by DMI (http://www.dmi.de/)

Link

http://www.dmi.de/

Stichworte

  1. 08.06.17 08.06.17 -
  2. 30.07.17 30.07.17 -
Hochgeladen am

30. Juli 2017

DOI

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Lizenz

Creative Commons BY-NC 3.0

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Birth sheet, newborn Routine documentation in German hospitals DMI

Birth sheet, newborn Routine documentation in German hospitals DMI

Child no. 1
Beschreibung

Child no. 1

Alias
UMLS CUI-1
C0008059
Sex
Beschreibung

Sex

Datentyp

text

Alias
UMLS CUI [1]
C0079399
Weight
Beschreibung

Weight

Datentyp

integer

Maßeinheiten
  • g
Alias
UMLS CUI [1]
C0005910
g
Length
Beschreibung

Length

Datentyp

float

Maßeinheiten
  • cm
Alias
UMLS CUI [1]
C1444754
cm
Head circumference
Beschreibung

Head circumference

Datentyp

float

Maßeinheiten
  • cm
Alias
UMLS CUI [1]
C0262499
cm
Shoulder circumference
Beschreibung

circumference Shoulder

Datentyp

float

Maßeinheiten
  • cm
Alias
UMLS CUI [1,1]
C0332520
UMLS CUI [1,2]
C0037004
cm
Blennorrhoea prevention
Beschreibung

prevention Blennorrhoea

Datentyp

text

Alias
UMLS CUI [1,1]
C0199176
UMLS CUI [1,2]
C0456116
2 mg Konakion oral
Beschreibung

Konakion

Datentyp

boolean

Alias
UMLS CUI [1]
C0031862
Child no. 2
Beschreibung

Child no. 2

Alias
UMLS CUI-1
C0008059
Sex
Beschreibung

Sex

Datentyp

text

Alias
UMLS CUI [1]
C0079399
Weight
Beschreibung

Weight

Datentyp

integer

Maßeinheiten
  • g
Alias
UMLS CUI [1]
C0005910
g
Length
Beschreibung

Length

Datentyp

integer

Maßeinheiten
  • cm
Alias
UMLS CUI [1]
C1444754
cm
Head circumference
Beschreibung

Head circumference

Datentyp

integer

Maßeinheiten
  • cm
Alias
UMLS CUI [1]
C0262499
cm
Shoulder circumference
Beschreibung

circumference Shoulder

Datentyp

integer

Maßeinheiten
  • cm
Alias
UMLS CUI [1,1]
C0332520
UMLS CUI [1,2]
C0037004
cm
Blennorrhoea prevention
Beschreibung

prevention Blennorrhoea

Datentyp

text

Alias
UMLS CUI [1,1]
C0199176
UMLS CUI [1,2]
C0456116
2 mg Konakion oral
Beschreibung

Konakion

Datentyp

boolean

Alias
UMLS CUI [1]
C0031862
Maturity
Beschreibung

Maturity

Alias
UMLS CUI-1
C0419397
Fingernails
Beschreibung

Fingernails

Datentyp

text

Alias
UMLS CUI [1]
C0222001
Vernix
Beschreibung

Vernix

Datentyp

text

Alias
UMLS CUI [1]
C0042541
Lanugo
Beschreibung

Lanugo

Datentyp

text

Alias
UMLS CUI [1]
C0423866
Testicles
Beschreibung

Testicles

Datentyp

text

Alias
UMLS CUI [1]
C0039597
Vulva
Beschreibung

Vulva

Datentyp

text

Alias
UMLS CUI [1]
C0042993
Peeling skin
Beschreibung

Peeling skin

Datentyp

text

Alias
UMLS CUI [1]
C0237849
Wrinkled hands and feet
Beschreibung

Wrinkled hands and feet

Datentyp

text

Alias
UMLS CUI [1]
C1856714
Apgar score: 1'
Beschreibung

Apgar score: 1'

Alias
UMLS CUI-1
C0426279
Skin color
Beschreibung

Skin color

Datentyp

integer

Alias
UMLS CUI [1]
C0599910
Respiration
Beschreibung

Respiration

Datentyp

integer

Alias
UMLS CUI [1]
C0035203
Muscle tone
Beschreibung

Muscle tone

Datentyp

text

Alias
UMLS CUI [1]
C0026841
Reflex irritability
Beschreibung

Reflex irritability

Datentyp

integer

Alias
UMLS CUI [1]
C1317677
Heart rate
Beschreibung

Heart rate

Datentyp

integer

Alias
UMLS CUI [1]
C0018810
Apgar score: 5'
Beschreibung

Apgar score: 5'

Alias
UMLS CUI-1
C1286416
Skin color
Beschreibung

Skin color

Datentyp

integer

Alias
UMLS CUI [1]
C0599910
Respiration
Beschreibung

Respiration

Datentyp

integer

Alias
UMLS CUI [1]
C0035203
Muscle tone
Beschreibung

Muscle tone

Datentyp

text

Alias
UMLS CUI [1]
C0026841
Reflex irritability
Beschreibung

Reflex irritability

Datentyp

integer

Alias
UMLS CUI [1]
C1317677
Heart rate
Beschreibung

Heart rate

Datentyp

integer

Alias
UMLS CUI [1]
C0018810
Apgar score: 10'
Beschreibung

Apgar score: 10'

Alias
UMLS CUI-1
C1286417
Skin color
Beschreibung

Skin color

Datentyp

integer

Alias
UMLS CUI [1]
C0599910
Respiration
Beschreibung

Respiration

Datentyp

integer

Alias
UMLS CUI [1]
C0035203
Muscle tone
Beschreibung

Muscle tone

Datentyp

text

Alias
UMLS CUI [1]
C0026841
Reflex irritability
Beschreibung

Reflex irritability

Datentyp

integer

Alias
UMLS CUI [1]
C1317677
Heart rate
Beschreibung

Heart rate

Datentyp

integer

Alias
UMLS CUI [1]
C0018810
Analysis of umbilical cord blood
Beschreibung

Analysis of umbilical cord blood

Alias
UMLS CUI-1
C0936012
UMLS CUI-2
C0162371
Art.
Beschreibung

Artery

Datentyp

boolean

Alias
UMLS CUI [1]
C0003842
Vein
Beschreibung

Vein

Datentyp

boolean

Alias
UMLS CUI [1]
C0042449
Further procedures
Beschreibung

Further procedures

Alias
UMLS CUI-1
C2700391
Suctioning
Beschreibung

Suctioning

Datentyp

boolean

Alias
UMLS CUI [1]
C0204794
Pediatrician present at birth
Beschreibung

Pediatrician

Datentyp

boolean

Alias
UMLS CUI [1]
C0237433
Presentation at pediatrician
Beschreibung

Seen by pediatrician

Datentyp

boolean

Alias
UMLS CUI [1]
C0583542
Presentation at pediatrician because of
Beschreibung

reason

Datentyp

text

Alias
UMLS CUI [1]
C0392360
Transfer to pediatric clinic
Beschreibung

pediatric clinic

Datentyp

boolean

Alias
UMLS CUI [1]
C3839701
Transfer to pediatric clinic because of
Beschreibung

reason

Datentyp

text

Alias
UMLS CUI [1]
C0392360
Oxygen mask
Beschreibung

Oxygen mask

Datentyp

boolean

Alias
UMLS CUI [1]
C0181744
Intubation
Beschreibung

Intubation

Datentyp

boolean

Alias
UMLS CUI [1]
C0021925
Child development
Beschreibung

Child development

Alias
UMLS CUI-1
C0008071
Normal
Beschreibung

normal

Datentyp

boolean

Alias
UMLS CUI [1]
C0205307
Child development
Beschreibung

Child development

Datentyp

text

Alias
UMLS CUI [1]
C0008071

Ähnliche Modelle

Birth sheet, newborn Routine documentation in German hospitals DMI

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Child no. 1
C0008059 (UMLS CUI-1)
Sex
Item
Sex
text
C0079399 (UMLS CUI [1])
Weight
Item
Weight
integer
C0005910 (UMLS CUI [1])
Length
Item
Length
float
C1444754 (UMLS CUI [1])
Head circumference
Item
Head circumference
float
C0262499 (UMLS CUI [1])
circumference Shoulder
Item
Shoulder circumference
float
C0332520 (UMLS CUI [1,1])
C0037004 (UMLS CUI [1,2])
Item
Blennorrhoea prevention
text
C0199176 (UMLS CUI [1,1])
C0456116 (UMLS CUI [1,2])
Code List
Blennorrhoea prevention
CL Item
executed (executed)
CL Item
refused (refused)
Konakion
Item
2 mg Konakion oral
boolean
C0031862 (UMLS CUI [1])
Item Group
Child no. 2
C0008059 (UMLS CUI-1)
Sex
Item
Sex
text
C0079399 (UMLS CUI [1])
Weight
Item
Weight
integer
C0005910 (UMLS CUI [1])
Length
Item
Length
integer
C1444754 (UMLS CUI [1])
Head circumference
Item
Head circumference
integer
C0262499 (UMLS CUI [1])
circumference Shoulder
Item
Shoulder circumference
integer
C0332520 (UMLS CUI [1,1])
C0037004 (UMLS CUI [1,2])
Item
Blennorrhoea prevention
text
C0199176 (UMLS CUI [1,1])
C0456116 (UMLS CUI [1,2])
Code List
Blennorrhoea prevention
CL Item
executed (executed)
CL Item
refused (refused)
Konakion
Item
2 mg Konakion oral
boolean
C0031862 (UMLS CUI [1])
Item Group
Maturity
C0419397 (UMLS CUI-1)
Item
Fingernails
text
C0222001 (UMLS CUI [1])
Code List
Fingernails
CL Item
Extend beyond the fingertips (Extend beyond the fingertips)
CL Item
Reach the fingertips (Reach the fingertips)
CL Item
Do not reach the fingertips (Do not reach the fingertips)
Item
Vernix
text
C0042541 (UMLS CUI [1])
Code List
Vernix
CL Item
O (O)
CL Item
+ (+)
CL Item
++ (++)
Item
Lanugo
text
C0423866 (UMLS CUI [1])
Code List
Lanugo
CL Item
O (O)
CL Item
+ (+)
CL Item
++ (++)
Item
Testicles
text
C0039597 (UMLS CUI [1])
Code List
Testicles
CL Item
descended (descended)
CL Item
undescended (undescended)
Item
Vulva
text
C0042993 (UMLS CUI [1])
Code List
Vulva
CL Item
closed (closed)
CL Item
gaping (gaping)
Item
Peeling skin
text
C0237849 (UMLS CUI [1])
Code List
Peeling skin
CL Item
+ (+)
CL Item
O (O)
Item
Wrinkled hands and feet
text
C1856714 (UMLS CUI [1])
Code List
Wrinkled hands and feet
CL Item
+ (+)
CL Item
O (O)
Item Group
Apgar score: 1'
C0426279 (UMLS CUI-1)
Item
Skin color
integer
C0599910 (UMLS CUI [1])
Code List
Skin color
CL Item
blue or pale (0)
CL Item
blue at extremities, body pink (1)
CL Item
pink (2)
Item
Respiration
integer
C0035203 (UMLS CUI [1])
Code List
Respiration
CL Item
absent (0)
CL Item
weak, irregular, gasping (1)
CL Item
strong, robust cry (2)
Item
Muscle tone
text
C0026841 (UMLS CUI [1])
Code List
Muscle tone
CL Item
none (0)
CL Item
some flexion (1)
CL Item
active motion (2)
Item
Reflex irritability
integer
C1317677 (UMLS CUI [1])
Code List
Reflex irritability
CL Item
no response (0)
CL Item
grimacing (1)
CL Item
crying (2)
Item
Heart rate
integer
C0018810 (UMLS CUI [1])
Code List
Heart rate
CL Item
absent (0)
CL Item
<100 (1)
CL Item
>100 (2)
Item Group
Apgar score: 5'
C1286416 (UMLS CUI-1)
Item
Skin color
integer
C0599910 (UMLS CUI [1])
Code List
Skin color
CL Item
blue or pale (0)
CL Item
blue at extremities, body pink (1)
CL Item
pink (2)
Item
Respiration
integer
C0035203 (UMLS CUI [1])
Code List
Respiration
CL Item
absent (0)
CL Item
weak, irregular, gasping (1)
CL Item
strong, robust cry (2)
Item
Muscle tone
text
C0026841 (UMLS CUI [1])
Code List
Muscle tone
CL Item
none (0)
CL Item
some flexion (1)
CL Item
active motion (2)
Item
Reflex irritability
integer
C1317677 (UMLS CUI [1])
Code List
Reflex irritability
CL Item
no response (0)
CL Item
grimacing (1)
CL Item
crying (2)
Item
Heart rate
integer
C0018810 (UMLS CUI [1])
Code List
Heart rate
CL Item
absent (0)
CL Item
<100 (1)
CL Item
>100 (2)
Item Group
Apgar score: 10'
C1286417 (UMLS CUI-1)
Item
Skin color
integer
C0599910 (UMLS CUI [1])
Code List
Skin color
CL Item
blue or pale (0)
CL Item
blue at extremities, body pink (1)
CL Item
pink (2)
Item
Respiration
integer
C0035203 (UMLS CUI [1])
Code List
Respiration
CL Item
absent (0)
CL Item
weak, irregular, gasping (1)
CL Item
strong, robust cry (2)
Item
Muscle tone
text
C0026841 (UMLS CUI [1])
Code List
Muscle tone
CL Item
none (0)
CL Item
some flexion (1)
CL Item
active motion (2)
Item
Reflex irritability
integer
C1317677 (UMLS CUI [1])
Code List
Reflex irritability
CL Item
no response (0)
CL Item
grimacing (1)
CL Item
crying (2)
Item
Heart rate
integer
C0018810 (UMLS CUI [1])
Code List
Heart rate
CL Item
absent (0)
CL Item
<100 (1)
CL Item
>100 (2)
Item Group
Analysis of umbilical cord blood
C0936012 (UMLS CUI-1)
C0162371 (UMLS CUI-2)
Artery
Item
Art.
boolean
C0003842 (UMLS CUI [1])
Vein
Item
Vein
boolean
C0042449 (UMLS CUI [1])
Item Group
Further procedures
C2700391 (UMLS CUI-1)
Suctioning
Item
Suctioning
boolean
C0204794 (UMLS CUI [1])
Pediatrician
Item
Pediatrician present at birth
boolean
C0237433 (UMLS CUI [1])
Seen by pediatrician
Item
Presentation at pediatrician
boolean
C0583542 (UMLS CUI [1])
reason
Item
Presentation at pediatrician because of
text
C0392360 (UMLS CUI [1])
pediatric clinic
Item
Transfer to pediatric clinic
boolean
C3839701 (UMLS CUI [1])
reason
Item
Transfer to pediatric clinic because of
text
C0392360 (UMLS CUI [1])
Oxygen mask
Item
Oxygen mask
boolean
C0181744 (UMLS CUI [1])
Intubation
Item
Intubation
boolean
C0021925 (UMLS CUI [1])
Item Group
Child development
C0008071 (UMLS CUI-1)
normal
Item
Normal
boolean
C0205307 (UMLS CUI [1])
Child development
Item
Child development
text
C0008071 (UMLS CUI [1])

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