Sichel-Reg, 1. Meldebogen

1 formularios

StudyEvent: ODM-Test
1. Sichel-Reg, 1. Meldebogen

Patient data

Descripción

Patient data

Alias

UMLS CUI-1: C2707520

Last Name

Descripción

Last Name

Tipo de datos

text

Alias

UMLS CUI-1: C1301584

First Name

Descripción

First Name

Tipo de datos

text

Alias

UMLS CUI-1: C1443235

Birth Date

Descripción

Birth Date

Tipo de datos

date

Alias

UMLS CUI-1: C0421451

Gender

Descripción

Gender

Tipo de datos

integer

Alias

UMLS CUI-1: C0079399

male (1)

female (2)

Reporting date

Descripción

Date of report

Tipo de datos

date

Alias

UMLS CUI-1: C1302584

Registry ID

Descripción

Registry ID

Tipo de datos

text

Alias

UMLS CUI-1: C1549709

Street (patient)

Descripción

Street (patient)

Tipo de datos

text

Alias

UMLS CUI-1: C1301826

UMLS CUI-2: C0421449

ZIP (patient)

Descripción

ZIP (patient)

Tipo de datos

text

Alias

UMLS CUI-1: C0421454

Town (patient)

Descripción

Town (patient)

Tipo de datos

text

Alias

UMLS CUI-1: C1555315

E-mail (patient)

Descripción

E-mail (patient)

Tipo de datos

text

Alias

UMLS CUI-1: C1705961

UMLS CUI-2: C0030705

Telephone (patient)

Descripción

Telephone (patient)

Tipo de datos

text

Alias

UMLS CUI-1: C0421455

Treating Clinic

Descripción

Treating Clinic

Alias

UMLS CUI-1: C1522326

UMLS CUI-2: C0442592

Clinic

Descripción

Clinic

Tipo de datos

text

Alias

UMLS CUI-1: C0442592

Contact person

Descripción

Contact person

Tipo de datos

text

Alias

UMLS CUI-1: C0337611

Street (clinic)

Descripción

Street (clinic)

Tipo de datos

text

Alias

UMLS CUI-1: C1301826

UMLS CUI-2: C0442592

ZIP (clinic)

Descripción

ZIP (clinic)

Tipo de datos

text

Alias

UMLS CUI-1: C1521842

UMLS CUI-2: C0442592

Town (Clinic)

Descripción

Town (Clinic)

Tipo de datos

text

Alias

UMLS CUI-1: C1555315

UMLS CUI-2: C0442592

E-mail (clinic)

Descripción

E-mail (clinic)

Tipo de datos

text

Alias

UMLS CUI-1: C1705961

UMLS CUI-2: C0442592

Telephone (clinic)

Descripción

Telephone (clinic)

Tipo de datos

text

Alias

UMLS CUI-1: C0039457

UMLS CUI-2: C0442592

Fax (clinic)

Descripción

Fax (clinic)

Tipo de datos

text

Alias

UMLS CUI-1: C1549619

UMLS CUI-2: C0442592

General practitioner

Descripción

General practitioner

Alias

UMLS CUI-1: C0017319

Physicians office

Descripción

Physicians office

Tipo de datos

text

Alias

UMLS CUI-1: C0031834

Contact person

Descripción

Contact person

Tipo de datos

text

Alias

UMLS CUI-1: C0337611

Street (GP)

Descripción

Street (GP)

Tipo de datos

text

Alias

UMLS CUI-1: C1301826

UMLS CUI-2: C0017319

ZIP (GP)

Descripción

ZIP (GP)

Tipo de datos

text

Alias

UMLS CUI-1: C1521842

UMLS CUI-2: C0017319

Town (GP)

Descripción

Town (GP)

Tipo de datos

text

Alias

UMLS CUI-1: C1555315

UMLS CUI-2: C0017319

E-Mail (GP)

Descripción

E-Mail (General practitioner)

Tipo de datos

text

Alias

UMLS CUI-1: C1705961

UMLS CUI-2: C0017319

Telephone (GP)

Descripción

Telephone (GP)

Tipo de datos

text

Alias

UMLS CUI-1: C0039457

UMLS CUI-2: C0017319

Fax (GP)

Descripción

Fax (general practitioner)

Tipo de datos

text

Alias

UMLS CUI-1: C1549619

UMLS CUI-2: C0017319

Patient Characteristics

Descripción

Patient Characteristics

Alias

UMLS CUI-1: C0815172

Diagnosis

Descripción

Diagnosis (e.g. HbSS, HbSC...)

Tipo de datos

text

Alias

UMLS CUI-1: C0011900

Country of origin

Descripción

Country of origin

Tipo de datos

text

Alias

UMLS CUI-1: C3262211

Marital status

Descripción

Marital status

Tipo de datos

text

Alias

UMLS CUI-1: C0024819

NEVER MARRIED (1)

MARRIED (2)

DIVORCED (3)

WIDOWED (4)

Professional career

Descripción

Professional career

Alias

UMLS CUI-1: C0178534

School type

Descripción

Type of school

Tipo de datos

text

Alias

UMLS CUI-1: C1547791

School graduation

Descripción

School graduation

Tipo de datos

text

Alias

UMLS CUI-1: C0237640

Educational Status

Descripción

Educational Status

Tipo de datos

text

Alias

UMLS CUI-1: C0013658

Current activities

Descripción

Current activities

Tipo de datos

text

Alias

UMLS CUI-1: C0336911

Comments

Descripción

Comments

Alias

UMLS CUI-1: C0947611

Comments

Descripción

Comments

Tipo de datos

text

Alias

UMLS CUI-1: C0947611

Signature

Descripción

Signature

Alias

UMLS CUI-1: C1519316

Physicians

Descripción

Name of physician

Tipo de datos

text

Alias

UMLS CUI-1: C0031831

UMLS CUI-2: C0027365

Date signed

Descripción

Date of signature

Tipo de datos

text

Alias

UMLS CUI-1: C3262251

Signature

Descripción

Signature

Tipo de datos

text

Alias

UMLS CUI-1: C1519316

Volver a la parte superior de la página

Similar models

Show recommended models

Sichel-Reg, 1. Meldebogen

1 formularios

StudyEvent: ODM-Test
1. Sichel-Reg, 1. Meldebogen

Name

Tipo

Description | Question | Decode (Coded Value)

Tipo de datos

Alias

Patient data

Item Group

Patient data

C2707520 (UMLS CUI-1)

Last Name

Item

Last Name

text

C1301584 (UMLS CUI-1)

First Name

Item

text

C1443235 (UMLS CUI-1)

Birth Date

Item

date

C0421451 (UMLS CUI-1)

Gender

Item

integer

C0079399 (UMLS CUI-1)

Gender

Code List

Gender

CL Item

male (1)

C0024554 (UMLS CUI-1)

CL Item

female (2)

C0015780 (UMLS CUI-1)

Reporting date

Item

date

C1302584 (UMLS CUI-1)

Registry ID

Item

text

C1549709 (UMLS CUI-1)

Street (patient)

Item

text

C1301826 (UMLS CUI-1)
C0421449 (UMLS CUI-2)

ZIP (patient)

Item

text

C0421454 (UMLS CUI-1)

Town (patient)

Item

text

C1555315 (UMLS CUI-1)

E-mail (patient)

Item

text

C1705961 (UMLS CUI-1)
C0030705 (UMLS CUI-2)

Telephone (patient)

Item

text

C0421455 (UMLS CUI-1)

Treating Clinic

Item Group

Treating Clinic

C1522326 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

Clinic

Item

text

C0442592 (UMLS CUI-1)

Contact person

Item

text

C0337611 (UMLS CUI-1)

Street (clinic)

Item

text

C1301826 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

ZIP (clinic)

Item

text

C1521842 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

Town (Clinic)

Item

text

C1555315 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

E-mail (clinic)

Item

text

C1705961 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

Telephone (clinic)

Item

text

C0039457 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

Fax (clinic)

Item

text

C1549619 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

General practitioner

Item Group

General practitioner

C0017319 (UMLS CUI-1)

Physicians office

Item

text

C0031834 (UMLS CUI-1)

Contact person

Item

text

C0337611 (UMLS CUI-1)

Street (GP)

Item

text

C1301826 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

ZIP (GP)

Item

text

C1521842 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

Town (GP)

Item

text

C1555315 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

E-Mail (GP)

Item

text

C1705961 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

Telephone (GP)

Item

text

C0039457 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

Fax (GP)

Item

text

C1549619 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

Patient Characteristics

Item Group

Patient Characteristics

C0815172 (UMLS CUI-1)

Diagnosis

Item

text

C0011900 (UMLS CUI-1)

Country of origin

Item

text

C3262211 (UMLS CUI-1)

Marital status

Item

text

C0024819 (UMLS CUI-1)

Marital status

Code List

Marital status

CL Item

NEVER MARRIED (1)

CL Item

MARRIED (2)

CL Item

DIVORCED (3)

CL Item

WIDOWED (4)

Professional career

Item Group

Professional career

C0178534 (UMLS CUI-1)

School type

Item

text

C1547791 (UMLS CUI-1)

School graduation

Item

text

C0237640 (UMLS CUI-1)

Educational Status

Item

text

C0013658 (UMLS CUI-1)

Current activities

Item

text

C0336911 (UMLS CUI-1)

Comments

Item Group

Comments

C0947611 (UMLS CUI-1)

Comments

Item

text

C0947611 (UMLS CUI-1)

Signature

Item Group

Signature

C1519316 (UMLS CUI-1)

Physicians

Item

text

C0031831 (UMLS CUI-1)
C0027365 (UMLS CUI-2)

Date signed

Item

text

C3262251 (UMLS CUI-1)

Signature

Item

text

C1519316 (UMLS CUI-1)

Volver a la parte superior de la página