ID

20887

Description

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

Keywords

  1. 3/24/17 3/24/17 -
  2. 9/17/21 9/17/21 -
Uploaded on

March 24, 2017

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0

Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Patient questionnaire Psychosomatic medicine UKM

Patient questionnaire

  1. StudyEvent: ODM
    1. Patient questionnaire
Patient demographics
Description

Patient demographics

Patient name
Description

Patient name

Data type

text

Alias
UMLS CUI [1]
C1299487
Address
Description

Address

Data type

integer

Alias
UMLS CUI [1]
C0421449
Telephone
Description

Telephone

Data type

integer

Alias
UMLS CUI [1]
C1515258
Relegion
Description

Religion

Data type

text

Alias
UMLS CUI [1]
C0035039
Gender
Description

Gender

Data type

integer

Alias
UMLS CUI [1]
C0079399
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Nationality
Description

Nationality

Data type

integer

Alias
UMLS CUI [1]
C0027473
Family status
Description

Family status

Data type

integer

Alias
UMLS CUI [1]
C0682315
Partner
Description

Partner

Data type

integer

Alias
UMLS CUI [1]
C0682323
In case of partnership
Description

In case of partnership

Data type

integer

Symptoms
Description

Symptoms

Alias
UMLS CUI-1
C1457887
Please state current symptoms
Description

Symptoms

Data type

integer

Alias
UMLS CUI [1]
C1457887
GP
Description

GP

Alias
UMLS CUI-1
C0017319
Name of GP
Description

GP

Data type

text

Alias
UMLS CUI [1]
C0017319
Address
Description

Address

Data type

integer

Alias
UMLS CUI [1]
C0421449
Telephone
Description

Telephone

Data type

integer

Outpatient departement
Description

Outpatient departement

Alias
UMLS CUI-1
C0557824
Who has advised you to come to the outpatient department?
Description

Outpatient department

Data type

integer

Alias
UMLS CUI [1,1]
C0557824
UMLS CUI [1,2]
C0566251
Household
Description

Household

Indicate the Person(s) living with
Description

Household

Data type

integer

Alias
UMLS CUI [1]
C0020052
Living arrangements
Description

Living arrangements

Data type

integer

Alias
UMLS CUI [1]
C0242487
Qualifications
Description

Qualifications

School degree
Description

Höchste(r) erreichte(r) Berufsabschluß/ Berufsausbildung:

Data type

integer

Alias
UMLS CUI [1]
C1709790
Vocational qualification
Description

Vocational qualification

Data type

integer

Alias
UMLS CUI [1]
C0013658
Current occupation
Description

occupation

Data type

integer

Alias
UMLS CUI [1]
C0421456
Who earned the hightest income in your household?
Description

Job

Data type

integer

Alias
UMLS CUI [1]
C0021162
Employable
Description

Employable

Data type

boolean

Retirement
Description

Retirement

Data type

integer

Alias
UMLS CUI [1]
C0035345
severe disability
Description

severe disability

Data type

integer

Alias
UMLS CUI [1]
C0424990
Work Capacity Evaluation
Description

Work Capacity Evaluation

Data type

boolean

Alias
UMLS CUI [1]
C0043228
Family history
Description

Family history

Do you have any children?
Description

Children

Data type

boolean

Alias
UMLS CUI [1]
C0008059
Name of Children
Description

Name of Children

Data type

integer

Alias
UMLS CUI [1]
C0008059
Siblings
Description

Siblings

Data type

boolean

Alias
UMLS CUI [1]
C0037047
Mother
Description

Mother

Data type

integer

Alias
UMLS CUI [1]
C0026591
Father
Description

Father

Data type

integer

Alias
UMLS CUI [1]
C0015671

Similar models

Patient questionnaire

  1. StudyEvent: ODM
    1. Patient questionnaire
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient demographics
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])
Item
Gender
integer
C0079399 (UMLS CUI [1])
Code List
Gender
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])
Item
Nationality
integer
C0027473 (UMLS CUI [1])
Code List
Nationality
CL Item
German (1)
C1556085 (UMLS CUI-1)
CL Item
Other nationality (2)
C0027473 (UMLS CUI-1)
CL Item
late repatriate (3)
Item
Family status
integer
C0682315 (UMLS CUI [1])
Code List
Family status
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)
Item
Partner
integer
C0682323 (UMLS CUI [1])
Code List
Partner
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)
Item
In case of partnership
integer
Code List
In case of partnership
CL Item
Date of birth of partner (1)
C0803906 (UMLS CUI-1)
CL Item
Job of partner (2)
C0028811 (UMLS CUI-1)
Item Group
Symptoms
C1457887 (UMLS CUI-1)
Item
Please state current symptoms
integer
C1457887 (UMLS CUI [1])
Code List
Please state current symptoms
CL Item
Symptoms since when? (1)
C3175529 (UMLS CUI-1)
Item Group
GP
C0017319 (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 Group
Outpatient departement
C0557824 (UMLS CUI-1)
Item
Who has advised you to come to the outpatient department?
integer
C0557824 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
Code List
Who has advised you to come to the outpatient department?
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)
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)
Item Group
Household
Item
Indicate the Person(s) living with
integer
C0020052 (UMLS CUI [1])
Code List
Indicate the Person(s) living with
Item
Living arrangements
integer
C0242487 (UMLS CUI [1])
Code List
Living arrangements
CL Item
Flat or house (1)
C0457933 (UMLS CUI-1)
CL Item
home for the elderly (2)
C0019870 (UMLS CUI-1)
Item Group
Qualifications
Item
School degree
integer
C1709790 (UMLS CUI [1])
Code List
School degree
CL Item
no degree (1)
Item
Vocational qualification
integer
C0013658 (UMLS CUI [1])
Code List
Vocational qualification
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)
Item
Current occupation
integer
C0421456 (UMLS CUI [1])
Code List
Current occupation
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)
Item
Who earned the hightest income in your household?
integer
C0021162 (UMLS CUI [1])
Code List
Who earned the hightest income in your household?
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
Item
Retirement
integer
C0035345 (UMLS CUI [1])
Code List
Retirement
CL Item
no (1)
C1298908 (UMLS CUI-1)
CL Item
pension application (2)
C0185125 (UMLS CUI-1)
Item
severe disability
integer
C0424990 (UMLS CUI [1])
Code List
severe disability
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)
CL Item
application (4)
C0185125 (UMLS CUI-1)
Work Capacity Evaluation
Item
Work Capacity Evaluation
boolean
C0043228 (UMLS CUI [1])
Item Group
Family history
Children
Item
Do you have any children?
boolean
C0008059 (UMLS CUI [1])
Item
Name of Children
integer
C0008059 (UMLS CUI [1])
Code List
Name of Children
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])
Item
Mother
integer
C0026591 (UMLS CUI [1])
Code List
Mother
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)
Item
Father
integer
C0015671 (UMLS CUI [1])
Code List
Father
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)

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial