ID

21795

Description

Hospital Routine Documentation Subform at the University Hospital Cologne. Original Form name: Arztbrief_Ortho

Keywords

Versions (2)
  1. 4/28/17 4/28/17 -
  2. 5/1/17 5/1/17 -
Uploaded on

May 1, 2017

DOI

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License

Creative Commons BY-NC 3.0
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Medical report, Orthopedics and trauma surgery, University Hospital Cologne

German

Medical report, Orthopedics and trauma surgery, University Hospital Cologne

1 forms  
Arztbrief Orthopädie und Unfallchirurgie
Description

Arztbrief Orthopädie und Unfallchirurgie

Alias
UMLS CUI-1
C0684224
UMLS CUI-2
C0029355
UMLS CUI-3
C0587530
Patient
Description

Patient name

Data type

text

Alias
UMLS CUI [1]
C1299487
Geburtsdatum
Description

Birth Date

Data type

date

Measurement units
  • dd.mm.yyyy
Alias
UMLS CUI [1]
C0421451
dd.mm.yyyy
Adresse des Patienten
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
Hausarzt
Description

General practitioner

Data type

text

Alias
UMLS CUI [1]
C0017319
Hausarzt Adresse
Description

General practitioner address

Data type

text

Alias
UMLS CUI [1,1]
C0017319
UMLS CUI [1,2]
C1442065
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Diagnose(n)
Description

Diagnosis

Data type

text

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C1136256
Operation(en)
Description

Surgical procedures

Data type

text

Alias
UMLS CUI [1,1]
C0543467
UMLS CUI [1,2]
C1550373
Studienteilnahme
Description

Study subject participation status

Data type

boolean

Alias
UMLS CUI [1]
C2348568
Falls Studienteilnahme: Spezifikation der Studie
Description

Study subject participation status

Data type

text

Alias
UMLS CUI [1,1]
C2348568
UMLS CUI [1,2]
C2348235
Anamnese
Description

Medical history

Data type

text

Alias
UMLS CUI [1]
C0262926
Klinische Untersuchung
Description

Physical examination

Data type

text

Alias
UMLS CUI [1,1]
C0031809
UMLS CUI [1,2]
C0243095
Befundart
Description

Finding type

Data type

integer

Alias
UMLS CUI [1,1]
C0243095
UMLS CUI [1,2]
C0332307
Apparative Befunde/Untersuchung
Description

Finding

Data type

text

Alias
UMLS CUI [1,1]
C0243095
UMLS CUI [1,2]
C0034601
Beurteilung
Description

Evaluation

Data type

text

Alias
UMLS CUI [1,1]
C0220825
UMLS CUI [1,2]
C0034601
Therapie und Verlauf
Description

Therapy and clinical course

Data type

text

Alias
UMLS CUI [1]
C0087111
UMLS CUI [2]
C0449259
Procedere
Description

Follow up

Data type

text

Alias
UMLS CUI [1]
C0001758
Letzte Medikation
Description

Discharge medication

Data type

text

Alias
UMLS CUI [1]
C1553894
Wiedervorstellung
Description

Follo up visit

Data type

text

Alias
UMLS CUI [1]
C0589121
Unterschrift
Description

Signature

Data type

text

Alias
UMLS CUI [1]
C1519316
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Similar models

Medical report, Orthopedics and trauma surgery, University Hospital Cologne

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Arztbrief Orthopädie und Unfallchirurgie
C0684224 (UMLS CUI-1)
C0029355 (UMLS CUI-2)
C0587530 (UMLS CUI-3)
Patient name
Item
Patient
text
C1299487 (UMLS CUI [1])
Birth Date
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Patient address
Item
Adresse des Patienten
text
C0421449 (UMLS CUI [1])
General practitioner
Item
Hausarzt
text
C0017319 (UMLS CUI [1])
General practitioner address
Item
Hausarzt Adresse
text
C0017319 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Diagnosis
Item
Diagnose(n)
text
C0011900 (UMLS CUI [1,1])
C1136256 (UMLS CUI [1,2])
Surgical procedures
Item
Operation(en)
text
C0543467 (UMLS CUI [1,1])
C1550373 (UMLS CUI [1,2])
Study subject participation status
Item
Studienteilnahme
boolean
C2348568 (UMLS CUI [1])
Study subject participation status
Item
Falls Studienteilnahme: Spezifikation der Studie
text
C2348568 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Medical history
Item
Anamnese
text
C0262926 (UMLS CUI [1])
Physical examination
Item
Klinische Untersuchung
text
C0031809 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
Item
Befundart
integer
C0243095 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Finding type
Code List
Befundart
CL Item
ORT Poliklinik (1)
CL Item
UCH Poliklinik (2)
CL Item
CIO - Tumorboard Sarkome und Knochentumoren (3)
Finding
Item
Apparative Befunde/Untersuchung
text
C0243095 (UMLS CUI [1,1])
C0034601 (UMLS CUI [1,2])
Evaluation
Item
Beurteilung
text
C0220825 (UMLS CUI [1,1])
C0034601 (UMLS CUI [1,2])
Therapy and clinical course
Item
Therapie und Verlauf
text
C0087111 (UMLS CUI [1])
C0449259 (UMLS CUI [2])
Follow up
Item
Procedere
text
C0001758 (UMLS CUI [1])
Discharge medication
Item
Letzte Medikation
text
C1553894 (UMLS CUI [1])
Follo up visit
Item
Wiedervorstellung
text
C0589121 (UMLS CUI [1])
Signature
Item
Unterschrift
text
C1519316 (UMLS CUI [1])
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