ID

21915

Description

M1 Breast carcinoma tumor board request form at the endocrinology polyclinic department University Hospital Cologne. Asking questions regarding basic patient information, tumor board organisation, diagnosis and comorbidity, pathology and tumor staging as well as diagnostic imaging. ODM derived from routine documentation of University Hospital Cologne.

Keywords

Versions (1)
  1. 5/8/17 5/8/17 -
Uploaded on

May 8, 2017

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Creative Commons BY-NC 3.0
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M1 Breast carcinoma tumor board Oncology Form University Hospital Cologne

German ( localization.languageCode.DE )

M1 Breast carcinoma tumor board Oncology Form University Hospital Cologne

1 forms  
M1 Tumorboard Mammakarzinom Anforderung
Description

M1 Tumorboard Mammakarzinom Anforderung

Alias
UMLS CUI-1
C2985541
UMLS CUI-2
C1272683
UMLS CUI-3
C0678222
UMLS CUI-4
C0441971
Patient
Description

patient

Data type

text

Alias
UMLS CUI [1]
C1299487
Geb.Dat.
Description

date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Auftragsnummer
Description

request identifier

Data type

text

Alias
UMLS CUI [1,1]
C1300638
UMLS CUI [1,2]
C1272683
Fall-Nr.
Description

Case ID

Data type

integer

Alias
UMLS CUI [1,1]
C1698493
UMLS CUI [1,2]
C0600091
PID
Description

PID

Data type

integer

Alias
UMLS CUI [1,1]
C0030705
UMLS CUI [1,2]
C1300638
Status
Description

status

Data type

text

Alias
UMLS CUI [1]
C0449438
Dringlichkeit
Description

urgency

Data type

text

Alias
UMLS CUI [1]
C4049774
Gew. Unters./Lstg.
Description

requested procedure

Data type

text

Alias
UMLS CUI [1,1]
C0430022
UMLS CUI [1,2]
C1272683
Gewünschte Untersuchung Zusatz
Description

requested procedure

Data type

text

Alias
UMLS CUI [1,1]
C0430022
UMLS CUI [1,2]
C1272683
Leistende Stelle
Description

performing department

Data type

text

Alias
UMLS CUI [1,1]
C0587450
UMLS CUI [1,2]
C0884358
Anf. Fachabteilung
Description

requesting department

Data type

text

Alias
UMLS CUI [1,1]
C0587450
UMLS CUI [1,2]
C1272683
Anfordernde Stelle
Description

requesting department

Data type

text

Alias
UMLS CUI [1,1]
C0587450
UMLS CUI [1,2]
C1272683
Anforderer
Description

Ordering physician

Data type

text

Alias
UMLS CUI [1]
C1709334
Terminwunsch
Description

requested appointment

Data type

date

Alias
UMLS CUI [1,1]
C0430022
UMLS CUI [1,2]
C0011008
Kommentar
Description

comment

Data type

text

Alias
UMLS CUI [1]
C0947611
Mobilität
Description

mobility

Data type

text

Alias
UMLS CUI [1]
C0449580
Vorbefunde
Description

previous findings

Data type

text

Alias
UMLS CUI [1,1]
C0243095
UMLS CUI [1,2]
C0205156
Konferenz Veranstaltungsinformationen
Description

conference information

Data type

text

Alias
UMLS CUI [1,1]
C2985541
UMLS CUI [1,2]
C1533716
ICD
Description

ICD

Data type

text

Alias
UMLS CUI [1,1]
C2598420
UMLS CUI [1,2]
C1274082
UMLS CUI [2,1]
C0678222
UMLS CUI [2,2]
C0441971
Freitextdiagnose
Description

diagnosis

Data type

text

Alias
UMLS CUI [1]
C0011900
UMLS CUI [2,1]
C0678222
UMLS CUI [2,2]
C0441971
Erstdiagnose-Zeitpunkt (Monat / Jahr)
Description

diagnosis date

Data type

date

Alias
UMLS CUI [1,1]
C3172269
UMLS CUI [1,2]
C0011008
UMLS CUI [2,1]
C0678222
UMLS CUI [2,2]
C0441971
Tumor-Stadium[Klassifikation]
Description

tumor stage classification

Data type

text

Alias
UMLS CUI [1]
C0474927
UMLS CUI [2,1]
C0678222
UMLS CUI [2,2]
C0441971
Komorbiditäten/Nebendiagnosen
Description

comorbidity and secondary diagnosis

Data type

text

Alias
UMLS CUI [1]
C0009488
UMLS CUI [2]
C0332138
Index zur Lebensqualität ('ECOG Perfomance Status')
Description

ECOG

Data type

integer

Alias
UMLS CUI [1]
C1520224
vorhandene Pathologie/Tumorgrading
Description

pathology and tumor staging

Data type

text

Alias
UMLS CUI [1]
C0030664
UMLS CUI [2]
C0027646
UMLS CUI [3,1]
C0678222
UMLS CUI [3,2]
C0441971
Verlauf
Description

progression

Data type

text

Alias
UMLS CUI [1,1]
C0242656
UMLS CUI [1,2]
C0678222
Bildgebung, die präsentiert werden soll: Datum
Description

diagnostic imaging date

Data type

date

Alias
UMLS CUI [1,1]
C0011923
UMLS CUI [1,2]
C0011008
Bildgebung, die präsentiert werden soll: Rö-Art
Description

diagnostic imaging type

Data type

text

Alias
UMLS CUI [1,1]
C0011923
UMLS CUI [1,2]
C0332307
Bildgebung, die präsentiert werden soll: Bezeichnung
Description

diagnostic imaging description

Data type

text

Alias
UMLS CUI [1,1]
C0011923
UMLS CUI [1,2]
C0678257
Bildgebung, die präsentiert werden soll: Hinweis Externbefund
Description

diagnostic imaging external

Data type

text

Alias
UMLS CUI [1,1]
C0011923
UMLS CUI [1,2]
C3844314
Bildgebung, die präsentiert werden soll: RIS
Description

diagnostic imaging RIS

Data type

text

Alias
UMLS CUI [1,1]
C0034601
UMLS CUI [1,2]
C0011923
CA 15-3
Description

CA 15-3

Data type

float

Measurement units
  • kU/l
Alias
UMLS CUI [1]
C0201547
kU/l
CEA
Description

CEA

Data type

float

Measurement units
  • μg/l
Alias
UMLS CUI [1]
C0201933
μg/l
SCC
Description

SCC

Data type

float

Measurement units
  • μg/l
Alias
UMLS CUI [1]
C0075091
μg/l
CA 125
Description

CA 125

Data type

float

Measurement units
  • kU/l
Alias
UMLS CUI [1]
C0201549
kU/l
Monat/Jahr CA 15-3
Description

Date of CA 15-3 measurement

Data type

date

Alias
UMLS CUI [1,1]
C1254595
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C0201547
Monat/Jahr CEA
Description

Date of CEA measurement

Data type

date

Alias
UMLS CUI [1,1]
C1254595
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C0201933
Monat/Jahr CA 125
Description

Date of CA 125 measurement

Data type

date

Alias
UMLS CUI [1,1]
C1254595
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C0201549
Monat/Jahr SCC
Description

Date of SCC measurement

Data type

date

Alias
UMLS CUI [1,1]
C1254595
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C0075091
Menopausenstatus
Description

menopause finding

Data type

integer

Alias
UMLS CUI [1]
C0455962
Familienanamnese
Description

family medical history

Data type

text

Alias
UMLS CUI [1,1]
C0241889
UMLS CUI [1,2]
C0262926
UMLS CUI [2,1]
C0678222
UMLS CUI [2,2]
C0441971
Diagnosedatum Metastase
Description

date of metastasis diagnosis

Data type

date

Alias
UMLS CUI [1,1]
C0027627
UMLS CUI [1,2]
C0011008
UMLS CUI [2,1]
C0678222
UMLS CUI [2,2]
C0441971
Lokalisation Metastase
Description

metastasis localization

Data type

text

Alias
UMLS CUI [1,1]
C0475264
UMLS CUI [1,2]
C0027627
UMLS CUI [2,1]
C0678222
UMLS CUI [2,2]
C0441971
Fragestellung
Description

question

Data type

text

Alias
UMLS CUI [1,1]
C1522634
UMLS CUI [1,2]
C0678222
UMLS CUI [1,3]
C0441971
Ansprechpartner
Description

contact person

Data type

text

Alias
UMLS CUI [1,1]
C0337611
UMLS CUI [1,2]
C0678222
Ansprechpartner Funknummer
Description

contact person pager number

Data type

integer

Alias
UMLS CUI [1,1]
C0337611
UMLS CUI [1,2]
C1515258
Einweiser/Überweiser
Description

referring physician

Data type

text

Alias
UMLS CUI [1]
C1709880
Einweiser/Überweiser Adresse
Description

referring physician address

Data type

text

Alias
UMLS CUI [1,1]
C1442065
UMLS CUI [1,2]
C1709880
Kontakt Studienteilnahme
Description

clinical trial contact

Data type

text

Alias
UMLS CUI [1,1]
C0337611
UMLS CUI [1,2]
C0008976
UMLS CUI [2]
C0678222
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Similar models

M1 Breast carcinoma tumor board Oncology Form University Hospital Cologne

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
M1 Tumorboard Mammakarzinom Anforderung
C2985541 (UMLS CUI-1)
C1272683 (UMLS CUI-2)
C0678222 (UMLS CUI-3)
C0441971 (UMLS CUI-4)
patient
Item
Patient
text
C1299487 (UMLS CUI [1])
date of birth
Item
Geb.Dat.
date
C0421451 (UMLS CUI [1])
request identifier
Item
Auftragsnummer
text
C1300638 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
Case ID
Item
Fall-Nr.
integer
C1698493 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
PID
Item
PID
integer
C0030705 (UMLS CUI [1,1])
C1300638 (UMLS CUI [1,2])
status
Item
Status
text
C0449438 (UMLS CUI [1])
urgency
Item
Dringlichkeit
text
C4049774 (UMLS CUI [1])
requested procedure
Item
Gew. Unters./Lstg.
text
C0430022 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
requested procedure
Item
Gewünschte Untersuchung Zusatz
text
C0430022 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
performing department
Item
Leistende Stelle
text
C0587450 (UMLS CUI [1,1])
C0884358 (UMLS CUI [1,2])
requesting department
Item
Anf. Fachabteilung
text
C0587450 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
requesting department
Item
Anfordernde Stelle
text
C0587450 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
Ordering physician
Item
Anforderer
text
C1709334 (UMLS CUI [1])
requested appointment
Item
Terminwunsch
date
C0430022 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
comment
Item
Kommentar
text
C0947611 (UMLS CUI [1])
mobility
Item
Mobilität
text
C0449580 (UMLS CUI [1])
previous findings
Item
Vorbefunde
text
C0243095 (UMLS CUI [1,1])
C0205156 (UMLS CUI [1,2])
conference information
Item
Konferenz Veranstaltungsinformationen
text
C2985541 (UMLS CUI [1,1])
C1533716 (UMLS CUI [1,2])
ICD
Item
ICD
text
C2598420 (UMLS CUI [1,1])
C1274082 (UMLS CUI [1,2])
C0678222 (UMLS CUI [2,1])
C0441971 (UMLS CUI [2,2])
diagnosis
Item
Freitextdiagnose
text
C0011900 (UMLS CUI [1])
C0678222 (UMLS CUI [2,1])
C0441971 (UMLS CUI [2,2])
diagnosis date
Item
Erstdiagnose-Zeitpunkt (Monat / Jahr)
date
C3172269 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0678222 (UMLS CUI [2,1])
C0441971 (UMLS CUI [2,2])
tumor stage classification
Item
Tumor-Stadium[Klassifikation]
text
C0474927 (UMLS CUI [1])
C0678222 (UMLS CUI [2,1])
C0441971 (UMLS CUI [2,2])
comorbidity and secondary diagnosis
Item
Komorbiditäten/Nebendiagnosen
text
C0009488 (UMLS CUI [1])
C0332138 (UMLS CUI [2])
ECOG
Item
Index zur Lebensqualität ('ECOG Perfomance Status')
integer
C1520224 (UMLS CUI [1])
pathology and tumor staging
Item
vorhandene Pathologie/Tumorgrading
text
C0030664 (UMLS CUI [1])
C0027646 (UMLS CUI [2])
C0678222 (UMLS CUI [3,1])
C0441971 (UMLS CUI [3,2])
progression
Item
Verlauf
text
C0242656 (UMLS CUI [1,1])
C0678222 (UMLS CUI [1,2])
diagnostic imaging date
Item
Bildgebung, die präsentiert werden soll: Datum
date
C0011923 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
diagnostic imaging type
Item
Bildgebung, die präsentiert werden soll: Rö-Art
text
C0011923 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
diagnostic imaging description
Item
Bildgebung, die präsentiert werden soll: Bezeichnung
text
C0011923 (UMLS CUI [1,1])
C0678257 (UMLS CUI [1,2])
diagnostic imaging external
Item
Bildgebung, die präsentiert werden soll: Hinweis Externbefund
text
C0011923 (UMLS CUI [1,1])
C3844314 (UMLS CUI [1,2])
diagnostic imaging RIS
Item
Bildgebung, die präsentiert werden soll: RIS
text
C0034601 (UMLS CUI [1,1])
C0011923 (UMLS CUI [1,2])
CA 15-3
Item
CA 15-3
float
C0201547 (UMLS CUI [1])
CEA
Item
CEA
float
C0201933 (UMLS CUI [1])
SCC
Item
SCC
float
C0075091 (UMLS CUI [1])
CA 125
Item
CA 125
float
C0201549 (UMLS CUI [1])
Date of CA 15-3 measurement
Item
Monat/Jahr CA 15-3
date
C1254595 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0201547 (UMLS CUI [1,3])
Date of CEA measurement
Item
Monat/Jahr CEA
date
C1254595 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0201933 (UMLS CUI [1,3])
Date of CA 125 measurement
Item
Monat/Jahr CA 125
date
C1254595 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0201549 (UMLS CUI [1,3])
Date of SCC measurement
Item
Monat/Jahr SCC
date
C1254595 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0075091 (UMLS CUI [1,3])
Item
Menopausenstatus
integer
C0455962 (UMLS CUI [1])
menopause finding
Code List
Menopausenstatus
CL Item
prämenopausal (1)
CL Item
postmenopausal (2)
CL Item
unbekannt (3)
family medical history
Item
Familienanamnese
text
C0241889 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
C0678222 (UMLS CUI [2,1])
C0441971 (UMLS CUI [2,2])
date of metastasis diagnosis
Item
Diagnosedatum Metastase
date
C0027627 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0678222 (UMLS CUI [2,1])
C0441971 (UMLS CUI [2,2])
metastasis localization
Item
Lokalisation Metastase
text
C0475264 (UMLS CUI [1,1])
C0027627 (UMLS CUI [1,2])
C0678222 (UMLS CUI [2,1])
C0441971 (UMLS CUI [2,2])
question
Item
Fragestellung
text
C1522634 (UMLS CUI [1,1])
C0678222 (UMLS CUI [1,2])
C0441971 (UMLS CUI [1,3])
contact person
Item
Ansprechpartner
text
C0337611 (UMLS CUI [1,1])
C0678222 (UMLS CUI [1,2])
contact person pager number
Item
Ansprechpartner Funknummer
integer
C0337611 (UMLS CUI [1,1])
C1515258 (UMLS CUI [1,2])
referring physician
Item
Einweiser/Überweiser
text
C1709880 (UMLS CUI [1])
referring physician address
Item
Einweiser/Überweiser Adresse
text
C1442065 (UMLS CUI [1,1])
C1709880 (UMLS CUI [1,2])
clinical trial contact
Item
Kontakt Studienteilnahme
text
C0337611 (UMLS CUI [1,1])
C0008976 (UMLS CUI [1,2])
C0678222 (UMLS CUI [2])
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