ID

25587

Description

Muster 39 - Krebsfrüherkennung - Frauen (Freigabe 22.10.2014). Formulare für die vertragsärztliche Versorgung - Freigabe durch Dezernat 4 - Ärztliche Leistungen und Versorgungsstruktur Geschäftsbereich Sicherstellung und Versorgungsstruktur Abteilung Sicherstellung Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Quelle: http://www.kbv.de/html/formulare.php --- Template 39 - Early Detection of Cancer Women (Released 10-22-2014). Released by Department 4 - Medical treatment and structure of supply, division ensurance and structure of supply, department ensurance Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Source: http://www.kbv.de/html/formulare.php

Link

www.kbv.de

Keywords

Versions (4)
  1. 1/29/17 1/29/17 -
  2. 8/16/17 8/16/17 -
  3. 9/7/17 9/7/17 -
  4. 9/7/17 9/7/17 -
Copyright Holder

Kassenärztliche Bundesvereinigung

Uploaded on

September 7, 2017

DOI

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License

Creative Commons BY-NC 3.0
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KBV Early Detection of Cancer Women Template 39b

German English

KBV Early Detection of Cancer Women Template 39b

2 forms  
Header
Description

Header

Health Insurance name
Description

Health Insurance name

Data type

text

Alias
UMLS CUI [1]
C0021682
Patient Name
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Patient address
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
Patient Birth Date
Description

Patient Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Insurance Company ID
Description

Insurance Company ID

Data type

integer

Alias
UMLS CUI [1]
C1547687
Insurance number
Description

Insurance number

Data type

integer

Alias
UMLS CUI [1]
C1549712
Status
Description

Status

Data type

integer

Alias
UMLS CUI [1]
C0449438
Facility ID
Description

Facility ID

Data type

integer

Alias
UMLS CUI [1]
C1549700
Physician ID
Description

Physician ID

Data type

integer

Alias
UMLS CUI [1]
C1548646
Date
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Past Medical History
Description

Past Medical History

Date of birth
Description

Date of birth

Data type

integer

Measurement units
  • JJJJ
Alias
UMLS CUI [1]
C0421451
JJJJ
Examination date
Description

Examination date

Data type

date

Alias
UMLS CUI [1]
C2826643
former cancer screening
Description

former cancer screening

Data type

boolean

Alias
UMLS CUI [1]
C0199230
date of last cancer screening
Description

date of last cancer screening

Data type

date

Alias
UMLS CUI [1,1]
C0199230
UMLS CUI [1,2]
C2826643
cytologic finding
Description

cytologic finding

Data type

integer

Alias
UMLS CUI [1]
C1265900
cytologic finding group
Description

cytologic finding group

Data type

text

Alias
UMLS CUI [1]
C3702111
gynecologic operation, radio- or chemotherapy of genitals
Description

gynecologic operation, radio- or chemotherapy of genitals

Data type

boolean

Alias
UMLS CUI [1,1]
C0038902
UMLS CUI [1,2]
C0392920
UMLS CUI [1,3]
C1522449
gynecologic therapy
Description

gynecologic therapy

Data type

text

date of gynecologic therapy
Description

date of gynecologic therapy

Data type

date

Alias
UMLS CUI [1]
C2584899
count of pregnancies
Description

count of pregnancies

Data type

integer

Alias
UMLS CUI [1]
C0032967
UMLS CUI [2]
C0000786
Current Medical History
Description

Current Medical History

Last menstrual period
Description

Last menstrual period

Data type

date

Alias
UMLS CUI [1]
C0369661
pregnancy
Description

pregnancy

Data type

boolean

Alias
UMLS CUI [1]
C0032961
pathologic gynecologic bleedings
Description

pathologic gynecologic bleedings

Data type

boolean

Alias
UMLS CUI [1,1]
C0019080
UMLS CUI [1,2]
C0205480
discharge
Description

discharge

Data type

boolean

Alias
UMLS CUI [1]
C0012621
intrauterine device
Description

intrauterine device

Data type

boolean

Alias
UMLS CUI [1]
C0021900
ovulation inhibitor
Description

ovulation inhibitor

Data type

boolean

Alias
UMLS CUI [1]
C0029968
hormone therapy
Description

hormone therapy

Data type

boolean

Alias
UMLS CUI [1]
C0279025
which hormone therapy
Description

which hormone therapy

Data type

text

hormone therapy indication
Description

hormone therapy indication

Data type

text

Alias
UMLS CUI [1,1]
C0279025
UMLS CUI [1,2]
C3146298
Finding
Description

Finding

vulva inspection
Description

vulva inspection

Data type

boolean

Alias
UMLS CUI [1,1]
C2381411
UMLS CUI [1,2]
C0425834
portio and vagina
Description

portio and vagina

Data type

boolean

Alias
UMLS CUI [1,1]
C0425844
UMLS CUI [1,2]
C1185877
physical examination of inner genital
Description

physical examination of inner genital

Data type

boolean

Alias
UMLS CUI [1,1]
C0037088
UMLS CUI [1,2]
C0200048
inguinal lymph nodes conspicuous
Description

inguinal lymph nodes conspicuous

Data type

boolean

Alias
UMLS CUI [1,1]
C0729596
UMLS CUI [1,2]
C0437527
other findings requiring treatment
Description

other findings requiring treatment

Data type

boolean

Alias
UMLS CUI [1]
C0582103
Skin
Description

Skin

Data type

boolean

Alias
UMLS CUI [1]
C0007114
Mamma
Description

Mamma

Data type

boolean

Alias
UMLS CUI [1,1]
C0006141
UMLS CUI [1,2]
C0437086
axillary lymph nodes
Description

axillary lymph nodes

Data type

boolean

Alias
UMLS CUI [1,1]
C0729594
UMLS CUI [1,2]
C2826279
hematochezia
Description

hematochezia

Data type

boolean

Alias
UMLS CUI [1]
C0018932
abnormalities in stool
Description

abnormalities in stool

Data type

boolean

Alias
UMLS CUI [1,1]
C1704258
UMLS CUI [1,2]
C0011135
Rectum palpation finding conspicious
Description

Rectum palpation finding conspicious

Data type

boolean

Alias
UMLS CUI [1,1]
C1384593
UMLS CUI [1,2]
C1290912
Rectum stool sample
Description

Rectum stool sample

Data type

boolean

Alias
UMLS CUI [1]
C1550661
Stool test positive
Description

Stool test positive

Data type

boolean

Alias
UMLS CUI [1]
C0202010
gynacologic finding
Description

gynacologic finding

Data type

text

Alias
UMLS CUI [1]
C0017411
Blood Pressure
Description

Blood Pressure

Data type

text

Measurement units
  • ___/___
Alias
UMLS CUI [1]
C0005823
___/___
Blood Pressure remeasurement
Description

Blood Pressure remeasurement

Data type

text

Measurement units
  • ___/___
Alias
UMLS CUI [1]
C0005823
___/___
Cytologic finding
Description

Cytologic finding

cytologic specimen not applicable
Description

cytologic specimen not applicable

Data type

boolean

Alias
UMLS CUI [1,1]
C0545978
UMLS CUI [1,2]
C4287930
endocervical cells
Description

endocervical cells

Data type

integer

Alias
UMLS CUI [1,1]
C4038423
UMLS CUI [1,2]
C0370003
proliferation
Description

proliferation

Data type

text

Alias
UMLS CUI [1]
C1514485
Lactobacillus
Description

Lactobacillus

Data type

boolean

Alias
UMLS CUI [1]
C0022938
vaginal flora
Description

vaginal flora

Data type

boolean

Alias
UMLS CUI [1]
C1982070
vaginal flora cocci
Description

vaginal flora cocci

Data type

boolean

Alias
UMLS CUI [1]
C0314746
Trichomonaden
Description

Trichomonaden

Data type

boolean

Alias
UMLS CUI [1]
C0040923
candida
Description

candida

Data type

boolean

Alias
UMLS CUI [1]
C0006837
Gardnerella
Description

Gardnerella

Data type

boolean

Alias
UMLS CUI [1]
C0017098
group
Description

group

Data type

text

Alias
UMLS CUI [1]
C3702111
comments
Description

comments

Data type

text

Alias
UMLS CUI [1]
C0947611
further treatment
Description

further treatment

Data type

integer

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C1517331
cytologic control after therapy
Description

cytologic control after therapy

Data type

text

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C0582103
Footer
Description

Footer

Signature date
Description

Signature date

Data type

date

Alias
UMLS CUI [1]
C0807937
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Similar models

KBV Early Detection of Cancer Women Template 39b

2 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Health Insurance name
Item
text
C0021682 (UMLS CUI [1])
Patient Name
Item
text
C1299487 (UMLS CUI [1])
Patient address
Item
text
C0421449 (UMLS CUI [1])
Patient Birth Date
Item
date
C0421451 (UMLS CUI [1])
Insurance Company ID
Item
integer
C1547687 (UMLS CUI [1])
Insurance number
Item
integer
C1549712 (UMLS CUI [1])
Status
Item
integer
C0449438 (UMLS CUI [1])
Facility ID
Item
integer
C1549700 (UMLS CUI [1])
Physician ID
Item
integer
C1548646 (UMLS CUI [1])
Date
Item
date
C0011008 (UMLS CUI [1])
Date of birth
Item
integer
C0421451 (UMLS CUI [1])
Examination date
Item
date
C2826643 (UMLS CUI [1])
former cancer screening
Item
boolean
C0199230 (UMLS CUI [1])
date of last cancer screening
Item
date
C0199230 (UMLS CUI [1,1])
C2826643 (UMLS CUI [1,2])
cytologic finding
Item
integer
C1265900 (UMLS CUI [1])
cytologic finding group
Item
text
C3702111 (UMLS CUI [1])
gynecologic operation, radio- or chemotherapy of genitals
Item
boolean
C0038902 (UMLS CUI [1,1])
C0392920 (UMLS CUI [1,2])
C1522449 (UMLS CUI [1,3])
gynecologic therapy
Item
text
date of gynecologic therapy
Item
date
C2584899 (UMLS CUI [1])
count of pregnancies
Item
integer
C0032967 (UMLS CUI [1])
C0000786 (UMLS CUI [2])
Last menstrual period
Item
date
C0369661 (UMLS CUI [1])
pregnancy
Item
boolean
C0032961 (UMLS CUI [1])
pathologic gynecologic bleedings
Item
boolean
C0019080 (UMLS CUI [1,1])
C0205480 (UMLS CUI [1,2])
discharge
Item
boolean
C0012621 (UMLS CUI [1])
intrauterine device
Item
boolean
C0021900 (UMLS CUI [1])
ovulation inhibitor
Item
boolean
C0029968 (UMLS CUI [1])
hormone therapy
Item
boolean
C0279025 (UMLS CUI [1])
which hormone therapy
Item
text
hormone therapy indication
Item
text
C0279025 (UMLS CUI [1,1])
C3146298 (UMLS CUI [1,2])
Item Group
vulva inspection
Item
boolean
C2381411 (UMLS CUI [1,1])
C0425834 (UMLS CUI [1,2])
portio and vagina
Item
boolean
C0425844 (UMLS CUI [1,1])
C1185877 (UMLS CUI [1,2])
physical examination of inner genital
Item
boolean
C0037088 (UMLS CUI [1,1])
C0200048 (UMLS CUI [1,2])
inguinal lymph nodes conspicuous
Item
boolean
C0729596 (UMLS CUI [1,1])
C0437527 (UMLS CUI [1,2])
other findings requiring treatment
Item
boolean
C0582103 (UMLS CUI [1])
Skin
Item
boolean
C0007114 (UMLS CUI [1])
Mamma
Item
boolean
C0006141 (UMLS CUI [1,1])
C0437086 (UMLS CUI [1,2])
axillary lymph nodes
Item
boolean
C0729594 (UMLS CUI [1,1])
C2826279 (UMLS CUI [1,2])
hematochezia
Item
boolean
C0018932 (UMLS CUI [1])
abnormalities in stool
Item
boolean
C1704258 (UMLS CUI [1,1])
C0011135 (UMLS CUI [1,2])
Rectum palpation finding conspicious
Item
boolean
C1384593 (UMLS CUI [1,1])
C1290912 (UMLS CUI [1,2])
Rectum stool sample
Item
boolean
C1550661 (UMLS CUI [1])
Stool test positive
Item
boolean
C0202010 (UMLS CUI [1])
gynacologic finding
Item
text
C0017411 (UMLS CUI [1])
Blood Pressure
Item
text
C0005823 (UMLS CUI [1])
Blood Pressure remeasurement
Item
text
C0005823 (UMLS CUI [1])
cytologic specimen not applicable
Item
boolean
C0545978 (UMLS CUI [1,1])
C4287930 (UMLS CUI [1,2])
Item
integer
C4038423 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
endocervical cells
Code List
endocervical cells
CL Item
 (1)
CL Item
 (2)
proliferation
Item
text
C1514485 (UMLS CUI [1])
Lactobacillus
Item
boolean
C0022938 (UMLS CUI [1])
vaginal flora
Item
boolean
C1982070 (UMLS CUI [1])
vaginal flora cocci
Item
boolean
C0314746 (UMLS CUI [1])
Trichomonaden
Item
boolean
C0040923 (UMLS CUI [1])
candida
Item
boolean
C0006837 (UMLS CUI [1])
Gardnerella
Item
boolean
C0017098 (UMLS CUI [1])
group
Item
text
C3702111 (UMLS CUI [1])
comments
Item
text
C0947611 (UMLS CUI [1])
Item
integer
C0087111 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
further treatment
Code List
further treatment
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
CL Item
 (5)
cytologic control after therapy
Item
text
C1522577 (UMLS CUI [1,1])
C0582103 (UMLS CUI [1,2])
Item Group
Signature date
Item
Signature date
date
C0807937 (UMLS CUI [1])
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