ID

11306

Descripción

Items used as routine documentation by the university hospital muenster. Derived from original form "DAST Aufnahme PSYCH MS", converted to ODM format.

Palabras clave

Versiones (2)
  1. 28/6/15 28/6/15 -
  2. 28/6/15 28/6/15 -
Subido en

28 de junio de 2015

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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DAST Basic Documentation_Admission

Alemán ( localization.languageCode.DE ) Inglés

DAST Basic Documentation_Admission

1 formularios  
Patient informations
Descripción

Patient informations

Alias
UMLS CUI-1
C1955348
Name of the patient:
Descripción

Patient's name

Tipo de datos

text

Alias
UMLS CUI-1
C1299487
Date of birth:
Descripción

Date of birth

Tipo de datos

date

Alias
UMLS CUI-1
C0421451
Date of admission:
Descripción

Date of admission

Tipo de datos

date

Alias
UMLS CUI-1
C0011008
UMLS CUI-2
C0019994
UMLS CUI-3
C0809949
Document date:
Descripción

Document date

Tipo de datos

date

Alias
UMLS CUI-1
C1978797
Gender:
Descripción

Gender

Tipo de datos

text

Alias
UMLS CUI-1
C0079399
Age in years:
Descripción

Age

Tipo de datos

integer

Alias
UMLS CUI-1
C0001779
Marital status:
Descripción

Marital status

Tipo de datos

text

Alias
UMLS CUI-1
C0024819
How many children do you have?
Descripción

Number of children

Tipo de datos

integer

Alias
UMLS CUI-1
C2229974
How many people live in your house? Please enter as follow: Number of children, number of adults and total number of people living in your house.
Descripción

Number of people in household

Tipo de datos

text

Name of the country you were born in:
Descripción

Birth country

Tipo de datos

text

Alias
UMLS CUI-1
C1300001
If you were not born in Germany, for how long are you living in Germany?
Descripción

Number of years in Germany

Tipo de datos

text

Alias
UMLS CUI-1
C0439234
UMLS CUI-2
C0017480
Birth country of your parents, please mention the birth country for both of your parents:
Descripción

Birth country of parents

Tipo de datos

text

Alias
UMLS CUI-1
C1300001
UMLS CUI-2
C0030551
What is your highest school-leaving qualification?
Descripción

School-leaving qualification

Tipo de datos

text

Alias
UMLS CUI-1
C1522410
UMLS CUI-2
C0036375
UMLS CUI-3
C1711333
How many years did you go to school?
Descripción

Number of years in school

Tipo de datos

integer

Alias
UMLS CUI-1
C0237753
UMLS CUI-2
C0439234
UMLS CUI-3
C0036375
What is your highest vocational qualification?
Descripción

Highest vocational qualification

Tipo de datos

text

Alias
UMLS CUI-1
C0042933
What is your present profession?
Descripción

Profession

Tipo de datos

text

Alias
UMLS CUI-1
C0028811
Do you have any first-degree relative who suffers from psychiatric disorder? If yes, please mention the person's relation to you and the type of psychiatric disorder he has.
Descripción

Psychiatric disorders in first-degree relatives

Tipo de datos

text

Alias
UMLS CUI-1
C0004936
UMLS CUI-2
C1517194
Pretreatments in the last 8 weeks before the present admission
Descripción

Pretreatments in the last 8 weeks before the present admission

None
Descripción

None

Tipo de datos

boolean

Alias
UMLS CUI-1
C0549184
Did you undergo antidepressive therapy? If yes please mention the drug generic, dose and therapy duration:
Descripción

Antidepressive therapy

Tipo de datos

text

Alias
UMLS CUI-1
C0003289
UMLS CUI-2
C0087111
Did you undergo electroconvulsive therapy, ECT? If yes, please state the number of single stimulations you recieved.
Descripción

Electroconvulsive therapy

Tipo de datos

text

Alias
UMLS CUI-1
C0013806
Did you undergo a therapy for sleep deprivation?
Descripción

Sleep deprivation

Tipo de datos

boolean

Alias
UMLS CUI-1
C0037316
Did you undergo light therapy?
Descripción

Light therapy

Tipo de datos

boolean

Alias
UMLS CUI-1
C0031765
Did you receive any individual psychotherapy session?
Descripción

Psychotherapy

Tipo de datos

boolean

Alias
UMLS CUI-1
C0033968
Did you receive any group psychotherapy session?
Descripción

Psychotherapy

Tipo de datos

boolean

Others:
Descripción

Others

Tipo de datos

text

Alias
UMLS CUI-1
C0205394
Diagnoses
Descripción

Diagnoses

Alias
UMLS CUI-1
C0011900
Main diagnosis according to DSM-IV
Descripción

Main diagnosis

Tipo de datos

text

Alias
UMLS CUI-1
C0332137
Secondary diagnoses according to DSM-IV:
Descripción

Secondary diagnosis

Tipo de datos

text

Alias
UMLS CUI-1
C0332138
Body height (in centimetres):
Descripción

Body height

Tipo de datos

float

Alias
UMLS CUI-1
C0005890
Weight (in kilograms):
Descripción

Weight

Tipo de datos

float

Alias
UMLS CUI-1
C0005910
Electrocardiogram, QTC- Interval (in seconds):
Descripción

Electrocardiogram, QTC- time

Tipo de datos

float

Alias
UMLS CUI-1
C1623258
When did you have your first depressive episode?
Descripción

Depressive episode

Tipo de datos

text

Alias
UMLS CUI-1
C0349217
Number of previous depressive episodes:
Descripción

Depressive episode

Tipo de datos

integer

Alias
UMLS CUI-1
C0349217
Number of previous stationary psychiatric hospitalizations:
Descripción

stationary psychiatric hospitalization

Tipo de datos

integer

Clinical global impression (Severity of illness), please evaluate only for the period of last week.
Descripción

Clinical global impression

Tipo de datos

text

Please select the score range based on the Global Assessment of Functioning (GAF) Scale. The evaluation of the GAF scale should relate to the period of last week before admission:
Descripción

Global Assessment of Functioning (GAF) Scale

Tipo de datos

text

Alias
UMLS CUI-1
C0561904
Patient's actual score:
Descripción

Score

Tipo de datos

float

Alias
UMLS CUI-1
C0030705
UMLS CUI-2
C0018684
UMLS CUI-3
C0449820
Assessment Form for admission
Descripción

Assessment Form for admission

Beck Depression Inventory, BDI:
Descripción

Beck Depression Inventory

Tipo de datos

text

Alias
UMLS CUI-1
C0451022
Hamilton Anxiety Rating Scale, HAM-A:
Descripción

Hamilton Anxiety Rating Scale

Tipo de datos

text

Young Mania Rating Scale, YMRS:
Descripción

Young Mania Rating Scale

Tipo de datos

text

Others:
Descripción

Others

Tipo de datos

text

Alias
UMLS CUI-1
C0205394
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Similar models

DAST Basic Documentation_Admission

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Patient informations
C1955348 (UMLS CUI-1)
Patient's name
Item
Name of the patient:
text
C1299487 (UMLS CUI-1)
Date of birth
Item
Date of birth:
date
C0421451 (UMLS CUI-1)
Date of admission
Item
Date of admission:
date
C0011008 (UMLS CUI-1)
C0019994 (UMLS CUI-2)
C0809949 (UMLS CUI-3)
Document date
Item
Document date:
date
C1978797 (UMLS CUI-1)
Item
Gender:
text
C0079399 (UMLS CUI-1)
Gender
Code List
Gender:
CL Item
Male (1)
CL Item
Female (2)
Age
Item
Age in years:
integer
C0001779 (UMLS CUI-1)
Item
Marital status:
text
C0024819 (UMLS CUI-1)
Marital status
Code List
Marital status:
CL Item
Married (1)
CL Item
Single (2)
CL Item
Widowed (3)
CL Item
Separated/ Divorced (4)
CL Item
Fixed partnership (5)
Number of children
Item
How many children do you have?
integer
C2229974 (UMLS CUI-1)
Number of people in household
Item
How many people live in your house? Please enter as follow: Number of children, number of adults and total number of people living in your house.
text
Birth country
Item
Name of the country you were born in:
text
C1300001 (UMLS CUI-1)
Number of years in Germany
Item
If you were not born in Germany, for how long are you living in Germany?
text
C0439234 (UMLS CUI-1)
C0017480 (UMLS CUI-2)
Birth country of parents
Item
Birth country of your parents, please mention the birth country for both of your parents:
text
C1300001 (UMLS CUI-1)
C0030551 (UMLS CUI-2)
Item
What is your highest school-leaving qualification?
text
C1522410 (UMLS CUI-1)
C0036375 (UMLS CUI-2)
C1711333 (UMLS CUI-3)
Highest school-leaving qualification
Code List
What is your highest school-leaving qualification?
CL Item
Without graduation (1)
CL Item
Primary school (2)
CL Item
Secondary school (3)
CL Item
University (4)
CL Item
University of applied science (5)
CL Item
Others (6)
Number of years in school
Item
How many years did you go to school?
integer
C0237753 (UMLS CUI-1)
C0439234 (UMLS CUI-2)
C0036375 (UMLS CUI-3)
Highest vocational qualification
Item
What is your highest vocational qualification?
text
C0042933 (UMLS CUI-1)
Item
What is your present profession?
text
C0028811 (UMLS CUI-1)
Profession
Code List
What is your present profession?
CL Item
Unemployed (1)
CL Item
Employed (2)
CL Item
Self-employed (3)
CL Item
Free-lancer (4)
CL Item
Craftsman (5)
CL Item
Skilled worker (6)
CL Item
Employee (7)
Psychiatric disorders in first-degree relatives
Item
Do you have any first-degree relative who suffers from psychiatric disorder? If yes, please mention the person's relation to you and the type of psychiatric disorder he has.
text
C0004936 (UMLS CUI-1)
C1517194 (UMLS CUI-2)
Item Group
Pretreatments in the last 8 weeks before the present admission
None
Item
None
boolean
C0549184 (UMLS CUI-1)
Antidepressive therapy
Item
Did you undergo antidepressive therapy? If yes please mention the drug generic, dose and therapy duration:
text
C0003289 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
Electroconvulsive therapy
Item
Did you undergo electroconvulsive therapy, ECT? If yes, please state the number of single stimulations you recieved.
text
C0013806 (UMLS CUI-1)
Sleep deprivation
Item
Did you undergo a therapy for sleep deprivation?
boolean
C0037316 (UMLS CUI-1)
Light therapy
Item
Did you undergo light therapy?
boolean
C0031765 (UMLS CUI-1)
Psychotherapy
Item
Did you receive any individual psychotherapy session?
boolean
C0033968 (UMLS CUI-1)
Psychotherapy
Item
Did you receive any group psychotherapy session?
boolean
Others
Item
Others:
text
C0205394 (UMLS CUI-1)
Item Group
Diagnoses
C0011900 (UMLS CUI-1)
Main diagnosis
Item
Main diagnosis according to DSM-IV
text
C0332137 (UMLS CUI-1)
Secondary diagnosis
Item
Secondary diagnoses according to DSM-IV:
text
C0332138 (UMLS CUI-1)
Body height
Item
Body height (in centimetres):
float
C0005890 (UMLS CUI-1)
Weight
Item
Weight (in kilograms):
float
C0005910 (UMLS CUI-1)
Electrocardiogram
Item
Electrocardiogram, QTC- Interval (in seconds):
float
C1623258 (UMLS CUI-1)
Depressive episode
Item
When did you have your first depressive episode?
text
C0349217 (UMLS CUI-1)
Depressive episode
Item
Number of previous depressive episodes:
integer
C0349217 (UMLS CUI-1)
stationary psychiatric hospitalization
Item
Number of previous stationary psychiatric hospitalizations:
integer
Item
Clinical global impression (Severity of illness), please evaluate only for the period of last week.
text
Clinical global impression
Code List
Clinical global impression (Severity of illness), please evaluate only for the period of last week.
CL Item
0 Can not be assessed. (1)
CL Item
1 Patient is not ill. (2)
CL Item
2 Patient is a borderline case of psychiatric illness. (3)
CL Item
3 Patient is only slightly ill. (4)
CL Item
4 Patient is moderately ill. (5)
CL Item
5 Patient is clearly ill. (6)
CL Item
6 Patient is seriously ill. (7)
Item
Please select the score range based on the Global Assessment of Functioning (GAF) Scale. The evaluation of the GAF scale should relate to the period of last week before admission:
text
C0561904 (UMLS CUI-1)
Global Assessment of Functioning (GAF) Scale
Code List
Please select the score range based on the Global Assessment of Functioning (GAF) Scale. The evaluation of the GAF scale should relate to the period of last week before admission:
CL Item
100-91 Superior functioning in all areas. (1)
CL Item
90-81 Good functioning in all areas. (2)
CL Item
80-71 No more than slight impairment. (3)
CL Item
70-61 Some difficulty. (4)
CL Item
60-51 Moderate difficulty. (5)
CL Item
50-41 Serious impairment. (6)
CL Item
40-31 Major impairment in several areas. (7)
CL Item
30-21 Inability to function in almost all areas. (8)
CL Item
20-11 Some danger of hurting self or others. (9)
CL Item
10-1 Permanent risk or persistent inability.  (10)
CL Item
Inadequate information. (0)
Score
Item
Patient's actual score:
float
C0030705 (UMLS CUI-1)
C0018684 (UMLS CUI-2)
C0449820 (UMLS CUI-3)
Item Group
Assessment Form for admission
Item
Beck Depression Inventory, BDI:
text
C0451022 (UMLS CUI-1)
Beck Depression Inventory
Code List
Beck Depression Inventory, BDI:
CL Item
Not specified (1)
CL Item
Is available (2)
CL Item
Patient is severely ill. (3)
CL Item
Denied (4)
CL Item
Others (5)
Item
Hamilton Anxiety Rating Scale, HAM-A:
text
Hamilton Anxiety Rating Scale
Code List
Hamilton Anxiety Rating Scale, HAM-A:
CL Item
Not specified (1)
CL Item
Is available (2)
CL Item
Patient is severely ill. (3)
CL Item
Denied (4)
CL Item
Others (5)
Item
Young Mania Rating Scale, YMRS:
text
Young Mania Rating Scale
Code List
Young Mania Rating Scale, YMRS:
CL Item
Not specified (1)
CL Item
Is available (2)
CL Item
Patient is severely ill. (3)
CL Item
Denied (4)
CL Item
Others (5)
Others
Item
Others:
text
C0205394 (UMLS CUI-1)
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