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DAST - Basic documentation - Patient Admission Form

1 Formulários  
Patient Demographics
Descrição

Patient Demographics

Alias
UMLS CUI-1
C1955348
Patient Name
Descrição

Patient Name

Tipo de dados

integer

Alias
UMLS CUI-1
C1299487
Date of admission
Descrição

Date of admission

Tipo de dados

date

Alias
UMLS CUI-1
C1302393
Date of birth
Descrição

Date of birth

Tipo de dados

date

Alias
UMLS CUI-1
C0421451
Entry date
Descrição

Entry date

Tipo de dados

date

Alias
UMLS CUI-1
C1978797
Attending physician
Descrição

Physician attending and documenting the patient`s admission

Tipo de dados

text

Alias
UMLS CUI-1
C1320929
Gender
Descrição

Gender

Alias
UMLS CUI-1
C0079399
Patient Gender
Descrição

Patient Gender

Tipo de dados

integer

Alias
UMLS CUI-1
C0079399
Patient age
Descrição

Patient age

Patient age
Descrição

Patient age

Tipo de dados

integer

Marital status
Descrição

Marital status

Marital status
Descrição

Marital status

Tipo de dados

text

Alias
UMLS CUI-1
C0024819
Offspring
Descrição

Offspring

How many children do you have?
Descrição

How many children do you have?

Tipo de dados

integer

Alias
UMLS CUI-1
C2229974
Sharde household
Descrição

Sharde household

How many children live with you in your household?
Descrição

How many children live with you in your household?

Tipo de dados

integer

Alias
UMLS CUI-1
C1518468
How many adults live with you in your household?
Descrição

How many adults live with you in your household?

Tipo de dados

integer

Alias
UMLS CUI-1
C0557510
UMLS CUI-2
C0557510
Total amount of people living in your household
Descrição

Total amount of people living with patient in household

Tipo de dados

integer

Alias
UMLS CUI-1
C0682277
Descent
Descrição

Descent

Country of birth?
Descrição

Where was the patient born?

Tipo de dados

text

Alias
UMLS CUI-1
C1300001
Years in Germany
Descrição

Years in Germany

In case you where not born in Germany, how many years have you lived in Germany for?
Descrição

In case you where not born in Germany, how many years have you lived in Germany for?

Tipo de dados

text

Alias
UMLS CUI-1
C0017480
UMLS CUI-2
C0682130
UMLS CUI-3
C0946385
Patient's parents country of birth
Descrição

Patient's parents country of birth

Where was your mother born?
Descrição

Where was your mother born?

Tipo de dados

text

Alias
UMLS CUI-1
C1300001
UMLS CUI-2
C0026591
Where was your father born?
Descrição

Where was your father born?

Tipo de dados

text

Alias
UMLS CUI-1
C1300001
UMLS CUI-2
C0015671
School leaving certificate
Descrição

School leaving certificate

What is your highest achieved level of education?
Descrição

What is your highest achieved level of education?

Tipo de dados

text

Alias
UMLS CUI-1
C2030935
Number of school years
Descrição

Number of school years

How many years of schooling have you completed?
Descrição

How many years of schooling have you completed?

Tipo de dados

integer

Alias
UMLS CUI-1
C2360044
Training qualification / Professional education
Descrição

Training qualification / Professional education

What is your highest level of vocational training
Descrição

What is your highest level of vocational training

Tipo de dados

text

Alias
UMLS CUI-1
C0204116
UMLS CUI-2
C2030935
Current employment situation
Descrição

Current employment situation

What is your current employment situation?
Descrição

What is your current employment situation?

Tipo de dados

text

Alias
UMLS CUI-1
C3261398
Family history of psychiatric disease
Descrição

Family history of psychiatric disease

Has any of your first-degree relatives suffered from a mental disorder?
Descrição

Has any of your first-degree relatives suffered from a psychiatric disease?

Tipo de dados

text

Alias
UMLS CUI-1
C0004936
UMLS CUI-2
C1518469
In case mental disorders have occured in your family: Who has been affected and by which mental disorder specifically? (Mother, Father, Brother, Sister, Aunt, Uncle, Grandfather, Grandmother, others)
Descrição

In case mental disorders have occured in your family: Who has been affected and by which mental disorder specifically?

Tipo de dados

text

Alias
UMLS CUI-1
C0455379
Treatment prior to admission
Descrição

Treatment prior to admission

Treatment received in the last 8 weeks prior to current admission
Descrição

Treatment received in the last 8 weeks prior to current admission

Tipo de dados

text

Alias
UMLS CUI-1
C1514463
Admission diagnosis
Descrição

Admission diagnosis

Primary mental disorder admission diagnosis (DSM-IV)
Descrição

Primary mental disorder admission diagnosis (DSM-IV)

Tipo de dados

text

Alias
UMLS CUI-1
C1628992
Relevant secondary diagnosis
Descrição

Relevant secondary diagnosis

Tipo de dados

text

Vital status
Descrição

Vital status

Patient height
Descrição

Patient height

Tipo de dados

integer

Unidades de medida
  • cm
Alias
UMLS CUI-1
C0489786
cm
Patient weight
Descrição

Patient weight

Tipo de dados

integer

Unidades de medida
  • kg
Alias
UMLS CUI-1
C0005910
kg
Electrocardiography
Descrição

Electrocardiography

Corrected QT Interval (QTc)
Descrição

Corrected QT Interval (QTc)

Tipo de dados

integer

Unidades de medida
  • sec
sec
Major depressive disorder
Descrição

Major depressive disorder

Occurrence first major depressive episode
Descrição

Occurrence first major depressive episode

Tipo de dados

date

Alias
UMLS CUI-1
C0024517
Number of major depressive episodes
Descrição

Number of major depressive episodes

Tipo de dados

integer

Alias
UMLS CUI-1
C0024517
UMLS CUI-2
C0449788
Number of times patient was hospitalized a psychiatric clinic
Descrição

Number of times patient was hospitalized a psychiatric clinic

Tipo de dados

integer

Alias
UMLS CUI-1
C0019993
UMLS CUI-2
C0871167
Clinical Global Impression (Degrees of severity)
Descrição

Clinical Global Impression (Degrees of severity)

Severity Score
Descrição

Severity Score

Tipo de dados

text

Global Assessment of Functioning (GAF) Scale
Descrição

Global Assessment of Functioning (GAF) Scale

Evaluation of GAF shall refer to the last 8 weeks prior to admission
Descrição

intermediary values i.e 45,68,72 shall be entered

Tipo de dados

integer

Alias
UMLS CUI-1
C0017644
Rating sheet / Evaluation sheet at admission
Descrição

Rating sheet / Evaluation sheet at admission

Beck Depression Inventory
Descrição

Beck Depression Inventory

Tipo de dados

integer

Alias
UMLS CUI-1
C0451022
Hamilton Depression Scale (HAMD)
Descrição

Hamilton Depression Scale (HAMD)

Tipo de dados

text

Alias
UMLS CUI-1
C0451203
Young's Mania Rating Scale (YMRS-C)
Descrição

Young's Mania Rating Scale (YMRS-C)

Tipo de dados

text

Alias
UMLS CUI-1
C3640523
Other
Descrição

Other

Tipo de dados

text

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DAST - Basic documentation - Patient Admission Form

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Patient Demographics
C1955348 (UMLS CUI-1)
Patient Name
Item
Patient Name
integer
C1299487 (UMLS CUI-1)
Date of admission
Item
Date of admission
date
C1302393 (UMLS CUI-1)
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI-1)
Entry date
Item
Entry date
date
C1978797 (UMLS CUI-1)
Attending physician
Item
Attending physician
text
C1320929 (UMLS CUI-1)
Item Group
Gender
C0079399 (UMLS CUI-1)
Item
Patient Gender
integer
C0079399 (UMLS CUI-1)
Patient Gender
Code List
Patient Gender
CL Item
male (1)
CL Item
female (2)
Item Group
Patient age
Patient age
Item
Patient age
integer
Item Group
Marital status
Marital status
Item
Marital status
text
C0024819 (UMLS CUI-1)
Item Group
Offspring
How many children do you have?
Item
How many children do you have?
integer
C2229974 (UMLS CUI-1)
Item Group
Sharde household
Number of Children in Household
Item
How many children live with you in your household?
integer
C1518468 (UMLS CUI-1)
Number of Adults in Household
Item
How many adults live with you in your household?
integer
C0557510 (UMLS CUI-1)
C0557510 (UMLS CUI-2)
Total number of persons in your household
Item
Total amount of people living in your household
integer
C0682277 (UMLS CUI-1)
Country of birth
Item
Country of birth?
text
C1300001 (UMLS CUI-1)
Item Group
Years in Germany
In case you where not born in Germany, how many years have you lived in Germany for?
Item
In case you where not born in Germany, how many years have you lived in Germany for?
text
C0017480 (UMLS CUI-1)
C0682130 (UMLS CUI-2)
C0946385 (UMLS CUI-3)
Item Group
Patient's parents country of birth
Where was your mother born?
Item
Where was your mother born?
text
C1300001 (UMLS CUI-1)
C0026591 (UMLS CUI-2)
Where was your father born?
Item
Where was your father born?
text
C1300001 (UMLS CUI-1)
C0015671 (UMLS CUI-2)
Item Group
School leaving certificate
What is your highest achieved level of education?
Item
What is your highest achieved level of education?
text
C2030935 (UMLS CUI-1)
Item Group
Number of school years
How many years of schooling have you completed?
Item
How many years of schooling have you completed?
integer
C2360044 (UMLS CUI-1)
Item Group
Training qualification / Professional education
What is your highest level of vocational training
Item
What is your highest level of vocational training
text
C0204116 (UMLS CUI-1)
C2030935 (UMLS CUI-2)
Item Group
Current employment situation
What is your current employment situation?
Item
What is your current employment situation?
text
C3261398 (UMLS CUI-1)
Item Group
Family history of psychiatric disease
Has any of your first-degree relatives suffered from a psychiatric disease?
Item
Has any of your first-degree relatives suffered from a mental disorder?
text
C0004936 (UMLS CUI-1)
C1518469 (UMLS CUI-2)
In case mental disorders have occured in your family
Item
In case mental disorders have occured in your family: Who has been affected and by which mental disorder specifically? (Mother, Father, Brother, Sister, Aunt, Uncle, Grandfather, Grandmother, others)
text
C0455379 (UMLS CUI-1)
Item Group
Treatment prior to admission
Item
Treatment received in the last 8 weeks prior to current admission
text
C1514463 (UMLS CUI-1)
Treatment received in the last 8 weeks prior to current admission
Code List
Treatment received in the last 8 weeks prior to current admission
CL Item
None (None)
CL Item
Antidepressive Agents (generic name, mg/d, Duration) (Antidepressive Agents (generic name, mg/d, Duration))
CL Item
Electroconvulsive therapy: Number of single stimulations  (Electroconvulsive therapy: Number of single stimulations )
CL Item
Sleep deprivation (Sleep deprivation)
CL Item
Phototherapy (Phototherapy)
CL Item
Psychotherapy: individual therapy (Psychotherapy: individual therapy)
CL Item
Psychotherapy: group therapy (Psychotherapy: group therapy)
CL Item
Other: (Other:)
Item Group
Admission diagnosis
Primary mental disorder admission diagnosis (DSM-IV)
Item
Primary mental disorder admission diagnosis (DSM-IV)
text
C1628992 (UMLS CUI-1)
Relevant secondary diagnosis
Item
Relevant secondary diagnosis
text
Item Group
Vital status
Patient height
Item
Patient height
integer
C0489786 (UMLS CUI-1)
Patient weight
Item
Patient weight
integer
C0005910 (UMLS CUI-1)
Item Group
Electrocardiography
Corrected QT Interval (QTc)
Item
Corrected QT Interval (QTc)
integer
Item Group
Major depressive disorder
Major depressive disorder
Item
Occurrence first major depressive episode
date
C0024517 (UMLS CUI-1)
Number of major depressive episodes
Item
Number of major depressive episodes
integer
C0024517 (UMLS CUI-1)
C0449788 (UMLS CUI-2)
Number of times patient was hospitalized a psychiatric clinic
Item
Number of times patient was hospitalized a psychiatric clinic
integer
C0019993 (UMLS CUI-1)
C0871167 (UMLS CUI-2)
Item Group
Clinical Global Impression (Degrees of severity)
Item
Severity Score
text
Severity Score
Code List
Severity Score
CL Item
cannot be assessed (0)
CL Item
patient is not sick at all (1)
CL Item
patient is a limit case mental disorder (2)
CL Item
patient is only slightly ill (3)
CL Item
 (4)
CL Item
 (5)
CL Item
 (6)
CL Item
 (7)
Item Group
Global Assessment of Functioning (GAF) Scale
Item
Evaluation of GAF shall refer to the last 8 weeks prior to admission
integer
C0017644 (UMLS CUI-1)
Evaluation of GAF shall refer to the last 8 weeks prior to admission
Code List
Evaluation of GAF shall refer to the last 8 weeks prior to admission
CL Item
Inadequate information (0 )
CL Item
No symptoms (100-91 )
CL Item
Absent or minimal symptoms  (90-81 )
CL Item
If symptoms are present, they are transient and expectable reactions to psychosocial stressors  (80-71 )
CL Item
Some mild symptomss. (70-61 )
CL Item
Moderate symptoms (60-51 )
CL Item
Serious symptoms (50-41 )
CL Item
Some impairment  (40-31 )
CL Item
Behavior is considerably influenced by delusions or hallucinations or serious impairment (30-21 )
CL Item
Some danger of hurting self or others (20-11 )
CL Item
Persistent danger of severely hurting self or others (10-1 )
Item Group
Rating sheet / Evaluation sheet at admission
Item
Beck Depression Inventory
integer
C0451022 (UMLS CUI-1)
Beck Depression Inventory
Code List
Beck Depression Inventory
CL Item
available (1)
CL Item
patient too sick (2)
CL Item
refused (3)
CL Item
other (4)
CL Item
not specified (5)
Item
Hamilton Depression Scale (HAMD)
text
C0451203 (UMLS CUI-1)
Hamilton Depression Scale (HAMD)
Code List
Hamilton Depression Scale (HAMD)
CL Item
available (1)
CL Item
patient too sick (2)
CL Item
refused (3)
CL Item
other (4)
CL Item
not specified (5)
Item
Young's Mania Rating Scale (YMRS-C)
text
C3640523 (UMLS CUI-1)
Young's Mania Rating Scale (YMRS-C)
Code List
Young's Mania Rating Scale (YMRS-C)
CL Item
available (1)
CL Item
patient too sick (2)
CL Item
refused (3)
CL Item
other (4)
CL Item
not specified (5)
Other
Item
Other
text
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