ID

11656

Beschrijving

Form from HIS OpenVistA

Trefwoorden

Versies (3)
  1. 19-02-12 19-02-12 -
  2. 25-07-15 25-07-15 - Martin Dugas
  3. 04-08-15 04-08-15 - Martin Dugas
Geüploaded op

25 juli 2015

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

PHARMACY CONSULT RESULTS

Duits Engels

HIS

1 Formulieren  
  1. StudyEvent: HIS
    1. HIS
ADULT IMMUNIZATION PROTOCOL
Beschrijving

ADULT IMMUNIZATION PROTOCOL

Immunization ordered and available on Unit per protocol
Beschrijving

Immunization ordered and available on Unit per protocol

Datatype

boolean

Grippeimpfung
Beschrijving

Influenza vaccine to be administered

Datatype

boolean

Alias
UMLS CUI 2011AA
C0042200
SNOMED CT 2011_0131
86198006
MedDRA 14.1
10059429
ICD-9-CM Version 2011
99.52
Pneumokokkenimpfung
Beschrijving

Pneumococcal vaccine to be administered

Datatype

boolean

Alias
UMLS CUI 2011AA
C0419707
SNOMED CT 2011_0131
12866006
GENTAMICIN
Beschrijving

GENTAMICIN

Alter
Beschrijving

patient age

Datatype

integer

Alias
UMLS CUI 2011AA
C0001779
SNOMED CT 2011_0131
397669002
Geschlecht
Beschrijving

Gender

Datatype

text

Alias
SNOMED CT 2011_0131
263495000
LOINC Version 232
MTHU002975
UMLS CUI-1
C0079399
Größe
Beschrijving

Height

Datatype

float

Maateenheden
  • cm
Alias
LOINC Version 232
MTHU005354
UMLS CUI-1
C0005890
cm
Gewicht
Beschrijving

Weight

Datatype

float

Maateenheden
  • kg
Alias
SNOMED CT 2011_0131
107647005
MedDRA 14.1
10047890
LOINC Version 232
LP18015-5
UMLS CUI-1
C0005910
kg
Kreatinin im Serum
Beschrijving

current serum creatinine

Datatype

float

Alias
UMLS CUI 2011AA
C0201976
SNOMED CT 2011_0131
113075003
MedDRA 14.1
10040230
Blut Harnstoff-Stickstoff
Beschrijving

current BUN

Datatype

float

Alias
UMLS CUI 2011AA
C0005845
SNOMED CT 2011_0131
250623007
MedDRA 14.1
10005845
AMINOGLYCOSIDE EXCLUSIONS (14years and younger, burns over greater than 20% Body surface area (BSA), Endocarditis, CrCl <= 40ml/hr, Pregnancy, Cystic Fibrosis, Severe liver disease or ascites)
Beschrijving

AMINOGLYCOSIDE EXCLUSIONS

Datatype

integer

Alias
UMLS CUI 2011AA
C0005902, C0014118, C0373595, C0549206, C0010674, C0860197
SNOMED CT 2011_0131
128178001, 56819008, 167181009, 190905008
MedDRA 14.1
10050311, 10014665, 10011371, 10036586, 10011762, 10001422
TOBRAMYCIN
Beschrijving

TOBRAMYCIN

Alter
Beschrijving

patient age

Datatype

integer

Alias
UMLS CUI 2011AA
C0001779
SNOMED CT 2011_0131
397669002
Geschlecht
Beschrijving

patient gender

Datatype

integer

Alias
UMLS CUI 2011AA
C0079399
SNOMED CT 2011_0131
263495000
LOINC Version 232
MTHU002975
Größe
Beschrijving

Height

Datatype

float

Maateenheden
  • cm
Alias
LOINC Version 232
MTHU005354
UMLS CUI-1
C0005890
cm
Gewicht
Beschrijving

Weight

Datatype

float

Maateenheden
  • kg
Alias
SNOMED CT 2011_0131
107647005
MedDRA 14.1
10047890
LOINC Version 232
LP18015-5
UMLS CUI-1
C0005910
kg
Kreatinin im Serum
Beschrijving

current serum creatinine

Datatype

float

Alias
UMLS CUI 2011AA
C0201976
SNOMED CT 2011_0131
113075003
MedDRA 14.1
10040230
Blut Harnstoff-Stickstoff
Beschrijving

current BUN

Datatype

float

Alias
UMLS CUI 2011AA
C0005845
SNOMED CT 2011_0131
250623007
MedDRA 14.1
10005845
AMINOGLYCOSIDE EXCLUSIONS (14years and younger, burns over greater than 20% BSA, Endocarditis, CrCl <= 40ml/hr, Pregnancy, Cystic Fibrosis, Severe liver disease or ascites)
Beschrijving

AMINOGLYCOSIDE EXCLUSIONS

Datatype

integer

Alias
UMLS CUI 2011AA
C0005902, C0014118, C0373595, C0549206, C0010674, C0860197
SNOMED CT 2011_0131
128178001, 56819008, 167181009, 190905008
MedDRA 14.1
10050311, 10014665, 10011371, 10036586, 10011762, 10001422
VANCOMYCIN
Beschrijving

VANCOMYCIN

VANCOMYCIN ORDER APPROVED (GUIDELINES FOR RECULTURE: VANCOMYCIN AFTER 7 DAYS MUST BE REEVALUATED AND IV THERAPY DISCONTINUED, IF INDICATED. RECULTURE IF NECESSARY 72 HOURS AFTER ANTIBIOTIC IS STOPPED)
Beschrijving

VANCOMYCIN ORDER APPROVED

Datatype

boolean

Alias
UMLS CUI 2011AA
C0042313
SNOMED CT 2011_0131
42082003
LOINC Version 232
MTHU004271
UNAPPROVED VANCO ORDER, VANCOMYCIN IS NOT APPROVED FOR THE FOLLOWING USE:
Beschrijving

UNAPPROVED VANCO ORDER, VANCOMYCIN IS NOT APPROVED FOR THE FOLLOWING USE:

Datatype

string

Routine surgical prophylaxis other than in a patient who has a life-threatening condition
Beschrijving

Routine surgical prophylaxis other than in a patient who has a life-threatening condition

Datatype

boolean

Alias
UMLS CUI 2011AA
C0199176, C2711184
SNOMED CT 2011_0131
360271000, 442452003
MedDRA 14.1
10036898
Treatment in response to a single blood culture positive for coagulase-negative staphylococcus, if other blood cultures drawn in the same time frame are negative,and if contamination of the blood culture is likely.
Beschrijving

Treatment in response to a single blood culture positive for coagulase-negative staphylococcus, if other blood cultures drawn in the same time frame are negative,and if contamination of the blood culture is likely.

Datatype

boolean

Alias
UMLS CUI 2011AA
C0200949, C0038160
SNOMED CT 2011_0131
30088009, 56038003
MedDRA 14.1
10005485, 10041925
ICD-10-CM Version 2010
A49.0
ICD-9-CM Version 2011
90.52
Continued empiric use for presumed infections in patients whose cultures are negative for beta-lactam-resistant gram-positive microorganisms.
Beschrijving

Continued empiric use for presumed infections in patients whose cultures are negative for beta-lactam-resistant gram-positive microorganisms.

Datatype

boolean

Systemic or local prophylaxis for infection or colonization of indwelling central or peripheral intravascular catheters.
Beschrijving

Systemic or local prophylaxis for infection or colonization of indwelling central or peripheral intravascular catheters.

Datatype

boolean

Alias
UMLS CUI 2011AA
C0199176, C1145640, C0179768
SNOMED CT 2011_0131
360271000, 52124006, 82449006
MedDRA 14.1
10036898
Selective decontamination of the digestive tract.
Beschrijving

Selective decontamination of the digestive tract.

Datatype

boolean

Eradication of MRSA colonization (mupiracin should be applied topically).
Beschrijving

Eradication of MRSA colonization (mupiracin should be applied topically).

Datatype

boolean

Alias
UMLS CUI 2011AA
C0343401
SNOMED CT 2011_0131
266096002
MedDRA 14.1
10021839
ICD-9-CM Version 2011
041.12
Primary treatment of antibiotic-associated colitis.
Beschrijving

Primary treatment of antibiotic-associated colitis.

Datatype

boolean

Alias
UMLS CUI 2011AA
C0085819
SNOMED CT 2011_0131
397696004
MedDRA 14.1
10052815
Routine prophylaxis for very low-birth weight infants.
Beschrijving

Routine prophylaxis for very low-birth weight infants.

Datatype

boolean

Routine prophylaxis for patients on continuous ambulatory peritoneal dialysis or hemodialysis.
Beschrijving

Routine prophylaxis for patients on continuous ambulatory peritoneal dialysis or hemodialysis.

Datatype

boolean

Alias
UMLS CUI 2011AA
C0019004, C0031139
SNOMED CT 2011_0131
302497006, 71192002
MedDRA 14.1
10018875, 10034660
ICD-10-CM Version 2010
E71.43
ICD-9-CM Version 2011
39.95, 54.98
Treatment chosen for dosing convenience of infections due to beta-lactam sensitive gram-positive microorganisms in patients with renal failure.
Beschrijving

Treatment chosen for dosing convenience of infections due to beta-lactam sensitive gram-positive microorganisms in patients with renal failure.

Datatype

boolean

Alias
UMLS CUI 2011AA
C1565489
MedDRA 14.1
10038474
Use of vancomycin solution for topical application or irrigation.
Beschrijving

Use of vancomycin solution for topical application or irrigation.

Datatype

boolean

Alias
UMLS CUI 2011AA
C0042313, C0150349
SNOMED CT 2011_0131
42082003, 386439008
LOINC Version 232
MTHU004271
Other
Beschrijving

Other

vollständig parenterale Ernährung
Beschrijving

TPN

Datatype

string

Alias
UMLS CUI 2011AA
C0030548
SNOMED CT 2011_0131
225372007
MedDRA 14.1
10044107
LOINC Version 232
MTHU014331
ICD-9-CM Version 2011
99.15
Home medications reviewed and printout sent to floor.
Beschrijving

PHARMACY SCREENING

Datatype

string

NURSERY MEDICATION ORDERS PLACED
Beschrijving

NURSERY MEDICATION ORDERS PLACED

Datatype

string

PHYTONADIONE NEONATAL INJ 1MG/0.5ML IM ONCE (Comments: Administer Vit K in the anterior thigh)
Beschrijving

Intramuscular vitamin K prophylaxis given in hospital

Datatype

boolean

Alias
UMLS CUI 2011AA
C1533032
ERYTHROMYCIN OINT, OPHTHALMIC ONCE (Apply to both eyes within 1 hour of birth in L&D)
Beschrijving

ERYTHROMYCIN OINT, OPHTHALMIC ONCE

Datatype

boolean

Alias
UMLS CUI 2011AA
C0014806
SNOMED CT 2011_0131
30427009
LOINC Version 232
MTHU003043
TRIPLE DYE PIN POINT APPLICATOR, TOPICAL ONCE (Apply to cord after first bath)
Beschrijving

TRIPLE DYE PIN POINT APPLICATOR, TOPICAL ONCE

Datatype

boolean

HEPATITIS B VACCINE PEDI INJ 5MCG/0.5ML IM ONCE (Give after consent is signed)
Beschrijving

HEPATITIS B VACCINE PEDI INJ 5MCG/0.5ML IM ONCE

Datatype

boolean

Alias
UMLS CUI 2011AA
C0019163, C0020971
SNOMED CT 2011_0131
66071002, 127785005
MedDRA 14.1
10019731, 10021431
A&D (VITAMIN A/VITAMIN D) OINT, TOP 60GM APPLY THIN LAYER PRN (May be used on perineum as needed)
Beschrijving

A&D (VITAMIN A/VITAMIN D) OINT, TOP 60GM APPLY THIN LAYER PRN

Datatype

boolean

Alias
UMLS CUI 2011AA
C0042839, C0042866
SNOMED CT 2011_0131
82622003, 30178006
LOINC Version 232
MTHU005041
OTHER
Beschrijving

OTHER

Datatype

string

Terug naar het begin van de pagina

Similar models

HIS

1 Formulieren
  1. StudyEvent: HIS
    1. HIS
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Immunization ordered and available on Unit per protocol
Item
Immunization ordered and available on Unit per protocol
boolean
Influenza vaccine to be administered
Item
Grippeimpfung
boolean
C0042200 (UMLS CUI 2011AA)
86198006 (SNOMED CT 2011_0131)
10059429 (MedDRA 14.1)
99.52 (ICD-9-CM Version 2011)
Pneumococcal vaccine to be administered
Item
Pneumokokkenimpfung
boolean
C0419707 (UMLS CUI 2011AA)
12866006 (SNOMED CT 2011_0131)
Item Group
patient age
Item
Alter
integer
C0001779 (UMLS CUI 2011AA)
397669002 (SNOMED CT 2011_0131)
Item
Geschlecht
text
263495000 (SNOMED CT 2011_0131)
MTHU002975 (LOINC Version 232)
C0079399 (UMLS CUI-1)
Gender
Code List
Geschlecht
CL Item
 (M)
CL Item
 (F)
Height
Item
Größe
float
MTHU005354 (LOINC Version 232)
C0005890 (UMLS CUI-1)
Weight
Item
Gewicht
float
107647005 (SNOMED CT 2011_0131)
10047890 (MedDRA 14.1)
LP18015-5 (LOINC Version 232)
C0005910 (UMLS CUI-1)
current serum creatinine
Item
Kreatinin im Serum
float
C0201976 (UMLS CUI 2011AA)
113075003 (SNOMED CT 2011_0131)
10040230 (MedDRA 14.1)
current BUN
Item
Blut Harnstoff-Stickstoff
float
C0005845 (UMLS CUI 2011AA)
250623007 (SNOMED CT 2011_0131)
10005845 (MedDRA 14.1)
AMINOGLYCOSIDE EXCLUSIONS
Item
AMINOGLYCOSIDE EXCLUSIONS (14years and younger, burns over greater than 20% Body surface area (BSA), Endocarditis, CrCl <= 40ml/hr, Pregnancy, Cystic Fibrosis, Severe liver disease or ascites)
integer
C0005902, C0014118, C0373595, C0549206, C0010674, C0860197 (UMLS CUI 2011AA)
128178001, 56819008, 167181009, 190905008 (SNOMED CT 2011_0131)
10050311, 10014665, 10011371, 10036586, 10011762, 10001422 (MedDRA 14.1)
Item Group
patient age
Item
Alter
integer
C0001779 (UMLS CUI 2011AA)
397669002 (SNOMED CT 2011_0131)
patient gender
Item
Geschlecht
integer
C0079399 (UMLS CUI 2011AA)
263495000 (SNOMED CT 2011_0131)
MTHU002975 (LOINC Version 232)
Height
Item
Größe
float
MTHU005354 (LOINC Version 232)
C0005890 (UMLS CUI-1)
Weight
Item
Gewicht
float
107647005 (SNOMED CT 2011_0131)
10047890 (MedDRA 14.1)
LP18015-5 (LOINC Version 232)
C0005910 (UMLS CUI-1)
current serum creatinine
Item
Kreatinin im Serum
float
C0201976 (UMLS CUI 2011AA)
113075003 (SNOMED CT 2011_0131)
10040230 (MedDRA 14.1)
current BUN
Item
Blut Harnstoff-Stickstoff
float
C0005845 (UMLS CUI 2011AA)
250623007 (SNOMED CT 2011_0131)
10005845 (MedDRA 14.1)
AMINOGLYCOSIDE EXCLUSIONS
Item
AMINOGLYCOSIDE EXCLUSIONS (14years and younger, burns over greater than 20% BSA, Endocarditis, CrCl <= 40ml/hr, Pregnancy, Cystic Fibrosis, Severe liver disease or ascites)
integer
C0005902, C0014118, C0373595, C0549206, C0010674, C0860197 (UMLS CUI 2011AA)
128178001, 56819008, 167181009, 190905008 (SNOMED CT 2011_0131)
10050311, 10014665, 10011371, 10036586, 10011762, 10001422 (MedDRA 14.1)
Item Group
VANCOMYCIN ORDER APPROVED
Item
VANCOMYCIN ORDER APPROVED (GUIDELINES FOR RECULTURE: VANCOMYCIN AFTER 7 DAYS MUST BE REEVALUATED AND IV THERAPY DISCONTINUED, IF INDICATED. RECULTURE IF NECESSARY 72 HOURS AFTER ANTIBIOTIC IS STOPPED)
boolean
C0042313 (UMLS CUI 2011AA)
42082003 (SNOMED CT 2011_0131)
MTHU004271 (LOINC Version 232)
UNAPPROVED VANCO ORDER, VANCOMYCIN IS NOT APPROVED FOR THE FOLLOWING USE:
Item
UNAPPROVED VANCO ORDER, VANCOMYCIN IS NOT APPROVED FOR THE FOLLOWING USE:
string
Routine surgical prophylaxis other than in a patient who has a life-threatening condition
Item
Routine surgical prophylaxis other than in a patient who has a life-threatening condition
boolean
C0199176, C2711184 (UMLS CUI 2011AA)
360271000, 442452003 (SNOMED CT 2011_0131)
10036898 (MedDRA 14.1)
Treatment in response to a single blood culture positive for coagulase-negative staphylococcus, if other blood cultures drawn in the same time frame are negative,and if contamination of the blood culture is likely.
Item
Treatment in response to a single blood culture positive for coagulase-negative staphylococcus, if other blood cultures drawn in the same time frame are negative,and if contamination of the blood culture is likely.
boolean
C0200949, C0038160 (UMLS CUI 2011AA)
30088009, 56038003 (SNOMED CT 2011_0131)
10005485, 10041925 (MedDRA 14.1)
A49.0 (ICD-10-CM Version 2010)
90.52 (ICD-9-CM Version 2011)
Continued empiric use for presumed infections in patients whose cultures are negative for beta-lactam-resistant gram-positive microorganisms.
Item
Continued empiric use for presumed infections in patients whose cultures are negative for beta-lactam-resistant gram-positive microorganisms.
boolean
Systemic or local prophylaxis for infection or colonization of indwelling central or peripheral intravascular catheters.
Item
Systemic or local prophylaxis for infection or colonization of indwelling central or peripheral intravascular catheters.
boolean
C0199176, C1145640, C0179768 (UMLS CUI 2011AA)
360271000, 52124006, 82449006 (SNOMED CT 2011_0131)
10036898 (MedDRA 14.1)
Selective decontamination of the digestive tract.
Item
Selective decontamination of the digestive tract.
boolean
Eradication of MRSA colonization (mupiracin should be applied topically).
Item
Eradication of MRSA colonization (mupiracin should be applied topically).
boolean
C0343401 (UMLS CUI 2011AA)
266096002 (SNOMED CT 2011_0131)
10021839 (MedDRA 14.1)
041.12 (ICD-9-CM Version 2011)
Primary treatment of antibiotic-associated colitis.
Item
Primary treatment of antibiotic-associated colitis.
boolean
C0085819 (UMLS CUI 2011AA)
397696004 (SNOMED CT 2011_0131)
10052815 (MedDRA 14.1)
Routine prophylaxis for very low-birth weight infants.
Item
Routine prophylaxis for very low-birth weight infants.
boolean
Routine prophylaxis for patients on continuous ambulatory peritoneal dialysis or hemodialysis.
Item
Routine prophylaxis for patients on continuous ambulatory peritoneal dialysis or hemodialysis.
boolean
C0019004, C0031139 (UMLS CUI 2011AA)
302497006, 71192002 (SNOMED CT 2011_0131)
10018875, 10034660 (MedDRA 14.1)
E71.43 (ICD-10-CM Version 2010)
39.95, 54.98 (ICD-9-CM Version 2011)
Treatment chosen for dosing convenience of infections due to beta-lactam sensitive gram-positive microorganisms in patients with renal failure.
Item
Treatment chosen for dosing convenience of infections due to beta-lactam sensitive gram-positive microorganisms in patients with renal failure.
boolean
C1565489 (UMLS CUI 2011AA)
10038474 (MedDRA 14.1)
Use of vancomycin solution for topical application or irrigation.
Item
Use of vancomycin solution for topical application or irrigation.
boolean
C0042313, C0150349 (UMLS CUI 2011AA)
42082003, 386439008 (SNOMED CT 2011_0131)
MTHU004271 (LOINC Version 232)
Item Group
TPN
Item
vollständig parenterale Ernährung
string
C0030548 (UMLS CUI 2011AA)
225372007 (SNOMED CT 2011_0131)
10044107 (MedDRA 14.1)
MTHU014331 (LOINC Version 232)
99.15 (ICD-9-CM Version 2011)
PHARMACY SCREENING
Item
Home medications reviewed and printout sent to floor.
string
NURSERY MEDICATION ORDERS PLACED
Item
NURSERY MEDICATION ORDERS PLACED
string
Intramuscular vitamin K prophylaxis given in hospital
Item
PHYTONADIONE NEONATAL INJ 1MG/0.5ML IM ONCE (Comments: Administer Vit K in the anterior thigh)
boolean
C1533032 (UMLS CUI 2011AA)
ERYTHROMYCIN OINT, OPHTHALMIC ONCE
Item
ERYTHROMYCIN OINT, OPHTHALMIC ONCE (Apply to both eyes within 1 hour of birth in L&D)
boolean
C0014806 (UMLS CUI 2011AA)
30427009 (SNOMED CT 2011_0131)
MTHU003043 (LOINC Version 232)
TRIPLE DYE PIN POINT APPLICATOR, TOPICAL ONCE
Item
TRIPLE DYE PIN POINT APPLICATOR, TOPICAL ONCE (Apply to cord after first bath)
boolean
HEPATITIS B VACCINE PEDI INJ 5MCG/0.5ML IM ONCE
Item
HEPATITIS B VACCINE PEDI INJ 5MCG/0.5ML IM ONCE (Give after consent is signed)
boolean
C0019163, C0020971 (UMLS CUI 2011AA)
66071002, 127785005 (SNOMED CT 2011_0131)
10019731, 10021431 (MedDRA 14.1)
A&D (VITAMIN A/VITAMIN D) OINT, TOP 60GM APPLY THIN LAYER PRN
Item
A&D (VITAMIN A/VITAMIN D) OINT, TOP 60GM APPLY THIN LAYER PRN (May be used on perineum as needed)
boolean
C0042839, C0042866 (UMLS CUI 2011AA)
82622003, 30178006 (SNOMED CT 2011_0131)
MTHU005041 (LOINC Version 232)
OTHER
Item
OTHER
string
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial