Informatie:
Fout:
ID
11672
Beschrijving
ODM form derived from [DAST Aufnahme PSYCH UKM]. Used as a routine documentation by the University Hospital Muenster, Germany.
Trefwoorden
Versies (6)
- 20-07-15 20-07-15 -
- 20-07-15 20-07-15 -
- 21-07-15 21-07-15 -
- 21-07-15 21-07-15 -
- 26-07-15 26-07-15 -
- 26-07-15 26-07-15 -
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26 juli 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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DAST - Basic documentation - Patient Admission Form
DAST - Basic documentation - Patient Admission Form
- StudyEvent: ODM
Similar models
DAST - Basic documentation - Patient Admission Form
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
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)
CL Item
male (1)
CL Item
female (2)
Patient age
Item
Patient age
integer
Marital status
Item
Marital status
text
C0024819 (UMLS CUI-1)
How many children do you have?
Item
How many children do you have?
integer
C2229974 (UMLS CUI-1)
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)
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)
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)
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)
C0026591 (UMLS CUI-2)
Where was your father born?
Item
Where was your father born?
text
C1300001 (UMLS CUI-1)
C0015671 (UMLS CUI-2)
C0015671 (UMLS CUI-2)
What is your highest achieved level of education?
Item
What is your highest achieved level of education?
text
C2030935 (UMLS CUI-1)
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)
C2030935 (UMLS CUI-2)
What is your current employment situation?
Item
What is your current employment situation?
text
C3261398 (UMLS CUI-1)
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)
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
Treatment received in the last 8 weeks prior to current admission
integer
C1514463 (UMLS CUI-1)
Code List
Treatment received in the last 8 weeks prior to current admission
CL Item
None (1)
CL Item
Antidepressive Agents (generic name, mg/d, Duration) (2)
CL Item
Electroconvulsive therapy: Number of single stimulations (3)
CL Item
Sleep deprivation (4)
CL Item
Phototherapy (5)
CL Item
Psychotherapy: individual therapy (6)
CL Item
Psychotherapy: group therapy (7)
CL Item
Other: (8)
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
Patient height
Item
Patient height
integer
C0489786 (UMLS CUI-1)
Patient weight
Item
Patient weight
integer
C0005910 (UMLS CUI-1)
Corrected QT Interval (QTc)
Item
Corrected QT Interval (QTc)
integer
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)
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)
C0871167 (UMLS CUI-2)
Item Group
Clinical Global Impression (Degrees of severity)
CL Item
cannot be assessed (0)
CL Item
normal, not at all ill (1)
CL Item
borderline mentally ill (2)
CL Item
mildly ill (3)
CL Item
moderately ill (4)
CL Item
markedly ill (5)
CL Item
severely ill (6)
CL Item
extremely ill (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)
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
CL Item
available (1)
CL Item
patient too sick (2)
CL Item
refused (3)
CL Item
other (4)
CL Item
not specified (5)
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)
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