ID

11767

Description

ODM form derived from Humangenetik Senologie UKM. Used as a routine documentation by the University Hospital Muenster, Germany.

Mots-clés

Versions (1)
  1. 30/07/2015 30/07/2015 -
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30 juillet 2015

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy
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Checklist for genetic disposition breast cancer and/or Ovarian cancer

Allemand ( localization.languageCode.DE ) Anglais

Checklist for genetic disposition breast cancer and/or Ovarian cancer

1 Formulaires  
Patient demographics
Description

Patient demographics

Date of birth
Description

Date of birth

Type de données

date

Case #
Description

Case #

Type de données

integer

Gender
Description

Gender

Type de données

text

Alias
UMLS CUI-1
C0079399
Stationary admission
Description

Stationary admission

Type de données

text

Registration date
Description

Registration date

Type de données

date

Registered by
Description

Registered by

Type de données

text

A. Patient and her siblings / children
Description

A. Patient and her siblings / children

Breast cancer prior to the age of 36
Description

Breast cancer prior to the age of 36

Type de données

integer

Alias
UMLS CUI-1
C0678222
Unilateral breast canster prior to the age of 51
Description

Unilateral breast canster prior to the age of 51

Type de données

integer

Bilateral breast canster prior to the age of 51
Description

Bilateral breast canster prior to the age of 51

Type de données

integer

Alias
UMLS CUI-1
C0238767
UMLS CUI-2
C0007104
Unilateral or Bilateral breast canster after the age of 50
Description

Unilateral or Bilateral breast canster after the age of 50

Type de données

integer

Alias
UMLS CUI-1
C0238767
UMLS CUI-2
C0007104
Ovarian cancer or a primary peritonitis carcinomatosa
Description

Ovarian cancer or a primary peritonitis carcinomatosa

Type de données

integer

Alias
UMLS CUI-1
C1611183
UMLS CUI-2
C0029925
Sister/daughter has breast cancer prior to the age of 36
Description

Sister/daughter has breast cancer prior to the age of 36

Type de données

integer

Sisiter/ daughter has unilateral breast canster prior to the age of 51
Description

Sisiter/ daughter has unilateral breast canster prior to the age of 51

Type de données

integer

Sister/ daughter has bilateral breast canster prior to the age of 51
Description

Sister/ daughter has bilateral breast canster prior to the age of 51

Type de données

integer

Sister/ daughter has unilateral or blateral breast canster after the age of 50
Description

Sister/ daughter has unilateral or blateral breast canster after the age of 50

Type de données

integer

Brother/ son has breast cancer
Description

Brother/ son has breast cancer

Type de données

integer

Sister/ daughter has ovarian cancer or a primary peritonitis carcinomatosa
Description

Sister/ daughter has ovarian cancer or a primary peritonitis carcinomatosa

Type de données

integer

Total
Description

Total

Type de données

integer

B. Matrilineality
Description

B. Matrilineality

Relatuve has breast cancer prior to the age of 36
Description

Relatuve has breast cancer prior to the age of 36

Type de données

integer

Relative has unilateral breast canster prior to the age of 51
Description

Relative has unilateral breast canster prior to the age of 51

Type de données

integer

Relative has bilateral breast canster prior to the age of 51
Description

Relative has bilateral breast canster prior to the age of 51

Type de données

integer

Relative has unilateral or blateral breast canster after the age of 50
Description

Relative has unilateral or blateral breast canster after the age of 50

Type de données

integer

Male relative has breast cancer
Description

Male relative has breast cancer

Type de données

integer

Relative has ovarian cancer or a primary peritonitis carcinomatosa
Description

Relative has ovarian cancer or a primary peritonitis carcinomatosa

Type de données

integer

Total
Description

Total

Type de données

integer

Patrilineality
Description

Patrilineality

Relative has breast cancer prior to the age of 36
Description

Relative has breast cancer prior to the age of 36

Type de données

integer

Relative has unilateral breast canster prior to the age of 51
Description

Relative has unilateral breast canster prior to the age of 51

Type de données

integer

Relative has bilateral breast canster prior to the age of 51
Description

Relative has bilateral breast canster prior to the age of 51

Type de données

integer

Relative has unilateral or blateral breast canster after the age of 50
Description

Relative has unilateral or blateral breast canster after the age of 50

Type de données

integer

Male relative has breast cancer
Description

Male relative has breast cancer

Type de données

integer

Relative has ovarian cancer or a primary peritonitis carcinomatosa
Description

Relative has ovarian cancer or a primary peritonitis carcinomatosa

Type de données

integer

Total
Description

Total

Type de données

integer

D. Higher score B. matrilineality or C. patrilineality
Description

D. Higher score B. matrilineality or C. patrilineality

E. Total A+D
Description

E. Total A+D

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Similar models

Checklist for genetic disposition breast cancer and/or Ovarian cancer

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Patient demographics
Date of birth
Item
Date of birth
date
Case #
Item
Case #
integer
Gender
Item
Gender
text
C0079399 (UMLS CUI-1)
Stationary admission
Item
Stationary admission
text
Registration date
Item
Registration date
date
Registered by
Item
Registered by
text
Item Group
A. Patient and her siblings / children
Item
Breast cancer prior to the age of 36
integer
C0678222 (UMLS CUI-1)
Breast cancer
Code List
Breast cancer prior to the age of 36
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Unilateral breast canster prior to the age of 51
integer
Breast cancer
Code List
Unilateral breast canster prior to the age of 51
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Bilateral breast canster prior to the age of 51
integer
C0238767 (UMLS CUI-1)
C0007104 (UMLS CUI-2)
Breast cancer
Code List
Bilateral breast canster prior to the age of 51
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Unilateral or Bilateral breast canster after the age of 50
integer
C0238767 (UMLS CUI-1)
C0007104 (UMLS CUI-2)
Breast cancer
Code List
Unilateral or Bilateral breast canster after the age of 50
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Ovarian cancer or a primary peritonitis carcinomatosa
integer
C1611183 (UMLS CUI-1)
C0029925 (UMLS CUI-2)
Breast cancer
Code List
Ovarian cancer or a primary peritonitis carcinomatosa
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Sister/daughter has breast cancer prior to the age of 36
integer
Breast cancer
Code List
Sister/daughter has breast cancer prior to the age of 36
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Sisiter/ daughter has unilateral breast canster prior to the age of 51
integer
Breast cancer
Code List
Sisiter/ daughter has unilateral breast canster prior to the age of 51
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Sister/ daughter has bilateral breast canster prior to the age of 51
integer
Breast cancer
Code List
Sister/ daughter has bilateral breast canster prior to the age of 51
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Sister/ daughter has unilateral or blateral breast canster after the age of 50
integer
Breast cancer
Code List
Sister/ daughter has unilateral or blateral breast canster after the age of 50
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Brother/ son has breast cancer
integer
Breast cancer
Code List
Brother/ son has breast cancer
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Sister/ daughter has ovarian cancer or a primary peritonitis carcinomatosa
integer
Breast cancer
Code List
Sister/ daughter has ovarian cancer or a primary peritonitis carcinomatosa
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Total
Item
Total
integer
Item Group
B. Matrilineality
Item
Relatuve has breast cancer prior to the age of 36
integer
Breast cancer
Code List
Relatuve has breast cancer prior to the age of 36
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Relative has unilateral breast canster prior to the age of 51
integer
Breast cancer
Code List
Relative has unilateral breast canster prior to the age of 51
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Relative has bilateral breast canster prior to the age of 51
integer
Breast cancer
Code List
Relative has bilateral breast canster prior to the age of 51
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Relative has unilateral or blateral breast canster after the age of 50
integer
Breast cancer
Code List
Relative has unilateral or blateral breast canster after the age of 50
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Male relative has breast cancer
integer
Breast cancer
Code List
Male relative has breast cancer
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Relative has ovarian cancer or a primary peritonitis carcinomatosa
integer
Breast cancer
Code List
Relative has ovarian cancer or a primary peritonitis carcinomatosa
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Total
Item
Total
integer
Item Group
Patrilineality
Item
Relative has breast cancer prior to the age of 36
integer
Breast cancer
Code List
Relative has breast cancer prior to the age of 36
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Relative has unilateral breast canster prior to the age of 51
integer
Breast cancer
Code List
Relative has unilateral breast canster prior to the age of 51
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Relative has bilateral breast canster prior to the age of 51
integer
Breast cancer
Code List
Relative has bilateral breast canster prior to the age of 51
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Relative has unilateral or blateral breast canster after the age of 50
integer
Breast cancer
Code List
Relative has unilateral or blateral breast canster after the age of 50
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Male relative has breast cancer
integer
Breast cancer
Code List
Male relative has breast cancer
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Item
Relative has ovarian cancer or a primary peritonitis carcinomatosa
integer
Breast cancer
Code List
Relative has ovarian cancer or a primary peritonitis carcinomatosa
CL Item
Amount (1)
CL Item
Weighting  (2)
CL Item
Result (3)
Total
Item
Total
integer
Item Group
D. Higher score B. matrilineality or C. patrilineality
Item Group
E. Total A+D
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