ID

11767

Beskrivning

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

Nyckelord

Versioner (1)
  1. 2015-07-30 2015-07-30 -
Uppladdad den

30 juli 2015

DOI

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

Tysk ( localization.languageCode.DE ) Engelsk

Checklist for genetic disposition breast cancer and/or Ovarian cancer

1 Formulär  
Patient demographics
Beskrivning

Patient demographics

Date of birth
Beskrivning

Date of birth

Datatyp

date

Case #
Beskrivning

Case #

Datatyp

integer

Gender
Beskrivning

Gender

Datatyp

text

Alias
UMLS CUI-1
C0079399
Stationary admission
Beskrivning

Stationary admission

Datatyp

text

Registration date
Beskrivning

Registration date

Datatyp

date

Registered by
Beskrivning

Registered by

Datatyp

text

A. Patient and her siblings / children
Beskrivning

A. Patient and her siblings / children

Breast cancer prior to the age of 36
Beskrivning

Breast cancer prior to the age of 36

Datatyp

integer

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

Unilateral breast canster prior to the age of 51

Datatyp

integer

Bilateral breast canster prior to the age of 51
Beskrivning

Bilateral breast canster prior to the age of 51

Datatyp

integer

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

Unilateral or Bilateral breast canster after the age of 50

Datatyp

integer

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

Ovarian cancer or a primary peritonitis carcinomatosa

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

Brother/ son has breast cancer
Beskrivning

Brother/ son has breast cancer

Datatyp

integer

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

Sister/ daughter has ovarian cancer or a primary peritonitis carcinomatosa

Datatyp

integer

Total
Beskrivning

Total

Datatyp

integer

B. Matrilineality
Beskrivning

B. Matrilineality

Relatuve has breast cancer prior to the age of 36
Beskrivning

Relatuve has breast cancer prior to the age of 36

Datatyp

integer

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

Relative has unilateral breast canster prior to the age of 51

Datatyp

integer

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

Relative has bilateral breast canster prior to the age of 51

Datatyp

integer

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

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

Datatyp

integer

Male relative has breast cancer
Beskrivning

Male relative has breast cancer

Datatyp

integer

Relative has ovarian cancer or a primary peritonitis carcinomatosa
Beskrivning

Relative has ovarian cancer or a primary peritonitis carcinomatosa

Datatyp

integer

Total
Beskrivning

Total

Datatyp

integer

Patrilineality
Beskrivning

Patrilineality

Relative has breast cancer prior to the age of 36
Beskrivning

Relative has breast cancer prior to the age of 36

Datatyp

integer

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

Relative has unilateral breast canster prior to the age of 51

Datatyp

integer

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

Relative has bilateral breast canster prior to the age of 51

Datatyp

integer

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

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

Datatyp

integer

Male relative has breast cancer
Beskrivning

Male relative has breast cancer

Datatyp

integer

Relative has ovarian cancer or a primary peritonitis carcinomatosa
Beskrivning

Relative has ovarian cancer or a primary peritonitis carcinomatosa

Datatyp

integer

Total
Beskrivning

Total

Datatyp

integer

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

D. Higher score B. matrilineality or C. patrilineality

E. Total A+D
Beskrivning

E. Total A+D

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Similar models

Checklist for genetic disposition breast cancer and/or Ovarian cancer

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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