ID

11767

Beschreibung

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

Stichworte

Versionen (1)
  1. 30.07.15 30.07.15 -
Hochgeladen am

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

Deutsch ( localization.languageCode.DE ) Englisch

Checklist for genetic disposition breast cancer and/or Ovarian cancer

1 Formulare  
Patient demographics
Beschreibung

Patient demographics

Date of birth
Beschreibung

Date of birth

Datentyp

date

Case #
Beschreibung

Case #

Datentyp

integer

Gender
Beschreibung

Gender

Datentyp

text

Alias
UMLS CUI-1
C0079399
Stationary admission
Beschreibung

Stationary admission

Datentyp

text

Registration date
Beschreibung

Registration date

Datentyp

date

Registered by
Beschreibung

Registered by

Datentyp

text

A. Patient and her siblings / children
Beschreibung

A. Patient and her siblings / children

Breast cancer prior to the age of 36
Beschreibung

Breast cancer prior to the age of 36

Datentyp

integer

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

Unilateral breast canster prior to the age of 51

Datentyp

integer

Bilateral breast canster prior to the age of 51
Beschreibung

Bilateral breast canster prior to the age of 51

Datentyp

integer

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

Unilateral or Bilateral breast canster after the age of 50

Datentyp

integer

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

Ovarian cancer or a primary peritonitis carcinomatosa

Datentyp

integer

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

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

Datentyp

integer

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

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

Datentyp

integer

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

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

Datentyp

integer

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

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

Datentyp

integer

Brother/ son has breast cancer
Beschreibung

Brother/ son has breast cancer

Datentyp

integer

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

Sister/ daughter has ovarian cancer or a primary peritonitis carcinomatosa

Datentyp

integer

Total
Beschreibung

Total

Datentyp

integer

B. Matrilineality
Beschreibung

B. Matrilineality

Relatuve has breast cancer prior to the age of 36
Beschreibung

Relatuve has breast cancer prior to the age of 36

Datentyp

integer

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

Relative has unilateral breast canster prior to the age of 51

Datentyp

integer

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

Relative has bilateral breast canster prior to the age of 51

Datentyp

integer

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

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

Datentyp

integer

Male relative has breast cancer
Beschreibung

Male relative has breast cancer

Datentyp

integer

Relative has ovarian cancer or a primary peritonitis carcinomatosa
Beschreibung

Relative has ovarian cancer or a primary peritonitis carcinomatosa

Datentyp

integer

Total
Beschreibung

Total

Datentyp

integer

Patrilineality
Beschreibung

Patrilineality

Relative has breast cancer prior to the age of 36
Beschreibung

Relative has breast cancer prior to the age of 36

Datentyp

integer

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

Relative has unilateral breast canster prior to the age of 51

Datentyp

integer

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

Relative has bilateral breast canster prior to the age of 51

Datentyp

integer

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

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

Datentyp

integer

Male relative has breast cancer
Beschreibung

Male relative has breast cancer

Datentyp

integer

Relative has ovarian cancer or a primary peritonitis carcinomatosa
Beschreibung

Relative has ovarian cancer or a primary peritonitis carcinomatosa

Datentyp

integer

Total
Beschreibung

Total

Datentyp

integer

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

D. Higher score B. matrilineality or C. patrilineality

E. Total A+D
Beschreibung

E. Total A+D

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Ähnliche Modelle

Checklist for genetic disposition breast cancer and/or Ovarian cancer

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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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