ID

11767

Descripción

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

Palabras clave

Versiones (1)
  1. 30/7/15 30/7/15 -
Subido en

30 de julio de 2015

DOI

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Licencia

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

Alemán ( localization.languageCode.DE ) Inglés

Checklist for genetic disposition breast cancer and/or Ovarian cancer

1 formularios  
Patient demographics
Descripción

Patient demographics

Date of birth
Descripción

Date of birth

Tipo de datos

date

Case #
Descripción

Case #

Tipo de datos

integer

Gender
Descripción

Gender

Tipo de datos

text

Alias
UMLS CUI-1
C0079399
Stationary admission
Descripción

Stationary admission

Tipo de datos

text

Registration date
Descripción

Registration date

Tipo de datos

date

Registered by
Descripción

Registered by

Tipo de datos

text

A. Patient and her siblings / children
Descripción

A. Patient and her siblings / children

Breast cancer prior to the age of 36
Descripción

Breast cancer prior to the age of 36

Tipo de datos

integer

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

Unilateral breast canster prior to the age of 51

Tipo de datos

integer

Bilateral breast canster prior to the age of 51
Descripción

Bilateral breast canster prior to the age of 51

Tipo de datos

integer

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

Unilateral or Bilateral breast canster after the age of 50

Tipo de datos

integer

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

Ovarian cancer or a primary peritonitis carcinomatosa

Tipo de datos

integer

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

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

Tipo de datos

integer

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

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

Tipo de datos

integer

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

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

Tipo de datos

integer

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

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

Tipo de datos

integer

Brother/ son has breast cancer
Descripción

Brother/ son has breast cancer

Tipo de datos

integer

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

Sister/ daughter has ovarian cancer or a primary peritonitis carcinomatosa

Tipo de datos

integer

Total
Descripción

Total

Tipo de datos

integer

B. Matrilineality
Descripción

B. Matrilineality

Relatuve has breast cancer prior to the age of 36
Descripción

Relatuve has breast cancer prior to the age of 36

Tipo de datos

integer

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

Relative has unilateral breast canster prior to the age of 51

Tipo de datos

integer

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

Relative has bilateral breast canster prior to the age of 51

Tipo de datos

integer

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

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

Tipo de datos

integer

Male relative has breast cancer
Descripción

Male relative has breast cancer

Tipo de datos

integer

Relative has ovarian cancer or a primary peritonitis carcinomatosa
Descripción

Relative has ovarian cancer or a primary peritonitis carcinomatosa

Tipo de datos

integer

Total
Descripción

Total

Tipo de datos

integer

Patrilineality
Descripción

Patrilineality

Relative has breast cancer prior to the age of 36
Descripción

Relative has breast cancer prior to the age of 36

Tipo de datos

integer

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

Relative has unilateral breast canster prior to the age of 51

Tipo de datos

integer

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

Relative has bilateral breast canster prior to the age of 51

Tipo de datos

integer

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

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

Tipo de datos

integer

Male relative has breast cancer
Descripción

Male relative has breast cancer

Tipo de datos

integer

Relative has ovarian cancer or a primary peritonitis carcinomatosa
Descripción

Relative has ovarian cancer or a primary peritonitis carcinomatosa

Tipo de datos

integer

Total
Descripción

Total

Tipo de datos

integer

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

D. Higher score B. matrilineality or C. patrilineality

E. Total A+D
Descripción

E. Total A+D

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Similar models

Checklist for genetic disposition breast cancer and/or Ovarian cancer

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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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