ID

11972

Description

Form from HIS OpenVistA

Keywords

Versions (6)
  1. 2/16/12 2/16/12 -
  2. 8/7/14 8/7/14 - Martin Dugas
  3. 8/7/14 8/7/14 - Martin Dugas
  4. 8/8/14 8/8/14 - Martin Dugas
  5. 8/9/14 8/9/14 - Martin Dugas
  6. 8/28/15 8/28/15 - Martin Dugas
Uploaded on

August 28, 2015

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0 Legacy
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

ENDOSCOPY PRE PROCEDURE ID RECORD

German English

HIS

1 forms  
  1. StudyEvent: HIS
    1. HIS
General Info
Description

General Info

Alias
UMLS CUI-1
C1508263
TODAY'S DATE & TIME OF ARRIVAL
Description

Arrival date and time

Data type

date

Alias
UMLS CUI [1]
C2215405
Hypersensitivity
Description

ALLERGIES

Data type

string

Alias
UMLS CUI 2011AA
C0020517
SNOMED CT 2011_0131
257550005
ICD-10-CM Version 2010
T78.40
Medication
Description

CURRENT MEDICATIONS

Data type

string

Alias
UMLS CUI 2011AA
C0013227
PATIENT STATUS
Description

PATIENT STATUS

Data type

text

Alias
UMLS CUI [1]
C0449437
HOW ARRIVED
Description

HOW ARRIVED

Data type

text

ACCOMPANIED BY
Description

ACCOMPANIED BY

Data type

text

CONDITION UPON ARRIVAL (stable, unstable)
Description

CONDITION UPON ARRIVAL

Data type

integer

Alias
UMLS CUI [1]
C0348080
LEVEL OF CONSCIOUSNESS
Description

LEVEL OF CONSCIOUSNESS

Data type

integer

Alias
SNOMED CT 2011_0131
106167005
UMLS CUI [1]
C0234425
CONSENT SIGNED BY
Description

CONSENT SIGNED BY

Data type

text

PATIENT ID BAND ON WITH CORRECT NAME, DOB AND PHYSICIAN
Description

PATIENT ID BAND ON WITH CORRECT NAME, DOB AND PHYSICIAN

Data type

boolean

NOTES Patient ID
Description

NOTES Patient ID

Data type

text

Treating Physician
Description

PHYSICIAN1

Data type

string

Alias
UMLS CUI 2011AA
C1710470
Treating Physician
Description

PHYSICIAN2

Data type

string

Alias
UMLS CUI 2011AA
C1710470
ASSISTED BY
Description

ASSISTED BY

Data type

text

ANESTHESIA BY
Description

Anesthesist

Data type

text

Alias
UMLS CUI [1]
C1550495
Past medical history
Description

MEDICAL/SURGICAL HISTORY

Data type

string

Alias
UMLS CUI 2011AA
C0262926
SNOMED CT 2011_0131
417662000
LOINC Version 232
MTHU027722
LANGUAGE BARRIER
Description

LANGUAGE BARRIER

Data type

boolean

TRANSLATOR (yes, N/A)
Description

TRANSLATOR

Data type

boolean

NOTES
Description

NOTES

Data type

text

PHYSICAL DISABILITIES
Description

PHYSICAL DISABILITIES

Data type

boolean

Physical handicap
Description

PHYSICAL DISABILITIES (Description)

Data type

string

Alias
UMLS CUI 2011AA
C0520817
SNOMED CT 2011_0131
32572006
MedDRA 14.1
10048624
Dental
Description

DENTAL

Data type

integer

Alias
UMLS CUI [1]
C0226984
Hearing
Description

HEARING

Data type

text

Alias
SNOMED CT 2011_0131
47078008
LOINC Version 232
MTHU015042
UMLS CUI [1]
C0018767
Visual
Description

VISUAL

Data type

integer

Alias
SNOMED CT 2011_0131
281004000
LOINC Version 232
MTHU014733
UMLS CUI [1]
C0042789
NOTES
Description

NOTES

Data type

text

ADMISSION VITAL SIGNS
Description

ADMISSION VITAL SIGNS

Data type

string

Alias
UMLS CUI 2011AA
C0518766
SNOMED CT 2011_0131
46680005
LOINC Version 232
MTHU024540
Oxygen saturation measurement (Pulse Oximetry Value)
Description

Pulse Oximetry

Data type

float

Measurement units
  • %
Alias
SNOMED CT 2011_0131
264598005
MedDRA 14.1
10033316
UMLS CUI [1]
C0034108
%
Body weight
Description

Weight

Data type

float

Measurement units
  • kg
Alias
SNOMED CT 2011_0131
107647005
MedDRA 14.1
10047890
LOINC Version 232
LP18015-5
UMLS CUI [1]
C0005910
kg
Height
Description

Height

Data type

float

Measurement units
  • cm
Alias
LOINC Version 232
MTHU005354
UMLS CUI [1]
C0005890
cm
NPO SINCE
Description

NPO SINCE

Data type

time

Prep (Fleet Enema, Fleet Prep Kit, Golytely, Half-Lightly, MAG Citrate, MOVI Prep, Nulytely, OSMO Prep)
Description

PREP

Data type

integer

PREP COMMENTS
Description

PREP COMMENTS

Data type

text

PRE-OP DIAGNOSIS
Description

PRE-OP DIAGNOSIS

Abnormal GI Xray
Description

Abnormal GI Xray

Data type

boolean

Abdominal Pain
Description

Abdominal Pain

Data type

boolean

Alias
UMLS CUI 2011AA
C0000737
SNOMED CT 2011_0131
21522001
MedDRA 14.1
10000081
LOINC Version 232
MTHU013636
ICD-10-CM Version 2010
R10.9
ICD-9-CM Version 2011
789.0
CTCAE 1105E
E10460
Abnormal weight loss (finding)
Description

Abnormal Weight Loss

Data type

boolean

Alias
UMLS CUI 2011AA
C0936227
SNOMED CT 2011_0131
267024001
MedDRA 14.1
10000159
ICD-10-CM Version 2010
R63.4
Achalasia
Description

Achalasia

Data type

boolean

Alias
UMLS CUI 2011AA
C1321756
SNOMED CT 2011_0131
48531003
MedDRA 14.1
10000420
ICD-10-CM Version 2010
K22.0
Anaemia
Description

Anemia

Data type

boolean

Alias
UMLS CUI 2011AA
C0002871
SNOMED CT 2011_0131
271737000
MedDRA 14.1
10002034
LOINC Version 232
MTHU020823
ICD-10-CM Version 2010
D64.9
ICD-9-CM Version 2011
285.9
CTCAE 1105E
E10010
Ascites
Description

Ascites

Data type

boolean

Alias
UMLS CUI 2011AA
C0003962
SNOMED CT 2011_0131
389026000
MedDRA 14.1
10003445
ICD-10-CM Version 2010
R18
ICD-9-CM Version 2011
789.5
CTCAE 1105E
E10502
Irregular bowel habits
Description

Change in Bowel Habits

Data type

boolean

Alias
UMLS CUI 2011AA
C2919545
SNOMED CT 2011_0131
444702007
Liver Cirrhosis
Description

Hepatic Cirrhosis

Data type

boolean

Alias
UMLS CUI 2011AA
C0023890
SNOMED CT 2011_0131
19943007
MedDRA 14.1
10019641
ICD-10-CM Version 2010
K74.60
Screening for Colorectal Cancer
Description

Colorectal Cancer Screening

Data type

boolean

Alias
UMLS CUI 2011AA
C0281185
Common Bile Duct Leak
Description

Common Bile Duct Leak

Data type

boolean

Common Bile Duct Stone
Description

Common Bile Duct Stone

Data type

boolean

Constipation
Description

Constipation

Data type

boolean

Alias
UMLS CUI 2011AA
C0009806
SNOMED CT 2011_0131
14760008
MedDRA 14.1
10010774
LOINC Version 232
MTHU020768
ICD-10-CM Version 2010
K59.0
ICD-9-CM Version 2011
564.0
CTCAE 1105E
E10562
Diarrhea
Description

Diarrhea

Data type

boolean

Alias
UMLS CUI 2011AA
C0011991
SNOMED CT 2011_0131
62315008
MedDRA 14.1
10012735
LOINC Version 232
MTHU013347
ICD-10-CM Version 2010
R19.7
ICD-9-CM Version 2011
787.91
CTCAE 1105E
E10572
Indigestion
Description

Dyspepsia

Data type

boolean

Alias
UMLS CUI 2011AA
C0013395
SNOMED CT 2011_0131
162031009
MedDRA 14.1
10013946
ICD-10-CM Version 2010
R10.13, K30
CTCAE 1105E
E10617
Deglutition Disorders
Description

Dysphagia

Data type

boolean

Alias
UMLS CUI 2011AA
C0011168
SNOMED CT 2011_0131
40739000
MedDRA 14.1
10013950
LOINC Version 232
MTHU029874
ICD-10-CM Version 2010
R13
ICD-9-CM Version 2011
787.2
CTCAE 1105E
E10621
Elevated Liver Function Tests
Description

Elevated Liver Function Tests

Data type

boolean

Oesophageal Varices
Description

Esophageal Varices

Data type

boolean

Alias
UMLS CUI 2011AA
C0014867
SNOMED CT 2011_0131
28670008
MedDRA 14.1
10030209
ICD-10-CM Version 2010
I85
Family History of Colon Cancer
Description

Family History of Colon Cancer

Data type

boolean

Alias
UMLS CUI [1]
C0730200
Family History of Polyps
Description

Family History of Polyps

Data type

boolean

Family History of Polyposis
Description

Family History of Polyposis

Data type

boolean

Foreign Body in Colon
Description

Foreign Body in Colon

Data type

boolean

Foreign Body in Esophagus
Description

Foreign Body in Esophagus

Data type

boolean

Foreign Body in Stomach
Description

Foreign Body in Stomach

Data type

boolean

Peptic Ulcer
Description

Gastric Ulcer

Data type

boolean

Alias
UMLS CUI 2011AA
C0030920
SNOMED CT 2011_0131
13200003
MedDRA 14.1
10034341
ICD-10-CM Version 2010
K27
Gastroesophageal reflux disease (GERD)
Description

GERD

Data type

boolean

Alias
UMLS CUI 2011AA
C0017168
SNOMED CT 2011_0131
235595009
MedDRA 14.1
10017885
ICD-10-CM Version 2010
K21
ICD-9-CM Version 2011
530.81
CTCAE 1105E
E10739
Gastrointestinal Hemorrhage
Description

GI Bleeding

Data type

boolean

Alias
UMLS CUI 2011AA
C0017181
SNOMED CT 2011_0131
74474003
MedDRA 14.1
10017955
ICD-10-CM Version 2010
K92.2
ICD-9-CM Version 2011
578
Haematemesis
Description

Hematemesis

Data type

boolean

Alias
UMLS CUI 2011AA
C0018926
SNOMED CT 2011_0131
8765009
MedDRA 14.1
10018830
ICD-10-CM Version 2010
K92.0
ICD-9-CM Version 2011
578.0
History of Barrett's
Description

History of Barrett's

Data type

boolean

History of Cholangiocarcinoma
Description

History of Cholangiocarcinoma

Data type

boolean

History of Colon Cancer
Description

History of Colon Cancer

Data type

boolean

History of Crohn's Disease
Description

History of Crohn's Disease

Data type

boolean

History of Diverticulosis
Description

History of Diverticulosis

Data type

boolean

History of Esophageal Cancer
Description

History of Esophageal Cancer

Data type

boolean

History of Esophageal/ Gastric Varicies
Description

History of Esophageal/ Gastric Varicies

Data type

boolean

History of Gastric Cancer
Description

History of Gastric Cancer

Data type

boolean

History of Pancreatic Cancer
Description

History of Pancreatic Cancer

Data type

boolean

History of Peptic Ulcer Disease
Description

History of Peptic Ulcer Disease

Data type

boolean

History of Polyps
Description

History of Polyps

Data type

boolean

History of Ulcerative Colitis
Description

History of Ulcerative Colitis

Data type

boolean

Blood in Stool
Description

Hematochezia

Data type

boolean

Alias
UMLS CUI 2011AA
C0018932
SNOMED CT 2011_0131
405729008
MedDRA 14.1
10018836
ICD-9-CM Version 2011
578.1
Iron Deficiency Anaemia
Description

Iron Deficiency Anemia

Data type

boolean

Alias
UMLS CUI 2011AA
C0162316
SNOMED CT 2011_0131
87522002
MedDRA 14.1
10022972
ICD-10-CM Version 2010
D50.0
ICD-9-CM Version 2011
280
Icterus
Description

Jaundice

Data type

boolean

Alias
UMLS CUI 2011AA
C0022346
SNOMED CT 2011_0131
18165001
MedDRA 14.1
10023126
ICD-10-CM Version 2010
R17
Melaena
Description

Melena

Data type

boolean

Alias
UMLS CUI 2011AA
C0025222
SNOMED CT 2011_0131
2901004
MedDRA 14.1
10027141
ICD-10-CM Version 2010
K92.1
Nausea
Description

Nausea

Data type

boolean

Alias
UMLS CUI 2011AA
C0027497
SNOMED CT 2011_0131
422587007
MedDRA 14.1
10028813
LOINC Version 232
MTHU013524
ICD-10-CM Version 2010
R11.0
CTCAE 1105E
E10878
Emesis
Description

Vomiting

Data type

boolean

Alias
UMLS CUI 2011AA
C0042963
SNOMED CT 2011_0131
249497008
MedDRA 14.1
10047700
LOINC Version 232
MTHU013530
ICD-10-CM Version 2010
R11.1
CTCAE 1105E
E11068
Occult/Guaiac Positive Stool
Description

Occult/Guaiac Positive Stool

Data type

boolean

Alias
UMLS CUI 2011AA
C0201811
SNOMED CT 2011_0131
104435004
MedDRA 14.1
10016297
Pancreatitis
Description

Pancreatitis

Data type

boolean

Alias
UMLS CUI 2011AA
C0030305
SNOMED CT 2011_0131
75694006
MedDRA 14.1
10033645
ICD-10-CM Version 2010
K85.9
ICD-9-CM Version 2011
577.0
CTCAE 1105E
E10930
Portal Hypertension
Description

Portal Hypertension

Data type

boolean

Alias
UMLS CUI 2011AA
C0020541
SNOMED CT 2011_0131
34742003
MedDRA 14.1
10036200
ICD-10-CM Version 2010
K76.6
ICD-9-CM Version 2011
572.3
CTCAE 1105E
E11238
gastric reflux
Description

Gastroesophageal Reflux

Data type

boolean

Alias
UMLS CUI 2011AA
C0558176
SNOMED CT 2011_0131
225587003
Abnormal weight loss
Description

Weight Loss

Data type

boolean

Alias
UMLS CUI 2011AA
C0936227
SNOMED CT 2011_0131
267024001
MedDRA 14.1
10000159
ICD-10-CM Version 2010
R63.4
Other
Description

Other

Data type

text

PRE-PROCEDURE ALDRETE SCORE
Description

PRE-PROCEDURE ALDRETE SCORE

ACTIVITY
Description

ACTIVITY

Data type

integer

Alias
UMLS CUI [1]
C0026606
RESPIRATORY
Description

RESPIRATORY

Data type

integer

Alias
UMLS CUI [1]
C0035237
BLOOD PRESSURE
Description

Blood pressure

Data type

integer

Alias
SNOMED CT 2011_0131
386534000
UMLS CUI [1]
C0005823
LEVEL OF CONSCIOUSNESS
Description

LEVEL OF CONSCIOUSNESS

Data type

integer

Alias
SNOMED CT 2011_0131
106167005
UMLS CUI [1]
C0234421
EVALUATION OF SKIN CONDITION AND COLOR
Description

EVALUATION OF SKIN CONDITION AND COLOR

Data type

integer

Alias
SNOMED CT 2011_0131
422000003
LOINC Version 232
MTHU034830
UMLS CUI [1]
C1719933
ALDRETE TOTAL SCORE
Description

ALDRETE TOTAL SCORE

Data type

integer

Alias
UMLS CUI [1]
C1821424
Back to the top of the page

Similar models

HIS

1 forms
  1. StudyEvent: HIS
    1. HIS
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
General Info
C1508263 (UMLS CUI-1)
Arrival date and time
Item
TODAY'S DATE & TIME OF ARRIVAL
date
C2215405 (UMLS CUI [1])
ALLERGIES
Item
Hypersensitivity
string
C0020517 (UMLS CUI 2011AA)
257550005 (SNOMED CT 2011_0131)
T78.40 (ICD-10-CM Version 2010)
CURRENT MEDICATIONS
Item
Medication
string
C0013227 (UMLS CUI 2011AA)
PATIENT STATUS
Item
PATIENT STATUS
text
C0449437 (UMLS CUI [1])
HOW ARRIVED
Item
HOW ARRIVED
text
ACCOMPANIED BY
Item
ACCOMPANIED BY
text
Item
CONDITION UPON ARRIVAL (stable, unstable)
integer
C0348080 (UMLS CUI [1])
CONDITION UPON ARRIVAL
Code List
CONDITION UPON ARRIVAL (stable, unstable)
CL Item
stable (1)
C0205360 (UMLS CUI-1)
CL Item
unstable (2)
C0443343 (UMLS CUI-1)
Item
LEVEL OF CONSCIOUSNESS
integer
106167005 (SNOMED CT 2011_0131)
C0234425 (UMLS CUI [1])
LEVEL OF CONSCIOUSNESS
Code List
LEVEL OF CONSCIOUSNESS
CL Item
alert (3)
C0239110 (UMLS CUI-1)
CL Item
lethargic (2)
C0023380 (UMLS CUI-1)
CL Item
sedated (1)
C0235195 (UMLS CUI-1)
CL Item
obtunded (0)
C0085628 (UMLS CUI-1)
CONSENT SIGNED BY
Item
CONSENT SIGNED BY
text
PATIENT ID BAND ON WITH CORRECT NAME, DOB AND PHYSICIAN
Item
PATIENT ID BAND ON WITH CORRECT NAME, DOB AND PHYSICIAN
boolean
NOTES Patient ID
Item
NOTES Patient ID
text
PHYSICIAN1
Item
Treating Physician
string
C1710470 (UMLS CUI 2011AA)
PHYSICIAN2
Item
Treating Physician
string
C1710470 (UMLS CUI 2011AA)
ASSISTED BY
Item
ASSISTED BY
text
Anesthesist
Item
ANESTHESIA BY
text
C1550495 (UMLS CUI [1])
MEDICAL/SURGICAL HISTORY
Item
Past medical history
string
C0262926 (UMLS CUI 2011AA)
417662000 (SNOMED CT 2011_0131)
MTHU027722 (LOINC Version 232)
LANGUAGE BARRIER
Item
LANGUAGE BARRIER
boolean
TRANSLATOR
Item
TRANSLATOR (yes, N/A)
boolean
NOTES
Item
NOTES
text
PHYSICAL DISABILITIES
Item
PHYSICAL DISABILITIES
boolean
PHYSICAL DISABILITIES (Description)
Item
Physical handicap
string
C0520817 (UMLS CUI 2011AA)
32572006 (SNOMED CT 2011_0131)
10048624 (MedDRA 14.1)
Item
Dental
integer
C0226984 (UMLS CUI [1])
DENTAL
Code List
Dental
CL Item
Dentures (1)
C0011394 (UMLS CUI-1)
CL Item
Partials (2)
C0011460 (UMLS CUI-1)
CL Item
Own Intact (3)
Item
Hearing
text
47078008 (SNOMED CT 2011_0131)
MTHU015042 (LOINC Version 232)
C0018767 (UMLS CUI [1])
HEARING
Code List
Hearing
CL Item
within normal limits (WNL)
C0442816 (UMLS CUI-1)
CL Item
Decreased R (DR)
C0018772 (UMLS CUI-1)
C0205090 (UMLS CUI-2)
CL Item
Decreased L (DL)
C0018772 (UMLS CUI-1)
C0205091 (UMLS CUI-2)
Item
Visual
integer
281004000 (SNOMED CT 2011_0131)
MTHU014733 (LOINC Version 232)
C0042789 (UMLS CUI [1])
VISUAL
Code List
Visual
CL Item
WNL (1)
C0442816 (UMLS CUI-1)
CL Item
Glasses (2)
C0015421 (UMLS CUI-1)
CL Item
Contacts (3)
C0009836 (UMLS CUI-1)
NOTES
Item
NOTES
text
ADMISSION VITAL SIGNS
Item
ADMISSION VITAL SIGNS
string
C0518766 (UMLS CUI 2011AA)
46680005 (SNOMED CT 2011_0131)
MTHU024540 (LOINC Version 232)
Pulse Oximetry
Item
Oxygen saturation measurement (Pulse Oximetry Value)
float
264598005 (SNOMED CT 2011_0131)
10033316 (MedDRA 14.1)
C0034108 (UMLS CUI [1])
Weight
Item
Body weight
float
107647005 (SNOMED CT 2011_0131)
10047890 (MedDRA 14.1)
LP18015-5 (LOINC Version 232)
C0005910 (UMLS CUI [1])
Height
Item
Height
float
MTHU005354 (LOINC Version 232)
C0005890 (UMLS CUI [1])
NPO SINCE
Item
NPO SINCE
time
PREP
Item
Prep (Fleet Enema, Fleet Prep Kit, Golytely, Half-Lightly, MAG Citrate, MOVI Prep, Nulytely, OSMO Prep)
integer
PREP COMMENTS
Item
PREP COMMENTS
text
Item Group
PRE-OP DIAGNOSIS
Abnormal GI Xray
Item
Abnormal GI Xray
boolean
Abdominal Pain
Item
Abdominal Pain
boolean
C0000737 (UMLS CUI 2011AA)
21522001 (SNOMED CT 2011_0131)
10000081 (MedDRA 14.1)
MTHU013636 (LOINC Version 232)
R10.9 (ICD-10-CM Version 2010)
789.0 (ICD-9-CM Version 2011)
E10460 (CTCAE 1105E)
Abnormal Weight Loss
Item
Abnormal weight loss (finding)
boolean
C0936227 (UMLS CUI 2011AA)
267024001 (SNOMED CT 2011_0131)
10000159 (MedDRA 14.1)
R63.4 (ICD-10-CM Version 2010)
Achalasia
Item
Achalasia
boolean
C1321756 (UMLS CUI 2011AA)
48531003 (SNOMED CT 2011_0131)
10000420 (MedDRA 14.1)
K22.0 (ICD-10-CM Version 2010)
Anemia
Item
Anaemia
boolean
C0002871 (UMLS CUI 2011AA)
271737000 (SNOMED CT 2011_0131)
10002034 (MedDRA 14.1)
MTHU020823 (LOINC Version 232)
D64.9 (ICD-10-CM Version 2010)
285.9 (ICD-9-CM Version 2011)
E10010 (CTCAE 1105E)
Ascites
Item
Ascites
boolean
C0003962 (UMLS CUI 2011AA)
389026000 (SNOMED CT 2011_0131)
10003445 (MedDRA 14.1)
R18 (ICD-10-CM Version 2010)
789.5 (ICD-9-CM Version 2011)
E10502 (CTCAE 1105E)
Change in Bowel Habits
Item
Irregular bowel habits
boolean
C2919545 (UMLS CUI 2011AA)
444702007 (SNOMED CT 2011_0131)
Hepatic Cirrhosis
Item
Liver Cirrhosis
boolean
C0023890 (UMLS CUI 2011AA)
19943007 (SNOMED CT 2011_0131)
10019641 (MedDRA 14.1)
K74.60 (ICD-10-CM Version 2010)
Colorectal Cancer Screening
Item
Screening for Colorectal Cancer
boolean
C0281185 (UMLS CUI 2011AA)
Common Bile Duct Leak
Item
Common Bile Duct Leak
boolean
Common Bile Duct Stone
Item
Common Bile Duct Stone
boolean
Constipation
Item
Constipation
boolean
C0009806 (UMLS CUI 2011AA)
14760008 (SNOMED CT 2011_0131)
10010774 (MedDRA 14.1)
MTHU020768 (LOINC Version 232)
K59.0 (ICD-10-CM Version 2010)
564.0 (ICD-9-CM Version 2011)
E10562 (CTCAE 1105E)
Diarrhea
Item
Diarrhea
boolean
C0011991 (UMLS CUI 2011AA)
62315008 (SNOMED CT 2011_0131)
10012735 (MedDRA 14.1)
MTHU013347 (LOINC Version 232)
R19.7 (ICD-10-CM Version 2010)
787.91 (ICD-9-CM Version 2011)
E10572 (CTCAE 1105E)
Dyspepsia
Item
Indigestion
boolean
C0013395 (UMLS CUI 2011AA)
162031009 (SNOMED CT 2011_0131)
10013946 (MedDRA 14.1)
R10.13, K30 (ICD-10-CM Version 2010)
E10617 (CTCAE 1105E)
Dysphagia
Item
Deglutition Disorders
boolean
C0011168 (UMLS CUI 2011AA)
40739000 (SNOMED CT 2011_0131)
10013950 (MedDRA 14.1)
MTHU029874 (LOINC Version 232)
R13 (ICD-10-CM Version 2010)
787.2 (ICD-9-CM Version 2011)
E10621 (CTCAE 1105E)
Elevated Liver Function Tests
Item
Elevated Liver Function Tests
boolean
Esophageal Varices
Item
Oesophageal Varices
boolean
C0014867 (UMLS CUI 2011AA)
28670008 (SNOMED CT 2011_0131)
10030209 (MedDRA 14.1)
I85 (ICD-10-CM Version 2010)
Family History of Colon Cancer
Item
Family History of Colon Cancer
boolean
C0730200 (UMLS CUI [1])
Family History of Polyps
Item
Family History of Polyps
boolean
Family History of Polyposis
Item
Family History of Polyposis
boolean
Foreign Body in Colon
Item
Foreign Body in Colon
boolean
Foreign Body in Esophagus
Item
Foreign Body in Esophagus
boolean
Foreign Body in Stomach
Item
Foreign Body in Stomach
boolean
Gastric Ulcer
Item
Peptic Ulcer
boolean
C0030920 (UMLS CUI 2011AA)
13200003 (SNOMED CT 2011_0131)
10034341 (MedDRA 14.1)
K27 (ICD-10-CM Version 2010)
GERD
Item
Gastroesophageal reflux disease (GERD)
boolean
C0017168 (UMLS CUI 2011AA)
235595009 (SNOMED CT 2011_0131)
10017885 (MedDRA 14.1)
K21 (ICD-10-CM Version 2010)
530.81 (ICD-9-CM Version 2011)
E10739 (CTCAE 1105E)
GI Bleeding
Item
Gastrointestinal Hemorrhage
boolean
C0017181 (UMLS CUI 2011AA)
74474003 (SNOMED CT 2011_0131)
10017955 (MedDRA 14.1)
K92.2 (ICD-10-CM Version 2010)
578 (ICD-9-CM Version 2011)
Hematemesis
Item
Haematemesis
boolean
C0018926 (UMLS CUI 2011AA)
8765009 (SNOMED CT 2011_0131)
10018830 (MedDRA 14.1)
K92.0 (ICD-10-CM Version 2010)
578.0 (ICD-9-CM Version 2011)
History of Barrett's
Item
History of Barrett's
boolean
History of Cholangiocarcinoma
Item
History of Cholangiocarcinoma
boolean
History of Colon Cancer
Item
History of Colon Cancer
boolean
History of Crohn's Disease
Item
History of Crohn's Disease
boolean
History of Diverticulosis
Item
History of Diverticulosis
boolean
History of Esophageal Cancer
Item
History of Esophageal Cancer
boolean
History of Esophageal/ Gastric Varicies
Item
History of Esophageal/ Gastric Varicies
boolean
History of Gastric Cancer
Item
History of Gastric Cancer
boolean
History of Pancreatic Cancer
Item
History of Pancreatic Cancer
boolean
History of Peptic Ulcer Disease
Item
History of Peptic Ulcer Disease
boolean
History of Polyps
Item
History of Polyps
boolean
History of Ulcerative Colitis
Item
History of Ulcerative Colitis
boolean
Hematochezia
Item
Blood in Stool
boolean
C0018932 (UMLS CUI 2011AA)
405729008 (SNOMED CT 2011_0131)
10018836 (MedDRA 14.1)
578.1 (ICD-9-CM Version 2011)
Iron Deficiency Anemia
Item
Iron Deficiency Anaemia
boolean
C0162316 (UMLS CUI 2011AA)
87522002 (SNOMED CT 2011_0131)
10022972 (MedDRA 14.1)
D50.0 (ICD-10-CM Version 2010)
280 (ICD-9-CM Version 2011)
Jaundice
Item
Icterus
boolean
C0022346 (UMLS CUI 2011AA)
18165001 (SNOMED CT 2011_0131)
10023126 (MedDRA 14.1)
R17 (ICD-10-CM Version 2010)
Melena
Item
Melaena
boolean
C0025222 (UMLS CUI 2011AA)
2901004 (SNOMED CT 2011_0131)
10027141 (MedDRA 14.1)
K92.1 (ICD-10-CM Version 2010)
Nausea
Item
Nausea
boolean
C0027497 (UMLS CUI 2011AA)
422587007 (SNOMED CT 2011_0131)
10028813 (MedDRA 14.1)
MTHU013524 (LOINC Version 232)
R11.0 (ICD-10-CM Version 2010)
E10878 (CTCAE 1105E)
Vomiting
Item
Emesis
boolean
C0042963 (UMLS CUI 2011AA)
249497008 (SNOMED CT 2011_0131)
10047700 (MedDRA 14.1)
MTHU013530 (LOINC Version 232)
R11.1 (ICD-10-CM Version 2010)
E11068 (CTCAE 1105E)
Occult/Guaiac Positive Stool
Item
Occult/Guaiac Positive Stool
boolean
C0201811 (UMLS CUI 2011AA)
104435004 (SNOMED CT 2011_0131)
10016297 (MedDRA 14.1)
Pancreatitis
Item
Pancreatitis
boolean
C0030305 (UMLS CUI 2011AA)
75694006 (SNOMED CT 2011_0131)
10033645 (MedDRA 14.1)
K85.9 (ICD-10-CM Version 2010)
577.0 (ICD-9-CM Version 2011)
E10930 (CTCAE 1105E)
Portal Hypertension
Item
Portal Hypertension
boolean
C0020541 (UMLS CUI 2011AA)
34742003 (SNOMED CT 2011_0131)
10036200 (MedDRA 14.1)
K76.6 (ICD-10-CM Version 2010)
572.3 (ICD-9-CM Version 2011)
E11238 (CTCAE 1105E)
Gastroesophageal Reflux
Item
gastric reflux
boolean
C0558176 (UMLS CUI 2011AA)
225587003 (SNOMED CT 2011_0131)
Weight Loss
Item
Abnormal weight loss
boolean
C0936227 (UMLS CUI 2011AA)
267024001 (SNOMED CT 2011_0131)
10000159 (MedDRA 14.1)
R63.4 (ICD-10-CM Version 2010)
Other
Item
Other
text
Item Group
PRE-PROCEDURE ALDRETE SCORE
Item
ACTIVITY
integer
C0026606 (UMLS CUI [1])
ACTIVITY
Code List
ACTIVITY
CL Item
all 4 extremities move voluntarily or on command (2)
CL Item
2 extremities move voluntarily or on command (1)
CL Item
cannot move extremities (0)
Item
RESPIRATORY
integer
C0035237 (UMLS CUI [1])
RESPIRATORY
Code List
RESPIRATORY
CL Item
able to deep breath, cough freely (2)
CL Item
dyspnea or limited breathing (1)
CL Item
apnea or SAO2 <90% (0)
Item
BLOOD PRESSURE
integer
386534000 (SNOMED CT 2011_0131)
C0005823 (UMLS CUI [1])
Blood pressure
Code List
BLOOD PRESSURE
CL Item
BP +/- 20% of pre-procedure level (2)
CL Item
BP +/- 21-49% pre-procedure level (1)
CL Item
BP +/- 50% pre-procedure level (0)
Item
LEVEL OF CONSCIOUSNESS
integer
106167005 (SNOMED CT 2011_0131)
C0234421 (UMLS CUI [1])
LEVEL OF CONSCIOUSNESS
Code List
LEVEL OF CONSCIOUSNESS
CL Item
Responds to command & fully awake (2)
CL Item
easily awakened (1)
CL Item
unresponsive or requires vigorous stimulation to awaken (0)
Item
EVALUATION OF SKIN CONDITION AND COLOR
integer
422000003 (SNOMED CT 2011_0131)
MTHU034830 (LOINC Version 232)
C1719933 (UMLS CUI [1])
EVALUATION OF SKIN CONDITION AND COLOR
Code List
EVALUATION OF SKIN CONDITION AND COLOR
CL Item
Skin is pink-warm- dry (2)
CL Item
Skin is pale-dusky-blotchy- jaundice (1)
CL Item
Patient is cyanotic (0)
ALDRETE TOTAL SCORE
Item
ALDRETE TOTAL SCORE
integer
C1821424 (UMLS CUI [1])
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial