ID

11976

Description

Form from HIS OpenVistA

Keywords

Versions (3)
  1. 2/10/12 2/10/12 -
  2. 7/9/15 7/9/15 - Martin Dugas
  3. 8/28/15 8/28/15 - Martin Dugas
Uploaded on

August 28, 2015

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License

Creative Commons BY-NC 3.0 Legacy
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CARDIAC REHAB CONSULT RESULTS INTERDISCIPLINARY NOTE

German English

HIS

1 forms  
  1. StudyEvent: HIS
    1. HIS
Date, Diagnosis, BMI
Description

Date, Diagnosis, BMI

DATE REFERRAL RECEIVED
Description

DATE REFERRAL RECEIVED

Data type

date

ADMISSION DATE TO CARDIAC REHABILITATION
Description

ADMISSION DATE TO CARDIAC REHABILITATION

Data type

date

Diagnosis
Description

Diagnosis

Data type

string

Alias
UMLS CUI
C0011900
SNOMED CT 2010_0731
439401001
LOINC Version 232
MTHU008876
Weight
Description

Current Weight

Data type

text

Measurement units
  • kg
Alias
SNOMED CT 2010_0731
107647005
MedDRA 13.1
10047890
LOINC Version 232
LP18015-5
UMLS CUI [1]
C0005910
kg
Height
Description

Current Height

Data type

float

Measurement units
  • cm
Alias
LOINC Version 232
MTHU005354
UMLS CUI [1]
C0489786
cm
Body Mass Index
Description

BMI

Data type

float

Measurement units
  • kg/m2
Alias
SNOMED CT 2010_0731
140075008
MedDRA 13.1
10005894
LOINC Version 232
LP35925-4
UMLS CUI [1]
C1305855
kg/m2
SYMPTOM(S) ON ADMISSION
Description

SYMPTOM(S) ON ADMISSION

Alias
UMLS CUI-1
C1457887
SYMPTOM(S) ON ADMISSION
Description

SYMPTOM(S) ON ADMISSION (Arm/Shoulder discomfort, Chest discomfort, Diaphoresis and sweating, Dizziness, Dyspnea/SOB, Fatigue, Indigestion, Nausea/Vomiting, Neck/Jaw discomfort, Other)

Data type

text

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0457453
PAST CARDIAC HISTORY
Description

PAST CARDIAC HISTORY

Alias
UMLS CUI-1
C0559157
PAST CARDIAC HISTORY
Description

PAST CARDIAC HISTORY

Data type

text

Alias
UMLS CUI [1]
C0559157
PAST Medical HISTORY
Description

PAST Medical HISTORY

Alias
UMLS CUI-1
C0262926
Acute Renal Failure/Dialysis
Description

ARF/Dialysis

Data type

string

Arthritis
Description

Arthritis

Data type

string

Alias
UMLS CUI
C0003864
SNOMED CT 2010_0731
3723001
MedDRA 13.1
10003246
LOINC Version 232
MTHU020793
ICD-10-CM Version 2010
M19.90
ICD-9-CM Version 2011
716.9
CTCAE Version 4.03
E12378
Asthma
Description

Asthma

Data type

string

Alias
UMLS CUI
C0004096
SNOMED CT 2010_0731
195967001
MedDRA 13.1
10003553
LOINC Version 232
MTHU020815
ICD-10-CM Version 2010
J45
ICD-9-CM Version 2011
493
Malignant Neoplasms
Description

Cancer

Data type

string

Alias
UMLS CUI
C0006826
SNOMED CT 2010_0731
363346000
MedDRA 13.1
10028997
LOINC Version 232
MTHU010328
ICD-10-CM Version 2010
C00-C96
Chronic Obstructive Pulmonary Disease
Description

COPD

Data type

string

Alias
UMLS CUI
C0024117
SNOMED CT 2010_0731
13645005
MedDRA 13.1
10009033
ICD-10-CM Version 2010
J44.9
ICD-9-CM Version 2011
496
Depression
Description

Depression

Data type

string

Alias
UMLS CUI
C0011581
SNOMED CT 2010_0731
35489007
MedDRA 13.1
10012401
ICD-10-CM Version 2010
F32.9
Orthopedic Limitation
Description

Orthopedic Limitation

Data type

string

Thyroid Disease
Description

Thyroid Disorder

Data type

string

Alias
UMLS CUI
C0040128
SNOMED CT 2010_0731
14304000
MedDRA 13.1
10043709
ICD-10-CM Version 2010
E00-E07
ICD-9-CM Version 2011
240-246.99
Other
Description

Other

Data type

string

History of Hypertension
Description

History of Hypertension

Data type

text

Alias
UMLS CUI [1]
C0455527
History of Diabetes
Description

History of Diabetes

Data type

string

Cholesterol History
Description

Cholesterol History

Data type

string

LIPID VALUES THIS ADMISSION
Description

LIPID VALUES THIS ADMISSION

Data type

string

Physical activity
Description

Physical Activity

Data type

string

Alias
UMLS CUI
C0026606
SNOMED CT 2010_0731
68130003
LOINC Version 232
MTHU017278
PERTINENT SOCIAL HISTORY
Description

PERTINENT SOCIAL HISTORY

Family Status
Description

Family Status

Data type

text

Alias
UMLS CUI-1
C0682315
PATIENT LIVES
Description

PATIENT LIVES

Data type

string

Employment status
Description

Employment Status

Data type

string

Alias
UMLS CUI
C0242271
SNOMED CT 2010_0731
224362002
Family history (FH) of
Description

Family History

Data type

string

Alias
UMLS CUI
C0241889
SNOMED CT 2010_0731
57177007
Stress
Description

Stress/ Psychological Concerns

Data type

string

Alias
UMLS CUI
C0038435
SNOMED CT 2010_0731
262188008
MedDRA 13.1
10042209
PATIENT APPEARS (Behavior)
Description

PATIENT APPEARS (Behavior)

Data type

string

Smoking History
Description

Smoking History

Alias
UMLS CUI-1
C1519384
Smoker
Description

Smoker

Data type

text

Alias
UMLS CUI-1
C0543414
HOW MUCH Smoking
Description

HOW MUCH Smoking

Data type

text

Alias
UMLS CUI-1
C1822491
Quit at time of hospitalization
Description

Quit at time of hospitalization

Data type

string

Former smoker(not smoked more than 6 months)
Description

Former smoker(not smoked more than 6 months)

Data type

string

Quit smoking in
Description

Quit smoking in

Data type

date

Never Smoked
Description

Never Smoked

Data type

string

NARRATIVE
Description

NARRATIVE

Data type

string

Procedure Date and Results
Description

Procedure Date and Results

Heart catheterization
Description

CARDIAC CATHETERIZATION

Data type

string

Alias
UMLS CUI
C0018795
SNOMED CT 2010_0731
41976001
MedDRA 13.1
10007815
ICD-9-CM Version 2011
37.21
CARDIAC CATHETERIZATION DATE
Description

CARDIAC CATHETERIZATION DATE

Data type

string

Cardiac ejection fraction
Description

Ejection Fraction

Data type

string

Alias
UMLS CUI
C0232174
SNOMED CT 2010_0731
70822001
LV FUNCTION
Description

LV FUNCTION

Data type

string

MARK WITH % OCCLUSIONS
Description

MARK WITH % OCCLUSIONS

Data type

string

LM
Description

LM

Data type

string

LAD
Description

LAD

Data type

string

DIAGONAL
Description

DIAGONAL

Data type

string

CX
Description

CX

Data type

string

ADDITIONAL COMMENTS
Description

ADDITIONAL COMMENTS

Data type

string

PTCI / STENT
Description

PTCI / STENT

Data type

string

PTCI DATE
Description

PTCI DATE

Data type

string

PTCA
Description

PTCA

Data type

text

Alias
UMLS CUI-1
C2936173
STENT
Description

STENT

Data type

text

Alias
UMLS CUI-1
C0038257
ATHERECTOMY
Description

ATHERECTOMY

Data type

string

IIB/IIA INHIBITOR
Description

IIB/IIA INHIBITOR

Data type

string

MARK WITH APPROPRIATE LETTER: PTCA-(P), STENT-(S), ATHERECTOMY-(A)
Description

MARK WITH APPROPRIATE LETTER: PTCA-(P), STENT-(S), ATHERECTOMY-(A)

Data type

string

LM
Description

LM

Data type

string

LAD
Description

LAD

Data type

text

Alias
UMLS CUI-1
C0226032
DIAGONAL
Description

DIAGONAL

Data type

string

CX
Description

CX

Data type

string

ADDITIONAL COMMENTS
Description

ADDITIONAL COMMENTS

Data type

string

SURGERY
Description

SURGERY

Data type

string

Coronary Artery Bypass Surgery
Description

CABG

Data type

string

Alias
UMLS CUI
C0010055
SNOMED CT 2010_0731
232717009
MedDRA 13.1
10011077
ICD-9-CM Version 2011
36.10
DATE CABG
Description

DATE CABG

Data type

date

MIDCAB
Description

MIDCAB

Data type

string

AVR
Description

AVR

Data type

string

MVR
Description

MVR

Data type

string

OTHER PROCEDURES
Description

OTHER PROCEDURES

Data type

string

CARDIOVASCULAR RISK FACTOR
Description

CARDIOVASCULAR RISK FACTOR

Data type

string

CORRELATE A NUMBER WITH GRAFT ORIGIN SITE
Description

CORRELATE A NUMBER WITH GRAFT ORIGIN SITE

Data type

string

DONOR AREA TO
Description

DONOR AREA TO

Data type

string

LIMA
Description

LIMA

Data type

string

RIMA
Description

RIMA

Data type

string

RADIAL
Description

RADIAL

Data type

string

SVG
Description

SVG

Data type

string

RPD
Description

RPD

Data type

string

PATIENT/FAMILY EDUCATION
Description

PATIENT/FAMILY EDUCATION

BOOKLET(S) GIVEN
Description

BOOKLET(S) GIVEN

Data type

string

DATE BOOKLET(S) given
Description

DATE BOOKLET(S) given

Data type

date

BOOKLET VERSIONS
Description

BOOKLET VERSIONS

Data type

string

VIDEO(S) SHOWN
Description

VIDEO(S) SHOWN

Data type

string

DATE VIDEO(S) shown
Description

DATE VIDEO(S) shown

Data type

string

VIDEO VERSION
Description

VIDEO VERSION

Data type

string

LEARNER
Description

LEARNER

Data type

string

PATIENT'S PHYSICAL READINESS TO LEARN
Description

PATIENT'S PHYSICAL READINESS TO LEARN

Data type

string

PSYCHOLOGICALLY WILLING TO LEARN
Description

PSYCHOLOGICALLY WILLING TO LEARN

Data type

string

EDUCATIONAL TOPICS: 1.Description of Cardiac Catheterization and site care, 2.Heart structure and function, 3.Myocardial Infarction symptoms and interventions, 4.Unstable Angina symptoms and interventons, 5.Congestive Heart Failure and importance of daily weights, 6.PTCI (Angioplasty,Stent), 7.Open Heart Surgery
Description

EDUCATIONAL TOPICS Heart Disease

Data type

string

EDUCATIONAL TOPICS CORONARY RISK AND MODIFICATION: 1.Tobacco Cessation, 2.Exercise guidelines, aerobic exercise for minimum of 30 minutes, 3.Dietary Modifications, 4.Stress Management, 5.Cholesterol and Triglycerides, 6.Diabetes Management, 7.Obesity, 8.Medication, 9.Hypertension
Description

EDUCATIONAL TOPICS CORONARY RISK AND MODIFICATION

Data type

string

DISCHARGE SPECIFIC INSTRUCTIONS: 1.Activity, 2.Site / Incision care, 3.Daily Weight, 4.Returning to work, 5.Driving, 6.Recurrent Chest Pain, 7.Psychosocial, 8.Coumadin, 9.Sex
Description

DISCHARGE SPECIFIC INSTRUCTIONS

Data type

string

CARDIAC REHAB NARRATIVE
Description

CARDIAC REHAB NARRATIVE

Data type

string

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Similar models

HIS

1 forms
  1. StudyEvent: HIS
    1. HIS
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Date, Diagnosis, BMI
DATE REFERRAL RECEIVED
Item
DATE REFERRAL RECEIVED
date
ADMISSION DATE TO CARDIAC REHABILITATION
Item
ADMISSION DATE TO CARDIAC REHABILITATION
date
Diagnosis
Item
Diagnosis
string
C0011900 (UMLS CUI)
439401001 (SNOMED CT 2010_0731)
MTHU008876 (LOINC Version 232)
Current Weight
Item
Weight
text
107647005 (SNOMED CT 2010_0731)
10047890 (MedDRA 13.1)
LP18015-5 (LOINC Version 232)
C0005910 (UMLS CUI [1])
Current Height
Item
Height
float
MTHU005354 (LOINC Version 232)
C0489786 (UMLS CUI [1])
BMI
Item
Body Mass Index
float
140075008 (SNOMED CT 2010_0731)
10005894 (MedDRA 13.1)
LP35925-4 (LOINC Version 232)
C1305855 (UMLS CUI [1])
Item Group
SYMPTOM(S) ON ADMISSION
C1457887 (UMLS CUI-1)
SYMPTOMS ON ADMISSION
Item
SYMPTOM(S) ON ADMISSION
text
C1457887 (UMLS CUI [1,1])
C0457453 (UMLS CUI [1,2])
Item Group
PAST CARDIAC HISTORY
C0559157 (UMLS CUI-1)
PAST CARDIAC HISTORY
Item
PAST CARDIAC HISTORY
text
C0559157 (UMLS CUI [1])
Item Group
PAST Medical HISTORY
C0262926 (UMLS CUI-1)
ARF/Dialysis
Item
Acute Renal Failure/Dialysis
string
Arthritis
Item
Arthritis
string
C0003864 (UMLS CUI)
3723001 (SNOMED CT 2010_0731)
10003246 (MedDRA 13.1)
MTHU020793 (LOINC Version 232)
M19.90 (ICD-10-CM Version 2010)
716.9 (ICD-9-CM Version 2011)
E12378 (CTCAE Version 4.03)
Asthma
Item
Asthma
string
C0004096 (UMLS CUI)
195967001 (SNOMED CT 2010_0731)
10003553 (MedDRA 13.1)
MTHU020815 (LOINC Version 232)
J45 (ICD-10-CM Version 2010)
493 (ICD-9-CM Version 2011)
Cancer
Item
Malignant Neoplasms
string
C0006826 (UMLS CUI)
363346000 (SNOMED CT 2010_0731)
10028997 (MedDRA 13.1)
MTHU010328 (LOINC Version 232)
C00-C96 (ICD-10-CM Version 2010)
COPD
Item
Chronic Obstructive Pulmonary Disease
string
C0024117 (UMLS CUI)
13645005 (SNOMED CT 2010_0731)
10009033 (MedDRA 13.1)
J44.9 (ICD-10-CM Version 2010)
496 (ICD-9-CM Version 2011)
Depression
Item
Depression
string
C0011581 (UMLS CUI)
35489007 (SNOMED CT 2010_0731)
10012401 (MedDRA 13.1)
F32.9 (ICD-10-CM Version 2010)
Orthopedic Limitation
Item
Orthopedic Limitation
string
Thyroid Disorder
Item
Thyroid Disease
string
C0040128 (UMLS CUI)
14304000 (SNOMED CT 2010_0731)
10043709 (MedDRA 13.1)
E00-E07 (ICD-10-CM Version 2010)
240-246.99 (ICD-9-CM Version 2011)
Other
Item
Other
string
History of Hypertension
Item
History of Hypertension
text
C0455527 (UMLS CUI [1])
History of Diabetes
Item
History of Diabetes
string
Cholesterol History
Item
Cholesterol History
string
LIPID VALUES THIS ADMISSION
Item
LIPID VALUES THIS ADMISSION
string
Physical Activity
Item
Physical activity
string
C0026606 (UMLS CUI)
68130003 (SNOMED CT 2010_0731)
MTHU017278 (LOINC Version 232)
Item Group
PERTINENT SOCIAL HISTORY
Family Status
Item
Family Status
text
C0682315 (UMLS CUI-1)
PATIENT LIVES
Item
PATIENT LIVES
string
Employment Status
Item
Employment status
string
C0242271 (UMLS CUI)
224362002 (SNOMED CT 2010_0731)
Family History
Item
Family history (FH) of
string
C0241889 (UMLS CUI)
57177007 (SNOMED CT 2010_0731)
Stress/ Psychological Concerns
Item
Stress
string
C0038435 (UMLS CUI)
262188008 (SNOMED CT 2010_0731)
10042209 (MedDRA 13.1)
PATIENT APPEARS (Behavior)
Item
PATIENT APPEARS (Behavior)
string
Item Group
Smoking History
C1519384 (UMLS CUI-1)
Uses tobacco products
Item
Smoker
text
C0543414 (UMLS CUI-1)
HOW MUCH Smoking
Item
HOW MUCH Smoking
text
C1822491 (UMLS CUI-1)
Quit at time of hospitalization
Item
Quit at time of hospitalization
string
Former smoker(not smoked more than 6 months)
Item
Former smoker(not smoked more than 6 months)
string
Quit smoking in
Item
Quit smoking in
date
Never Smoked
Item
Never Smoked
string
NARRATIVE
Item
NARRATIVE
string
Item Group
Procedure Date and Results
CARDIAC CATHETERIZATION
Item
Heart catheterization
string
C0018795 (UMLS CUI)
41976001 (SNOMED CT 2010_0731)
10007815 (MedDRA 13.1)
37.21 (ICD-9-CM Version 2011)
CARDIAC CATHETERIZATION DATE
Item
CARDIAC CATHETERIZATION DATE
string
Ejection Fraction
Item
Cardiac ejection fraction
string
C0232174 (UMLS CUI)
70822001 (SNOMED CT 2010_0731)
LV FUNCTION
Item
LV FUNCTION
string
MARK WITH % OCCLUSIONS
Item
MARK WITH % OCCLUSIONS
string
LM
Item
LM
string
LAD
Item
LAD
string
DIAGONAL
Item
DIAGONAL
string
CX
Item
CX
string
ADDITIONAL COMMENTS
Item
ADDITIONAL COMMENTS
string
PTCI / STENT
Item
PTCI / STENT
string
PTCI DATE
Item
PTCI DATE
string
PTCA
Item
PTCA
text
C2936173 (UMLS CUI-1)
STENT
Item
STENT
text
C0038257 (UMLS CUI-1)
ATHERECTOMY
Item
ATHERECTOMY
string
IIB/IIA INHIBITOR
Item
IIB/IIA INHIBITOR
string
MARK WITH APPROPRIATE LETTER: PTCA-(P), STENT-(S), ATHERECTOMY-(A)
Item
MARK WITH APPROPRIATE LETTER: PTCA-(P), STENT-(S), ATHERECTOMY-(A)
string
LM
Item
LM
string
LAD
Item
LAD
text
C0226032 (UMLS CUI-1)
DIAGONAL
Item
DIAGONAL
string
CX
Item
CX
string
ADDITIONAL COMMENTS
Item
ADDITIONAL COMMENTS
string
SURGERY
Item
SURGERY
string
CABG
Item
Coronary Artery Bypass Surgery
string
C0010055 (UMLS CUI)
232717009 (SNOMED CT 2010_0731)
10011077 (MedDRA 13.1)
36.10 (ICD-9-CM Version 2011)
DATE CABG
Item
DATE CABG
date
MIDCAB
Item
MIDCAB
string
AVR
Item
AVR
string
MVR
Item
MVR
string
OTHER PROCEDURES
Item
OTHER PROCEDURES
string
CARDIOVASCULAR RISK FACTOR
Item
CARDIOVASCULAR RISK FACTOR
string
CORRELATE A NUMBER WITH GRAFT ORIGIN SITE
Item
CORRELATE A NUMBER WITH GRAFT ORIGIN SITE
string
DONOR AREA TO
Item
DONOR AREA TO
string
LIMA
Item
LIMA
string
RIMA
Item
RIMA
string
RADIAL
Item
RADIAL
string
SVG
Item
SVG
string
RPD
Item
RPD
string
Item Group
PATIENT/FAMILY EDUCATION
BOOKLET(S) GIVEN
Item
BOOKLET(S) GIVEN
string
DATE BOOKLET(S) given
Item
DATE BOOKLET(S) given
date
BOOKLET VERSIONS
Item
BOOKLET VERSIONS
string
VIDEO(S) SHOWN
Item
VIDEO(S) SHOWN
string
DATE VIDEO(S) shown
Item
DATE VIDEO(S) shown
string
VIDEO VERSION
Item
VIDEO VERSION
string
LEARNER
Item
LEARNER
string
PATIENT'S PHYSICAL READINESS TO LEARN
Item
PATIENT'S PHYSICAL READINESS TO LEARN
string
PSYCHOLOGICALLY WILLING TO LEARN
Item
PSYCHOLOGICALLY WILLING TO LEARN
string
EDUCATIONAL TOPICS Heart Disease
Item
EDUCATIONAL TOPICS: 1.Description of Cardiac Catheterization and site care, 2.Heart structure and function, 3.Myocardial Infarction symptoms and interventions, 4.Unstable Angina symptoms and interventons, 5.Congestive Heart Failure and importance of daily weights, 6.PTCI (Angioplasty,Stent), 7.Open Heart Surgery
string
EDUCATIONAL TOPICS CORONARY RISK AND MODIFICATION
Item
EDUCATIONAL TOPICS CORONARY RISK AND MODIFICATION: 1.Tobacco Cessation, 2.Exercise guidelines, aerobic exercise for minimum of 30 minutes, 3.Dietary Modifications, 4.Stress Management, 5.Cholesterol and Triglycerides, 6.Diabetes Management, 7.Obesity, 8.Medication, 9.Hypertension
string
DISCHARGE SPECIFIC INSTRUCTIONS
Item
DISCHARGE SPECIFIC INSTRUCTIONS: 1.Activity, 2.Site / Incision care, 3.Daily Weight, 4.Returning to work, 5.Driving, 6.Recurrent Chest Pain, 7.Psychosocial, 8.Coumadin, 9.Sex
string
CARDIAC REHAB NARRATIVE
Item
CARDIAC REHAB NARRATIVE
string
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