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Registration Form HYPER-PEI

1 Formulaires  
General Information
Description

General Information

Alias
UMLS CUI-1
C1507644
Weight
Description

Body weight of patient

Type de données

float

Unités de mesure
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Height
Description

Body height of patient

Type de données

float

Unités de mesure
  • cm
Alias
UMLS CUI [1]
C0489786
cm
Diagnosis
Description

Diagnose

Type de données

text

Alias
UMLS CUI [1]
C0011900
Date of diagnosis
Description

Date of Diagnosis

Type de données

date

Alias
UMLS CUI [1]
C2316983
Localisation
Description

Localisation of malignancy

Type de données

text

Alias
UMLS CUI [1,1]
C0475264
UMLS CUI [1,2]
C0027651
Primary Neoplasm
Description

Primary Neoplasm

Type de données

integer

Alias
UMLS CUI [1]
C0677930
1. Relapse
Description

first Relapse

Type de données

text

Alias
UMLS CUI [1]
C0277556
2./3./... Relapse
Description

second/third Relapse

Type de données

text

Alias
UMLS CUI [1]
C0277556
Metastasis
Description

Evidence of metastatic disease

Type de données

text

Alias
UMLS CUI [1]
C0027627
metastasis unifocal
Description

metastatis unifocal

Type de données

text

Alias
UMLS CUI [1,1]
C0027627
UMLS CUI [1,2]
C0443337
Metastasis multifocal
Description

metastasis multifocal

Type de données

text

Alias
UMLS CUI [1,1]
C0027627
UMLS CUI [1,2]
C0205292
Transferring Hospital
Description

Transferring Hospital

Alias
UMLS CUI-1
C0019994
Hospital Name
Description

Name of transferring,cooperating hospital

Type de données

text

Alias
UMLS CUI [1]
C2926025
Date
Description

Issuing Date

Type de données

date

Alias
UMLS CUI [1]
C0011008
Treating Physician
Description

Responsible Physician for Transfer

Type de données

text

Alias
UMLS CUI [1]
C1710470
Signature
Description

Responsible Person Signature

Type de données

text

Alias
UMLS CUI [1]
C1519316
Email
Description

Email

Type de données

text

Alias
UMLS CUI [1]
C0013849
Phone Number
Description

Phone number

Type de données

float

Alias
UMLS CUI [1]
C0039457
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Similar models

Registration Form HYPER-PEI

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
General Information
C1507644 (UMLS CUI-1)
Patient Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Patient Height
Item
Height
float
C0489786 (UMLS CUI [1])
Diagnose
Item
Diagnosis
text
C0011900 (UMLS CUI [1])
Date of Diagnosis
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1])
Localisation
Item
Localisation
text
C0475264 (UMLS CUI [1,1])
C0027651 (UMLS CUI [1,2])
Item
Primary Neoplasm
integer
C0677930 (UMLS CUI [1])
Primary Neoplasm
Code List
Primary Neoplasm
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
no information (no information)
Item
1. Relapse
text
C0277556 (UMLS CUI [1])
Relapse
Code List
1. Relapse
CL Item
yes, No=No, not known=not known (Yes)
Item
2./3./... Relapse
text
C0277556 (UMLS CUI [1])
Relapse
Code List
2./3./... Relapse
CL Item
Yes, No=No, not known=not known (Yes)
Item
Metastasis
text
C0027627 (UMLS CUI [1])
Metastasis
Code List
Metastasis
CL Item
Yes, No0No, not known=not known (Yes)
Item
metastasis unifocal
text
C0027627 (UMLS CUI [1,1])
C0443337 (UMLS CUI [1,2])
metastatis unifocal
Code List
metastasis unifocal
CL Item
Yes, No=No, not known=not known (Yes)
Item
Metastasis multifocal
text
C0027627 (UMLS CUI [1,1])
C0205292 (UMLS CUI [1,2])
metastasis multifocal
Code List
Metastasis multifocal
CL Item
Yes, No=No, not known=not known (Yes)
Item Group
Transferring Hospital
C0019994 (UMLS CUI-1)
Treating Hospital Name
Item
Hospital Name
text
C2926025 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Physician
Item
Treating Physician
text
C1710470 (UMLS CUI [1])
Responsible Person Signature
Item
Signature
text
C1519316 (UMLS CUI [1])
Email
Item
Email
text
C0013849 (UMLS CUI [1])
Phone number
Item
Phone Number
float
C0039457 (UMLS CUI [1])
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