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Registration Form HYPER-PEI

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General Information
Beschrijving

General Information

Alias
UMLS CUI-1
C1507644
Weight
Beschrijving

Body weight of patient

Datatype

float

Maateenheden
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Height
Beschrijving

Body height of patient

Datatype

float

Maateenheden
  • cm
Alias
UMLS CUI [1]
C0489786
cm
Diagnosis
Beschrijving

Diagnose

Datatype

text

Alias
UMLS CUI [1]
C0011900
Date of diagnosis
Beschrijving

Date of Diagnosis

Datatype

date

Alias
UMLS CUI [1]
C2316983
Localisation
Beschrijving

Localisation of malignancy

Datatype

text

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

Primary Neoplasm

Datatype

integer

Alias
UMLS CUI [1]
C0677930
1. Relapse
Beschrijving

first Relapse

Datatype

text

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

second/third Relapse

Datatype

text

Alias
UMLS CUI [1]
C0277556
Metastasis
Beschrijving

Evidence of metastatic disease

Datatype

text

Alias
UMLS CUI [1]
C0027627
metastasis unifocal
Beschrijving

metastatis unifocal

Datatype

text

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

metastasis multifocal

Datatype

text

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

Transferring Hospital

Alias
UMLS CUI-1
C0019994
Hospital Name
Beschrijving

Name of transferring,cooperating hospital

Datatype

text

Alias
UMLS CUI [1]
C2926025
Date
Beschrijving

Issuing Date

Datatype

date

Alias
UMLS CUI [1]
C0011008
Treating Physician
Beschrijving

Responsible Physician for Transfer

Datatype

text

Alias
UMLS CUI [1]
C1710470
Signature
Beschrijving

Responsible Person Signature

Datatype

text

Alias
UMLS CUI [1]
C1519316
Email
Beschrijving

Email

Datatype

text

Alias
UMLS CUI [1]
C0013849
Phone Number
Beschrijving

Phone number

Datatype

float

Alias
UMLS CUI [1]
C0039457
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Similar models

Registration Form HYPER-PEI

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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  (Yes)
CL Item
No  (No)
CL Item
not known (not known)
Item
metastasis unifocal
text
C0027627 (UMLS CUI [1,1])
C0443337 (UMLS CUI [1,2])
metastatis unifocal
Code List
metastasis unifocal
CL Item
Yes  (Yes)
CL Item
No  (No)
CL Item
not known (not known)
Item
Metastasis multifocal
text
C0027627 (UMLS CUI [1,1])
C0205292 (UMLS CUI [1,2])
metastasis multifocal
Code List
Metastasis multifocal
CL Item
Yes  (Yes)
CL Item
No  (No)
CL Item
not known (not known)
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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