ID

12730

Description

Form from HIS OpenVistA

Keywords

Versions (1)
  1. 12/15/15 12/15/15 -
Uploaded on

December 15, 2015

DOI

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License

Creative Commons BY-NC 3.0
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Family history

German English

HIS

1 forms  
  1. StudyEvent: HIS
    1. HIS
Maternal Family History
Description

Maternal Family History

Mother living
Description

Mother living

Data type

boolean

Hypertensive disease
Description

Hypertension

Data type

boolean

Alias
UMLS CUI
C0020538
SNOMED CT 2010_0731
38341003
MedDRA 13.1
10020772
LOINC Version 232
MTHU020789
ICD-10-CM Version 2010
I10
ICD-9-CM Version 2011
997.91
CTCAE Version 4.03
E13785
Diabetes mellitus
Description

Diabetes mellitus

Data type

boolean

Alias
UMLS CUI
C0011849
SNOMED CT 2010_0731
191044006
Stroke
Description

Stroke

Data type

boolean

Alias
UMLS CUI
C0038454
SNOMED CT 2010_0731
230690007
MedDRA 13.1
10042244
ICD-10-CM Version 2010
I63.9
CTCAE Version 4.03
E12826
Heart infarction
Description

Myocardial Infarction (MI)

Data type

boolean

Alias
UMLS CUI
C0027051
SNOMED CT 2010_0731
22298006
MedDRA 13.1
10028596
LOINC Version 232
MTHU035551
ICD-10-CM Version 2010
I21-I22
ICD-9-CM Version 2011
410
CTCAE Version 4.03
E10152
Early Coronary Vascular Disease
Description

Early Coronary Vascular Disease

Data type

boolean

Breast Carcinoma
Description

Breast Cancer

Data type

boolean

Alias
UMLS CUI
C0678222
SNOMED CT 2010_0731
254838004
MedDRA 13.1
10006204
Colon Carcinoma
Description

Colon Cancer

Data type

boolean

Alias
UMLS CUI
C0699790
SNOMED CT 2010_0731
269533000
MedDRA 13.1
10009957
Other
Description

Other

Data type

text

FH: Age at death
Description

Mother's age of death

Data type

integer

Alias
UMLS CUI
C1720406
Cause of Death
Description

Mother's cause of death

Data type

text

Alias
UMLS CUI
C0007465
SNOMED CT 2010_0731
184305005
LOINC Version 232
MTHU010441
comment
Description

comment

Data type

text

Paternal Family History
Description

Paternal Family History

Father living
Description

Father living

Data type

boolean

Hypertensive disease
Description

Hypertension

Data type

boolean

Alias
UMLS CUI
C0020538
SNOMED CT 2010_0731
38341003
MedDRA 13.1
10020772
LOINC Version 232
MTHU020789
ICD-10-CM Version 2010
I10
ICD-9-CM Version 2011
997.91
CTCAE Version 4.03
E13785
Diabetes mellitus
Description

Diabetes mellitus

Data type

boolean

Alias
UMLS CUI
C0011849
SNOMED CT 2010_0731
191044006
Stroke
Description

Stroke

Data type

boolean

Alias
UMLS CUI
C0038454
SNOMED CT 2010_0731
230690007
MedDRA 13.1
10042244
ICD-10-CM Version 2010
I63.9
CTCAE Version 4.03
E12826
Heart infarction
Description

Myocardial Infarction (MI)

Data type

boolean

Alias
UMLS CUI
C0027051
SNOMED CT 2010_0731
22298006
MedDRA 13.1
10028596
LOINC Version 232
MTHU035551
ICD-10-CM Version 2010
I21-I22
ICD-9-CM Version 2011
410
CTCAE Version 4.03
E10152
Early Coronary Vascular Disease
Description

Early Coronary Vascular Disease

Data type

boolean

Prostate carcinoma
Description

Prostate Cancer

Data type

boolean

Alias
UMLS CUI
C0600139
SNOMED CT 2010_0731
254900004
MedDRA 13.1
10036921
Colon Carcinoma
Description

Colon Cancer

Data type

boolean

Alias
UMLS CUI
C0699790
SNOMED CT 2010_0731
269533000
MedDRA 13.1
10009957
Other
Description

Other

Data type

text

FH: Age at death
Description

Father's age of death

Data type

integer

Alias
UMLS CUI
C1720406
Cause of Death
Description

Father's cause of death

Data type

text

Alias
UMLS CUI
C0007465
SNOMED CT 2010_0731
184305005
LOINC Version 232
MTHU010441
comment
Description

comment

Data type

text

Siblings Family History
Description

Siblings Family History

Siblings without significant disease
Description

Siblings without significant disease

Data type

text

Siblings with significant disease
Description

Siblings with significant disease

Data type

boolean

Hypertensive disease
Description

Hypertension

Data type

boolean

Alias
UMLS CUI
C0020538
SNOMED CT 2010_0731
38341003
MedDRA 13.1
10020772
LOINC Version 232
MTHU020789
ICD-10-CM Version 2010
I10
ICD-9-CM Version 2011
997.91
CTCAE Version 4.03
E13785
Stroke
Description

Stroke

Data type

boolean

Alias
UMLS CUI
C0038454
SNOMED CT 2010_0731
230690007
MedDRA 13.1
10042244
ICD-10-CM Version 2010
I63.9
CTCAE Version 4.03
E12826
Heart infarction
Description

Myocardial Infarction (MI)

Data type

boolean

Alias
UMLS CUI
C0027051
SNOMED CT 2010_0731
22298006
MedDRA 13.1
10028596
LOINC Version 232
MTHU035551
ICD-10-CM Version 2010
I21-I22
ICD-9-CM Version 2011
410
CTCAE Version 4.03
E10152
Diabetes mellitus
Description

Diabetes mellitus

Data type

boolean

Alias
UMLS CUI
C0011849
SNOMED CT 2010_0731
191044006
Early Coronary Vascular Disease
Description

Early Coronary Vascular Disease

Data type

boolean

Colon Carcinoma
Description

Colon Cancer

Data type

boolean

Alias
UMLS CUI
C0699790
SNOMED CT 2010_0731
269533000
MedDRA 13.1
10009957
Other
Description

Other

Data type

text

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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
Maternal Family History
Mother living
Item
Mother living
boolean
Hypertension
Item
Hypertensive disease
boolean
C0020538 (UMLS CUI)
38341003 (SNOMED CT 2010_0731)
10020772 (MedDRA 13.1)
MTHU020789 (LOINC Version 232)
I10 (ICD-10-CM Version 2010)
997.91 (ICD-9-CM Version 2011)
E13785 (CTCAE Version 4.03)
Diabetes mellitus
Item
Diabetes mellitus
boolean
C0011849 (UMLS CUI)
191044006 (SNOMED CT 2010_0731)
Stroke
Item
Stroke
boolean
C0038454 (UMLS CUI)
230690007 (SNOMED CT 2010_0731)
10042244 (MedDRA 13.1)
I63.9 (ICD-10-CM Version 2010)
E12826 (CTCAE Version 4.03)
Myocardial Infarction (MI)
Item
Heart infarction
boolean
C0027051 (UMLS CUI)
22298006 (SNOMED CT 2010_0731)
10028596 (MedDRA 13.1)
MTHU035551 (LOINC Version 232)
I21-I22 (ICD-10-CM Version 2010)
410 (ICD-9-CM Version 2011)
E10152 (CTCAE Version 4.03)
Early Coronary Vascular Disease
Item
Early Coronary Vascular Disease
boolean
Breast Cancer
Item
Breast Carcinoma
boolean
C0678222 (UMLS CUI)
254838004 (SNOMED CT 2010_0731)
10006204 (MedDRA 13.1)
Colon Cancer
Item
Colon Carcinoma
boolean
C0699790 (UMLS CUI)
269533000 (SNOMED CT 2010_0731)
10009957 (MedDRA 13.1)
Other
Item
Other
text
Mother's age of death
Item
FH: Age at death
integer
C1720406 (UMLS CUI)
Mother's cause of death
Item
Cause of Death
text
C0007465 (UMLS CUI)
184305005 (SNOMED CT 2010_0731)
MTHU010441 (LOINC Version 232)
comment
Item
comment
text
Item Group
Paternal Family History
Father living
Item
Father living
boolean
Hypertension
Item
Hypertensive disease
boolean
C0020538 (UMLS CUI)
38341003 (SNOMED CT 2010_0731)
10020772 (MedDRA 13.1)
MTHU020789 (LOINC Version 232)
I10 (ICD-10-CM Version 2010)
997.91 (ICD-9-CM Version 2011)
E13785 (CTCAE Version 4.03)
Diabetes mellitus
Item
Diabetes mellitus
boolean
C0011849 (UMLS CUI)
191044006 (SNOMED CT 2010_0731)
Stroke
Item
Stroke
boolean
C0038454 (UMLS CUI)
230690007 (SNOMED CT 2010_0731)
10042244 (MedDRA 13.1)
I63.9 (ICD-10-CM Version 2010)
E12826 (CTCAE Version 4.03)
Myocardial Infarction (MI)
Item
Heart infarction
boolean
C0027051 (UMLS CUI)
22298006 (SNOMED CT 2010_0731)
10028596 (MedDRA 13.1)
MTHU035551 (LOINC Version 232)
I21-I22 (ICD-10-CM Version 2010)
410 (ICD-9-CM Version 2011)
E10152 (CTCAE Version 4.03)
Early Coronary Vascular Disease
Item
Early Coronary Vascular Disease
boolean
Prostate Cancer
Item
Prostate carcinoma
boolean
C0600139 (UMLS CUI)
254900004 (SNOMED CT 2010_0731)
10036921 (MedDRA 13.1)
Colon Cancer
Item
Colon Carcinoma
boolean
C0699790 (UMLS CUI)
269533000 (SNOMED CT 2010_0731)
10009957 (MedDRA 13.1)
Other
Item
Other
text
Father's age of death
Item
FH: Age at death
integer
C1720406 (UMLS CUI)
Father's cause of death
Item
Cause of Death
text
C0007465 (UMLS CUI)
184305005 (SNOMED CT 2010_0731)
MTHU010441 (LOINC Version 232)
comment
Item
comment
text
Item Group
Siblings Family History
Siblings without significant disease
Item
Siblings without significant disease
text
Siblings with significant disease
Item
Siblings with significant disease
boolean
Hypertension
Item
Hypertensive disease
boolean
C0020538 (UMLS CUI)
38341003 (SNOMED CT 2010_0731)
10020772 (MedDRA 13.1)
MTHU020789 (LOINC Version 232)
I10 (ICD-10-CM Version 2010)
997.91 (ICD-9-CM Version 2011)
E13785 (CTCAE Version 4.03)
Stroke
Item
Stroke
boolean
C0038454 (UMLS CUI)
230690007 (SNOMED CT 2010_0731)
10042244 (MedDRA 13.1)
I63.9 (ICD-10-CM Version 2010)
E12826 (CTCAE Version 4.03)
Myocardial Infarction (MI)
Item
Heart infarction
boolean
C0027051 (UMLS CUI)
22298006 (SNOMED CT 2010_0731)
10028596 (MedDRA 13.1)
MTHU035551 (LOINC Version 232)
I21-I22 (ICD-10-CM Version 2010)
410 (ICD-9-CM Version 2011)
E10152 (CTCAE Version 4.03)
Diabetes mellitus
Item
Diabetes mellitus
boolean
C0011849 (UMLS CUI)
191044006 (SNOMED CT 2010_0731)
Early Coronary Vascular Disease
Item
Early Coronary Vascular Disease
boolean
Colon Cancer
Item
Colon Carcinoma
boolean
C0699790 (UMLS CUI)
269533000 (SNOMED CT 2010_0731)
10009957 (MedDRA 13.1)
Other
Item
Other
text
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