AML- Register_Registration form_SAL_University hospital dresden

Clinic information
Description

Clinic information

Name of the hospital:
Description

hospital name

Data type

text

Alias
UMLS CUI [1]
C2825164
Clinic code:
Description

Clinic code

Data type

integer

Alias
UMLS CUI [1,1]
C2825164
UMLS CUI [1,2]
C0600091
Hospital address:
Description

hospital address

Data type

text

Alias
UMLS CUI [1]
C1442065
Telephone number:
Description

Telephone number

Data type

integer

Alias
UMLS CUI [1]
C1515258
Fax number:
Description

Fax number

Data type

integer

Alias
UMLS CUI [1]
C0085205
Patient information
Description

Patient information

Alias
UMLS CUI-1
C2707520
Patient's surname:
Description

Surname

Data type

text

Alias
UMLS CUI [1,1]
C1299487
UMLS CUI [1,2]
C1301584
Patient's first name:
Description

first name

Data type

text

Alias
UMLS CUI [1]
C1443235
Patient ID:
Description

Patient ID

Data type

integer

Alias
UMLS CUI [1]
C2348585
Date of birth:
Description

date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Gender:
Description

Gender

Data type

text

Alias
UMLS CUI [1]
C0079399
Patient's address:
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
Address of the family doctor:
Description

family doctor address

Data type

text

Alias
UMLS CUI [1]
C0017319
Is the signed informed consent available?
Description

informed consent

Data type

boolean

Alias
UMLS CUI [1]
C0021430
Does the patient agree to the transfer of ownership of the collected tissue sample?
Description

transfer of ownership; tissue sample

Data type

boolean

Alias
UMLS CUI [1,1]
C1292533
UMLS CUI [1,2]
C0021430

Similar models

AML- Register_Registration form_SAL_University hospital dresden

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Clinic information
hospital name
Item
Name of the hospital:
text
C2825164 (UMLS CUI [1])
Clinic code
Item
Clinic code:
integer
C2825164 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
hospital address
Item
Hospital address:
text
C1442065 (UMLS CUI [1])
Telephone number
Item
Telephone number:
integer
C1515258 (UMLS CUI [1])
Fax number
Item
Fax number:
integer
C0085205 (UMLS CUI [1])
Item Group
Patient information
C2707520 (UMLS CUI-1)
Surname
Item
Patient's surname:
text
C1299487 (UMLS CUI [1,1])
C1301584 (UMLS CUI [1,2])
first name
Item
Patient's first name:
text
C1443235 (UMLS CUI [1])
Patient ID
Item
Patient ID:
integer
C2348585 (UMLS CUI [1])
date of birth
Item
Date of birth:
date
C0421451 (UMLS CUI [1])
Item
Gender:
text
C0079399 (UMLS CUI [1])
Code List
Gender:
CL Item
Male (1)
C0086582 (UMLS CUI-1)
CL Item
Female (2)
C0015780 (UMLS CUI-1)
Patient address
Item
Patient's address:
text
C0421449 (UMLS CUI [1])
family doctor address
Item
Address of the family doctor:
text
C0017319 (UMLS CUI [1])
informed consent
Item
Is the signed informed consent available?
boolean
C0021430 (UMLS CUI [1])
transfer of ownership; tissue sample
Item
Does the patient agree to the transfer of ownership of the collected tissue sample?
boolean
C1292533 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])