ID

13681

Beschrijving

ODM derived from HSCT forms on http://www.ebmt.org/

Link

http://www.ebmt.org/

Trefwoorden

Versies (2)
  1. 07-02-16 07-02-16 -
  2. 28-02-16 28-02-16 -
Geüploaded op

28 februari 2016

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC-ND 3.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Genereral information EBMT MDS

Engels

Genereral information EBMT MDS

1 Formulieren  
Team
Beschrijving

Team

Alias
UMLS CUI-1
C0019994
EBMT Centre Identification Code (CIC)
Beschrijving

EBMT Centre Identification Code

Datatype

text

Alias
UMLS CUI [1]
C0802049
Name of the hospital
Beschrijving

Hospital

Datatype

text

Alias
UMLS CUI [1]
C0019994
Unit
Beschrijving

Unit

Datatype

text

Alias
UMLS CUI [1]
C1704729
Name of contact person
Beschrijving

Contact person

Datatype

text

Alias
UMLS CUI [1]
C0337611
Telephone number of contact person
Beschrijving

Telephone

Datatype

text

Alias
UMLS CUI [1]
C1515258
Fax number of contact number
Beschrijving

Fax

Datatype

text

Alias
UMLS CUI [1]
C1549619
E-mail address of contact number
Beschrijving

E-mail

Datatype

text

Alias
UMLS CUI [1]
C1705961
Date of this report
Beschrijving

Date of this report

Datatype

date

Alias
UMLS CUI [1]
C1302584
Patient following national/ international study/ trial if yes specify name of study/ trial
Beschrijving

Study/ Trial

Datatype

text

Alias
UMLS CUI [1]
C2348568
Name of study trial
Beschrijving

Name of study trial

Datatype

text

Alias
UMLS CUI [1]
C2348560
Patient
Beschrijving

Patient

Alias
UMLS CUI-1
C0030705
Unique identification code (to be entered if patient previously reported)
Beschrijving

Unique identification code

Datatype

text

Alias
UMLS CUI [1]
C1827636
Hospital Unique Patient number or code
Beschrijving

Hospital Unique Patient number or code

Datatype

text

Alias
UMLS CUI [1]
C1827636
First name(s) - surname(s) (Registrations will not be accepted if this item is left blank)
Beschrijving

Initials

Datatype

text

Alias
UMLS CUI [1]
C2986440
Patient Firstname (Registrations will not be accepted if this item is left blank)
Beschrijving

Patient Firstname

Datatype

text

Alias
UMLS CUI [1]
C0421447
Patient Surname (Registrations will not be accepted if this item is left blank)
Beschrijving

Patient Surname

Datatype

text

Alias
UMLS CUI [1]
C0421448
Date of birth
Beschrijving

Date of birth

Datatype

date

Alias
UMLS CUI [1]
C0421451
Gender of patient
Beschrijving

Gender

Datatype

text

Alias
UMLS CUI [1]
C0079399
Patient's blood group (AB0)
Beschrijving

AB0 Group

Datatype

text

Alias
UMLS CUI [1]
C0000778
Specification of blood group (Rhesus factor)
Beschrijving

Rhesus Factor

Datatype

text

Alias
UMLS CUI [1]
C0427641
Disease
Beschrijving

Disease

Alias
UMLS CUI-1
C0012634
Date of diagnosis
Beschrijving

Date of diagnosis

Datatype

date

Alias
UMLS CUI [1]
C2316983
Check the disease for which this transplant was performed (if other diagnosis, specify)
Beschrijving

Primary Disease Diagnosis

Datatype

text

Alias
UMLS CUI [1]
C0277554
If use other diagnosis, specification
Beschrijving

Primary Disease Diagnosis

Datatype

text

Alias
UMLS CUI [1]
C0277554
Terug naar het begin van de pagina

Similar models

Genereral information EBMT MDS

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Team
C0019994 (UMLS CUI-1)
EBMT Centre Identification Code
Item
EBMT Centre Identification Code (CIC)
text
C0802049 (UMLS CUI [1])
Hospital
Item
Name of the hospital
text
C0019994 (UMLS CUI [1])
Unit
Item
Unit
text
C1704729 (UMLS CUI [1])
Contact person
Item
Name of contact person
text
C0337611 (UMLS CUI [1])
Telephone
Item
Telephone number of contact person
text
C1515258 (UMLS CUI [1])
Fax
Item
Fax number of contact number
text
C1549619 (UMLS CUI [1])
E-mail
Item
E-mail address of contact number
text
C1705961 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national/ international study/ trial if yes specify name of study/ trial
text
C2348568 (UMLS CUI [1])
Study/ Trial
Code List
Patient following national/ international study/ trial if yes specify name of study/ trial
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Name of study trial
Item
Name of study trial
text
C2348560 (UMLS CUI [1])
Item Group
Patient
C0030705 (UMLS CUI-1)
Unique identification code
Item
Unique identification code (to be entered if patient previously reported)
text
C1827636 (UMLS CUI [1])
Hospital Unique Patient number or code
Item
Hospital Unique Patient number or code
text
C1827636 (UMLS CUI [1])
Initials
Item
First name(s) - surname(s) (Registrations will not be accepted if this item is left blank)
text
C2986440 (UMLS CUI [1])
Patient Firstname
Item
Patient Firstname (Registrations will not be accepted if this item is left blank)
text
C0421447 (UMLS CUI [1])
Patient Surname
Item
Patient Surname (Registrations will not be accepted if this item is left blank)
text
C0421448 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Gender of patient
text
C0079399 (UMLS CUI [1])
Gender
Code List
Gender of patient
CL Item
Male (Male)
CL Item
Female (Female)
Item
Patient's blood group (AB0)
text
C0000778 (UMLS CUI [1])
AB0 Group
Code List
Patient's blood group (AB0)
CL Item
A (A)
CL Item
B (B)
CL Item
AB (AB)
CL Item
0 (0)
Item
Specification of blood group (Rhesus factor)
text
C0427641 (UMLS CUI [1])
Rhesus Factor
Code List
Specification of blood group (Rhesus factor)
CL Item
absent (absent)
CL Item
present (present)
CL Item
not evaluated (not evaluated)
Item Group
Disease
C0012634 (UMLS CUI-1)
Date of diagnosis
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1])
Item
Check the disease for which this transplant was performed (if other diagnosis, specify)
text
C0277554 (UMLS CUI [1])
Primary Disease Diagnosis
Code List
Check the disease for which this transplant was performed (if other diagnosis, specify)
CL Item
Acute Leukaemia (Acute Leukaemia)
CL Item
Myelogenous (AML) (Myelogenous (AML))
CL Item
Lymphoblastic (ALL) (Lymphoblastic (ALL))
CL Item
Secondary Acute Leukaemia (Do not use if transformed from MDS/ MPN) (Secondary Acute Leukaemia (Do not use if transformed from MDS/ MPN))
CL Item
Chronic Leukaemia (Chronic Leukaemia)
CL Item
Chronic Myeloid Leukaemia (CML) (Chronic Myeloid Leukaemia (CML))
CL Item
Chronic Lymphocytic Leukaemia (CLL) (Chronic Lymphocytic Leukaemia (CLL))
CL Item
Lymphoma (Lymphoma)
CL Item
Non Hodgkin (Non Hodgkin)
CL Item
Hodgkin's Disease (Hodgkin's Disease)
CL Item
Myeloma/ Plasma Cell Disorder (Myeloma/ Plasma Cell Disorder)
CL Item
Solid Tumor (Solid Tumor)
CL Item
Myelodysplastic Syndromes (Myelodysplastic Syndromes)
CL Item
MDS (MDS)
CL Item
MD/ MPN (MD/ MPN)
CL Item
Myeloproliferative neoplasm (Myeloproliferative neoplasm)
CL Item
Bone marrow failure including Aplastic Anaemia (Bone marrow failure including Aplastic Anaemia)
CL Item
Inherited disorders (Inherited disorders)
CL Item
Primary immune deficiencies (Primary immune deficiencies)
CL Item
Metabolic disorders (Metabolic disorders)
CL Item
Histocytic Disorders (Histocytic Disorders)
CL Item
Autoimmune Disease (Autoimmune Disease)
CL Item
Juvenile Idiopathic Arthritis (Juvenile Idiopathic Arthritis)
CL Item
Multiple Sclerosis (Multiple Sclerosis)
CL Item
Systemic Lupus (Systemic Lupus)
CL Item
Systemic Sclerosis (Systemic Sclerosis)
CL Item
Haemoglobinopathy (Haemoglobinopathy)
CL Item
Other diagnosis (Other diagnosis)
Primary Disease Diagnosis
Item
If use other diagnosis, specification
text
C0277554 (UMLS CUI [1])
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial