ID

13708

Description

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

Link

http://www.ebmt.org/

Keywords

Versions (2)
  1. 2/21/16 2/21/16 -
  2. 2/29/16 2/29/16 -
Uploaded on

February 29, 2016

DOI

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License

Creative Commons BY-NC-ND 3.0
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General Information EBMT CML

English

General Information EBMT CML

1 forms  
Team
Description

Team

EBMT Centre Identification Code (CIC)
Description

EBMT Centre Identification Code (CIC)

Data type

text

Alias
UMLS CUI [1]
C2348585
Hospital
Description

Hospital

Data type

text

Alias
UMLS CUI [1]
C0019994
Department within the Hospital
Description

Unit

Data type

text

Alias
UMLS CUI [1]
C1704729
Name of a Contact Person
Description

Contact Person

Data type

text

Alias
UMLS CUI [1]
C0337611
Telephone number
Description

Telephone

Data type

text

Alias
UMLS CUI [1]
C1515258
Fax number
Description

Fax

Data type

text

Alias
UMLS CUI [1]
C1549619
E-Mail Address
Description

E-Mail

Data type

text

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

Date of this report

Data type

date

Alias
UMLS CUI [1]
C1302584
Patient follwing national/ international study/ trial
Description

Study/ Trial

Data type

text

Alias
UMLS CUI [1]
C2348568
Patient following national/ international study/ trial: If yes, specify:
Description

Study name

Data type

text

Alias
UMLS CUI [1]
C2348560
Patient
Description

Patient

To be entered only if patient previously reported
Description

Unique Identification Code (UIC)

Data type

text

Alias
UMLS CUI [1]
C2348585
Hospital Unique Patient Number or Code
Description

Hospital Unique Patient Number or Code

Data type

text

Alias
UMLS CUI [1]
C2348585
First name(s) - surname(s) (Registration will not be accepted if this item is left blank)
Description

Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Date of birth (Registration will not be accepted if this item is left blank)
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Patient's sex (Registration will not be accepted if this item is left blank)
Description

Sex

Data type

text

Alias
UMLS CUI [1]
C0079399
AB0 Blood Group
Description

AB0 Blood Group

Data type

text

Alias
UMLS CUI [1]
C0005810
Rhesus factor
Description

Rhesus factor

Data type

text

Alias
UMLS CUI [1]
C0427641
Disease
Description

Disease

Date of Diagnosis
Description

Date of Diagnosis

Data type

date

Alias
UMLS CUI [1]
C2316983
Check the disease for which this transplant was performed
Description

Primary Disease Diagnosis

Data type

text

Alias
UMLS CUI [1]
C0277554
If other, specify:
Description

Other Primary Disease Diagnosis

Data type

text

Alias
UMLS CUI [1,1]
C0277554
UMLS CUI [1,2]
C2348235
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Similar models

General Information EBMT CML

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Team
EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
text
C2348585 (UMLS CUI [1])
Hospital
Item
Hospital
text
C0019994 (UMLS CUI [1])
Unit
Item
Department within the Hospital
text
C1704729 (UMLS CUI [1])
Contact Person
Item
Name of a Contact Person
text
C0337611 (UMLS CUI [1])
Telephone
Item
Telephone number
text
C1515258 (UMLS CUI [1])
Fax
Item
Fax number
text
C1549619 (UMLS CUI [1])
E-Mail
Item
E-Mail Address
text
C1705961 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient follwing national/ international study/ trial
text
C2348568 (UMLS CUI [1])
Study/ Trial
Code List
Patient follwing national/ international study/ trial
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Study name
Item
Patient following national/ international study/ trial: If yes, specify:
text
C2348560 (UMLS CUI [1])
Item Group
Patient
Unique Identification Code (UIC)
Item
To be entered only if patient previously reported
text
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number or Code
Item
Hospital Unique Patient Number or Code
text
C2348585 (UMLS CUI [1])
Initials
Item
First name(s) - surname(s) (Registration will not be accepted if this item is left blank)
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth (Registration will not be accepted if this item is left blank)
date
C0421451 (UMLS CUI [1])
Item
Patient's sex (Registration will not be accepted if this item is left blank)
text
C0079399 (UMLS CUI [1])
Sex
Code List
Patient's sex (Registration will not be accepted if this item is left blank)
CL Item
Male (Male)
CL Item
Female (Female)
Item
AB0 Blood Group
text
C0005810 (UMLS CUI [1])
Blood Group
Code List
AB0 Blood Group
CL Item
A (A)
CL Item
B (B)
CL Item
0 (0)
CL Item
AB (AB)
Item
Rhesus factor
text
C0427641 (UMLS CUI [1])
Blood Group
Code List
Rhesus factor
CL Item
Absent (Absent)
CL Item
Present (Present)
CL Item
Not evaluated (Not evaluated)
Item Group
Disease
Date of Diagnosis
Item
Date of Diagnosis
date
C2316983 (UMLS CUI [1])
Item
Check the disease for which this transplant was performed
text
C0277554 (UMLS CUI [1])
Primary Disease Diagnosis
Code List
Check the disease for which this transplant was performed
CL Item
Acute Leukaemia (Acute Leukaemia)
CL Item
Acute Myelogenous Leukaemia (AML) (Acute Myelogenous Leukaemia (AML))
CL Item
Acute Lymphoblastic Leukaemia (ALL) (Acute Lymphoblastic Leukaemia (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 (Chronic Lymphocytic Leukaemia)
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 Tumour (Solid Tumour)
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
Histiocytic disorders (Histiocytic 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
Haemoglobinopathiy (Haemoglobinopathiy)
CL Item
Other diagnosis (Other diagnosis)
Other Primary Disease Diagnosis
Item
If other, specify:
text
C0277554 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
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