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Genereral information EBMT CLL

1 Formulare  
Team
Beschreibung

Team

EBMT Centre Identification Code (CIC)
Beschreibung

EBMT Centre Identification Code (CIC)

Datentyp

text

Alias
UMLS CUI [1]
C2348585
Name of the hospital
Beschreibung

Hospital

Datentyp

text

Alias
UMLS CUI [1]
C0019994
Unit
Beschreibung

Department

Datentyp

text

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

Contact person

Datentyp

text

Alias
UMLS CUI [1]
C0337611
Telephone number
Beschreibung

Telephone

Datentyp

text

Alias
UMLS CUI [1]
C1515258
Fax number
Beschreibung

Fax

Datentyp

text

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

E-Mail

Datentyp

text

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

Date of this report

Datentyp

date

Alias
UMLS CUI [1]
C1302584
Patient following national/ international study/ trial
Beschreibung

Study/ Trial

Datentyp

text

Alias
UMLS CUI [1]
C2348568
If yes, specify Name of study/ trial
Beschreibung

Study Name

Datentyp

text

Alias
UMLS CUI [1]
C2348560
Patient
Beschreibung

Patient

To be entered only if patient previously reported
Beschreibung

Unique Identification Code (UIC)

Datentyp

text

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

Hospital Unique Patient Number or Code

Datentyp

text

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

Initials

Datentyp

text

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

Date of birth

Datentyp

date

Alias
UMLS CUI [1]
C0421451
Patient Gender
Beschreibung

Gender

Datentyp

text

Alias
UMLS CUI [1]
C0079399
AB0 Blood Group
Beschreibung

AB0 Blood Group

Datentyp

text

Alias
UMLS CUI [1]
C0005810
Specification of blood group (Rhesus factor)
Beschreibung

Rhesus Factor

Datentyp

text

Alias
UMLS CUI [1]
C0427641
Disease
Beschreibung

Disease

Date of Diagnosis
Beschreibung

Date of Diagnosis

Datentyp

date

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

Primary Disease Diagnosis

Datentyp

text

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

Primary Disease Diagnosis

Datentyp

text

Alias
UMLS CUI [1,1]
C0277554
UMLS CUI [1,2]
C2348235
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Ähnliche Modelle

Genereral information EBMT CLL

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Team
EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
text
C2348585 (UMLS CUI [1])
Hospital
Item
Name of the hospital
text
C0019994 (UMLS CUI [1])
Department
Item
Unit
text
C1704729 (UMLS CUI [1])
Contact person
Item
Name of 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 following national/ international study/ trial
text
C2348568 (UMLS CUI [1])
Study/ Trial
Code List
Patient following national/ international study/ trial
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Study Name
Item
If yes, specify Name of study/ trial
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
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])
Date of birth
Item
Date of birth (Registrations will not be accepted if this item is left blank)
date
C0421451 (UMLS CUI [1])
Item
Patient Gender
text
C0079399 (UMLS CUI [1])
Gender
Code List
Patient Gender
CL Item
Female (Female)
CL Item
Male (Male)
Item
AB0 Blood Group
text
C0005810 (UMLS CUI [1])
AB0 Blood Group
Code List
AB0 Blood Group
CL Item
A (A)
CL Item
B (B)
CL Item
0 (0)
CL Item
AB (AB)
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
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)
Primary Disease Diagnosis
Item
If other diagnosis, specify:
text
C0277554 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
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