Name
Item
Patient given name
text
C1299487 (UMLS CUI [1])
Surname
Item
Patient surname
text
C0421448 (UMLS CUI [1])
Date of birth
Item
Patient date of birth
date
C0421451 (UMLS CUI [1])
Item
Gender
integer
C0079399 (UMLS CUI [1])
Patient address
Item
Street name, house or appartement number, zip code and city of residence
text
C0421449 (UMLS CUI [1])
Phone contact
Item
Please enter a phone number for the annual interview
integer
C3476398 (UMLS CUI [1])
Cell phone number
Item
Please enter a cell phone number if applicable
integer
C1515258 (UMLS CUI [1])
Name
Item
Given name of patient´s relative
text
C0027365 (UMLS CUI [1])
Surname
Item
Last name of patient´s relative
text
C1301584 (UMLS CUI [1])
Date of birth
Item
Date of birth of patient´s relative
date
C0421451 (UMLS CUI [1])
Item
Gender
integer
C0079399 (UMLS CUI [1])
Address
Item
Home Address of patient´s relative
text
C1442065 (UMLS CUI [1])
Phone contact
Item
Please enter a phone number to contact the patient´s relative
integer
C3476398 (UMLS CUI [1])
Cell phone number
Item
Please enter a cell phone number, if applicable
integer
C1515258 (UMLS CUI [1])
Item
Relationship to patient
integer
C0015608 (UMLS CUI [1])
Code List
Relationship to patient
CL Item
spouse/cohabitee (1)
CL Item
father or mother (3)
CL Item
other (specify) (5)
Relationship
Item
Please specify other relationship to patient
text
C0439849 (UMLS CUI [1])
Name
Item
Name and Surname
text
C0027365 (UMLS CUI [1])
Function
Item
Function of contact person
text
C0542341 (UMLS CUI [1])
Facility name
Item
Facility name
text
C0018704 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
Department
Item
Department
text
C1704729 (UMLS CUI [1])
Address
Item
Address:street name, house number,zip code and city of residence.
text
C1442065 (UMLS CUI [1])
Phone contact
Item
Please enter a phone number for contact
integer
C3476398 (UMLS CUI [1])