Engels

CRF Continuous Documentation

1 Formulieren  
Diseases
Beschrijving

Diseases

Alias
UMLS CUI-1
C0012634
Study-ID:
Beschrijving

study id

Datatype

text

Alias
UMLS CUI [1]
C2826693
Does the participant have any pre-existing conditions or comorbidities?
Beschrijving

If 'yes' please fill-out the following table

Datatype

boolean

Alias
UMLS CUI [1]
C0521987
UMLS CUI [2]
C0009488
Documentation of diseases
Beschrijving

Documentation of diseases

No.
Beschrijving

no of diagnosis

Datatype

integer

Alias
UMLS CUI [1,1]
C0237753
UMLS CUI [1,2]
C0011900
Diagnosis
Beschrijving

Please regard the following diagnoses: Hypertension, diabetes mellitus, hypercholesterolemia, stroke, epilepsy, heart attack, recurrent depressive episode, neoplasms, thyroid disease, renal insufficiency. You can use the checklist pre-existing condition. In the database one can choose the ICD-Code after data entry.

Datatype

text

Alias
UMLS CUI [1]
C0011900
Onset of disease
Beschrijving

onset of disease

Datatype

date

Alias
UMLS CUI [1]
C0277793
End of disease
Beschrijving

end of disease

Datatype

date

Alias
UMLS CUI [1]
C4019088
Disease enduring
Beschrijving

enduring

Datatype

boolean

Alias
UMLS CUI [1]
C1314677
Checklist pre-existing conditions
Beschrijving

Checklist pre-existing conditions

No. 1 Hypertension
Beschrijving

hypertension diagnosed

Datatype

text

Alias
UMLS CUI [1]
C0020538
Initial diagnosis
Beschrijving

date initial diagnosis hypertension

Datatype

date

Alias
UMLS CUI [1,1]
C0020538
UMLS CUI [1,2]
C2316983
No.2 Hypercholesterolemia
Beschrijving

hypercholesterolemia

Datatype

text

Alias
UMLS CUI [1]
C0020443
Initial diagnosis
Beschrijving

date initial diagnosis hypercholesterolemia

Datatype

date

Alias
UMLS CUI [1,1]
C0020443
UMLS CUI [1,2]
C2316983
No.3 Hypertriglyceridemia
Beschrijving

hypertriglyceridemia

Datatype

text

Alias
UMLS CUI [1]
C0020557
Initial diagnosis
Beschrijving

date initial diagnosis hypertriglyceridemia

Datatype

date

Alias
UMLS CUI [1,1]
C0020557
UMLS CUI [1,2]
C2316983
No.4 Other hyperlipedimia or dyslipidemia
Beschrijving

hyperlipedimia or dyslipidemia

Datatype

text

Alias
UMLS CUI [1]
C0020473
UMLS CUI [2]
C0242339
Initial diagnosis
Beschrijving

initial diagnosis of hyperlipedimia or dyslipedimia

Datatype

date

Alias
UMLS CUI [1,1]
C0020473
UMLS CUI [1,2]
C2316983
UMLS CUI [2,1]
C0242339
UMLS CUI [2,2]
C2316983
No. 5 Diabetes mellitus type 1
Beschrijving

diabetes mellitus type 1

Datatype

text

Alias
UMLS CUI [1]
C0011854
Initial diagnosis
Beschrijving

initial diagnosis of diabetes type 1

Datatype

date

Alias
UMLS CUI [1,1]
C0011854
UMLS CUI [1,2]
C2316983
No. 6 Diabetes mellitus type 2
Beschrijving

diabetes mellitus type 2

Datatype

text

Alias
UMLS CUI [1]
C0011860
Initial diagnosis
Beschrijving

initial diagnosis of diabetes type 2

Datatype

date

Alias
UMLS CUI [1,1]
C0011860
UMLS CUI [1,2]
C2316983
No. 7 Diabetic polyneuropathy
Beschrijving

diabetic polyneuropathy

Datatype

text

Alias
UMLS CUI [1]
C0271680
Initial diagnosis
Beschrijving

initial diagnosis of diabetic polyneuropathy

Datatype

date

Alias
UMLS CUI [1,1]
C0271680
UMLS CUI [1,2]
C2316983
No. 8 Cardiac infarction
Beschrijving

cardiac infarction

Datatype

text

Alias
UMLS CUI [1]
C0027051
Initial diagnosis
Beschrijving

date of initial diagnosis cardiac infarction

Datatype

date

Alias
UMLS CUI [1,1]
C0027051
UMLS CUI [1,2]
C2316983
No.9 Transient ischemic attack (TIA)
Beschrijving

transient ischemic attack

Datatype

text

Alias
UMLS CUI [1]
C0007787
Initial diagnosis
Beschrijving

date of initial diagnosis TIA

Datatype

date

Alias
UMLS CUI [1,1]
C0007787
UMLS CUI [1,2]
C2316983
No. 10 Coronary heart disease
Beschrijving

coronary heart disease

Datatype

text

Alias
UMLS CUI [1]
C0010068
Initial diagnosis
Beschrijving

date of initial diagnosis coronary heart disease

Datatype

date

Alias
UMLS CUI [1,1]
C0010068
UMLS CUI [1,2]
C2316983
No. 11 Stroke (ischemic)
Beschrijving

stroke

Datatype

text

Alias
UMLS CUI [1]
C0038454
Initial diagnosis
Beschrijving

date of initial diagnosis stroke

Datatype

date

Alias
UMLS CUI [1,1]
C0038454
UMLS CUI [1,2]
C2316983
No. 12 Cerebral venous sinus thrombosis or cerebral thrombosis
Beschrijving

cerebral venous sinus thrombosis or cerebral thrombosis

Datatype

text

Alias
UMLS CUI [1]
C0338573
UMLS CUI [2]
C0079102
Initial date
Beschrijving

date of initial diagnosis cerebral venous sinus thrombosis

Datatype

date

Alias
UMLS CUI [1,1]
C0338573
UMLS CUI [1,2]
C2316983
UMLS CUI [2,1]
C0079102
UMLS CUI [2,2]
C2316983
No. 13 Subarachnoid hemorrhage
Beschrijving

subarachnoid hemorrhage

Datatype

text

Alias
UMLS CUI [1]
C0038525
Initial diagnosis
Beschrijving

date of initial diagnosis SAB

Datatype

date

Alias
UMLS CUI [1,1]
C0038525
UMLS CUI [1,2]
C2316983
No. 14 Intracerebral hemorrhage (ICH)
Beschrijving

ICH

Datatype

text

Alias
UMLS CUI [1]
C2937358
Initial diagnosis
Beschrijving

date of initial diagnosis ICH

Datatype

date

Alias
UMLS CUI [1,1]
C2937358
UMLS CUI [1,2]
C2316983
No. 15 Subdural hematoma
Beschrijving

subdural hematoma

Datatype

text

Alias
UMLS CUI [1]
C0018946
Initial diagnosis
Beschrijving

date of initial diagnosis subdural hematoma

Datatype

date

Alias
UMLS CUI [1,1]
C0018946
UMLS CUI [1,2]
C2316983
No. 16 Concussion
Beschrijving

concussion

Datatype

text

Alias
UMLS CUI [1]
C0006107
Initial diagnosis
Beschrijving

date of initial diagnosis concussion

Datatype

date

Alias
UMLS CUI [1,1]
C0006107
UMLS CUI [1,2]
C2316983
No. 17 Other pre-existing brain condition
Beschrijving

other pre-existing brain condition

Datatype

text

Alias
UMLS CUI [1,1]
C0006111
UMLS CUI [1,2]
C2347662
UMLS CUI [1,3]
C0205394
Initial diagnosis
Beschrijving

date of initial diagnosis other pre-existing brain condition

Datatype

date

Alias
UMLS CUI [1,1]
C0006111
UMLS CUI [1,2]
C2347662
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C2316983
No. 18 Peripheral arterial disease
Beschrijving

peripheral arterial disease

Datatype

text

Alias
UMLS CUI [1]
C1704436
Initial diagnosis
Beschrijving

date of initial diagnosis PAD

Datatype

date

Alias
UMLS CUI [1,1]
C1704436
UMLS CUI [1,2]
C2316983
No. 19 Atrial fibrillation
Beschrijving

atrial fibrillation

Datatype

text

Alias
UMLS CUI [1]
C0004238
Initial diagnosis
Beschrijving

date of initial diagnosis atrial fillibration

Datatype

date

Alias
UMLS CUI [1,1]
C0004238
UMLS CUI [1,2]
C2316983
No. 20 Hemophilia
Beschrijving

hemophilia

Datatype

text

Alias
UMLS CUI [1]
C0684275
Initial diagnosis
Beschrijving

date of initial diagnosis hemophilia

Datatype

date

Alias
UMLS CUI [1,1]
C0684275
UMLS CUI [1,2]
C2316983
No. 21 Parkinson's disease
Beschrijving

parkinsons disease

Datatype

text

Alias
UMLS CUI [1]
C0030567
Initial diagnosis
Beschrijving

date of initial diagnosis PD

Datatype

date

Alias
UMLS CUI [1,1]
C0030567
UMLS CUI [1,2]
C2316983
No. 22 Rheumatism or arthritis
Beschrijving

rheumatism or arthritis

Datatype

text

Alias
UMLS CUI [1]
C0035435
UMLS CUI [2]
C0003864
Initial diagnosis
Beschrijving

date of initial diagnosis rheumatism or arthritis

Datatype

date

Alias
UMLS CUI [1,1]
C0035435
UMLS CUI [1,2]
C2316983
UMLS CUI [2,1]
C0003864
UMLS CUI [2,2]
C2316983
No. 23 Hypersensitivity
Beschrijving

allergies

Datatype

text

Alias
UMLS CUI [1]
C0020517
Initial diagnosis
Beschrijving

date of initial diagnosis hypersensitivity

Datatype

date

Alias
UMLS CUI [1,1]
C0020517
UMLS CUI [1,2]
C2316983
Terug naar het begin van de pagina

Similar models

CRF Continuous Documentation

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Diseases
C0012634 (UMLS CUI-1)
study id
Item
Study-ID:
text
C2826693 (UMLS CUI [1])
pre-existing codition and comorbidities
Item
Does the participant have any pre-existing conditions or comorbidities?
boolean
C0521987 (UMLS CUI [1])
C0009488 (UMLS CUI [2])
Item Group
Documentation of diseases
no of diagnosis
Item
No.
integer
C0237753 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
diagnosis
Item
Diagnosis
text
C0011900 (UMLS CUI [1])
onset of disease
Item
Onset of disease
date
C0277793 (UMLS CUI [1])
end of disease
Item
End of disease
date
C4019088 (UMLS CUI [1])
enduring
Item
Disease enduring
boolean
C1314677 (UMLS CUI [1])
Item Group
Checklist pre-existing conditions
Item
No. 1 Hypertension
text
C0020538 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 1 Hypertension
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date initial diagnosis hypertension
Item
Initial diagnosis
date
C0020538 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No.2 Hypercholesterolemia
text
C0020443 (UMLS CUI [1])
hypertension diagnosed
Code List
No.2 Hypercholesterolemia
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date initial diagnosis hypercholesterolemia
Item
Initial diagnosis
date
C0020443 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No.3 Hypertriglyceridemia
text
C0020557 (UMLS CUI [1])
hypertension diagnosed
Code List
No.3 Hypertriglyceridemia
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date initial diagnosis hypertriglyceridemia
Item
Initial diagnosis
date
C0020557 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No.4 Other hyperlipedimia or dyslipidemia
text
C0020473 (UMLS CUI [1])
C0242339 (UMLS CUI [2])
hypertension diagnosed
Code List
No.4 Other hyperlipedimia or dyslipidemia
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
initial diagnosis of hyperlipedimia or dyslipedimia
Item
Initial diagnosis
date
C0020473 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
C0242339 (UMLS CUI [2,1])
C2316983 (UMLS CUI [2,2])
Item
No. 5 Diabetes mellitus type 1
text
C0011854 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 5 Diabetes mellitus type 1
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
initial diagnosis of diabetes type 1
Item
Initial diagnosis
date
C0011854 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 6 Diabetes mellitus type 2
text
C0011860 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 6 Diabetes mellitus type 2
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
initial diagnosis of diabetes type 2
Item
Initial diagnosis
date
C0011860 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 7 Diabetic polyneuropathy
text
C0271680 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 7 Diabetic polyneuropathy
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
initial diagnosis of diabetic polyneuropathy
Item
Initial diagnosis
date
C0271680 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 8 Cardiac infarction
text
C0027051 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 8 Cardiac infarction
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis cardiac infarction
Item
Initial diagnosis
date
C0027051 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No.9 Transient ischemic attack (TIA)
text
C0007787 (UMLS CUI [1])
hypertension diagnosed
Code List
No.9 Transient ischemic attack (TIA)
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis TIA
Item
Initial diagnosis
date
C0007787 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 10 Coronary heart disease
text
C0010068 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 10 Coronary heart disease
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis coronary heart disease
Item
Initial diagnosis
date
C0010068 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 11 Stroke (ischemic)
text
C0038454 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 11 Stroke (ischemic)
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis stroke
Item
Initial diagnosis
date
C0038454 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 12 Cerebral venous sinus thrombosis or cerebral thrombosis
text
C0338573 (UMLS CUI [1])
C0079102 (UMLS CUI [2])
hypertension diagnosed
Code List
No. 12 Cerebral venous sinus thrombosis or cerebral thrombosis
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis cerebral venous sinus thrombosis
Item
Initial date
date
C0338573 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
C0079102 (UMLS CUI [2,1])
C2316983 (UMLS CUI [2,2])
Item
No. 13 Subarachnoid hemorrhage
text
C0038525 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 13 Subarachnoid hemorrhage
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis SAB
Item
Initial diagnosis
date
C0038525 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 14 Intracerebral hemorrhage (ICH)
text
C2937358 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 14 Intracerebral hemorrhage (ICH)
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis ICH
Item
Initial diagnosis
date
C2937358 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 15 Subdural hematoma
text
C0018946 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 15 Subdural hematoma
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis subdural hematoma
Item
Initial diagnosis
date
C0018946 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 16 Concussion
text
C0006107 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 16 Concussion
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis concussion
Item
Initial diagnosis
date
C0006107 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 17 Other pre-existing brain condition
text
C0006111 (UMLS CUI [1,1])
C2347662 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
hypertension diagnosed
Code List
No. 17 Other pre-existing brain condition
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis other pre-existing brain condition
Item
Initial diagnosis
date
C0006111 (UMLS CUI [1,1])
C2347662 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2316983 (UMLS CUI [1,4])
Item
No. 18 Peripheral arterial disease
text
C1704436 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 18 Peripheral arterial disease
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis PAD
Item
Initial diagnosis
date
C1704436 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 19 Atrial fibrillation
text
C0004238 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 19 Atrial fibrillation
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis atrial fillibration
Item
Initial diagnosis
date
C0004238 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 20 Hemophilia
text
C0684275 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 20 Hemophilia
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis hemophilia
Item
Initial diagnosis
date
C0684275 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 21 Parkinson's disease
text
C0030567 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 21 Parkinson's disease
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis PD
Item
Initial diagnosis
date
C0030567 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
No. 22 Rheumatism or arthritis
text
C0035435 (UMLS CUI [1])
C0003864 (UMLS CUI [2])
hypertension diagnosed
Code List
No. 22 Rheumatism or arthritis
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis rheumatism or arthritis
Item
Initial diagnosis
date
C0035435 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
C0003864 (UMLS CUI [2,1])
C2316983 (UMLS CUI [2,2])
Item
No. 23 Hypersensitivity
text
C0020517 (UMLS CUI [1])
hypertension diagnosed
Code List
No. 23 Hypersensitivity
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Not specified (Not specified)
date of initial diagnosis hypersensitivity
Item
Initial diagnosis
date
C0020517 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Terug naar het begin van de pagina