ID

14884

Description

Item used as routine documentation by Clinic Erlangen, Dermatology, Outpatient Department. ODM derived from original form “Derma- Ambulanz Erlangen”.

Keywords

Versions (1)
  1. 5/3/16 5/3/16 -
Uploaded on

May 3, 2016

DOI

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License

Creative Commons BY-NC 3.0
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Outpatient Department Form Dermatology Clinic Erlangen

English

Outpatient Department Form Dermatology

1 forms  
Principal diagnosis
Description

Principal diagnosis

Alias
UMLS CUI-1
C0332137
Principal diagnosis 1
Description

principal diagnosis

Data type

text

Alias
UMLS CUI [1]
C0332137
Diagnosis unchanged since
Description

date diagnosis

Data type

date

Alias
UMLS CUI [1]
C2316983
Principal diagnosis 2
Description

Principal diagnosis

Data type

text

Alias
UMLS CUI [1]
C0332137
Diagnosis unchanged since
Description

date diagnosis

Data type

date

Alias
UMLS CUI [1]
C2316983
Attending physician today
Description

attending physician

Data type

text

Alias
UMLS CUI [1]
C2361125
Today's visit without appointment?
Description

Appointment

Data type

boolean

Alias
UMLS CUI [1]
C0586344
Important note (e.g. Infection)
Description

important note

Data type

text

Alias
UMLS CUI [1]
C1317574
Patient's occupation
Description

Patient occupation

Data type

text

Alias
UMLS CUI [1]
C0421456
Medical History
Description

Medical History

Alias
UMLS CUI-1
C0262926
Previous diseases
Description

Previous diseases

Data type

text

Alias
UMLS CUI [1]
C0262926
Diagnosis unchanged
Description

date diagnosis

Data type

date

Alias
UMLS CUI [1]
C2316983
Long- term medication
Description

long term medication

Data type

text

Alias
UMLS CUI [1]
C2054144
Medication unchanged since
Description

date Medication commenced

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0451613
Allergies
Description

Hypersensitivity

Data type

text

Alias
UMLS CUI [1]
C0020517
Allergy unchanged since
Description

date hypersensitivity

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0020517
Medical history of family
Description

Family medical history

Data type

text

Alias
UMLS CUI [1]
C0241889
Family history unchanged since
Description

date family history

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0241889
Current average alcohol consumption
Description

alcohol consumption

Data type

text

Alias
UMLS CUI [1]
C0001948
Current nicotine consumption
Description

nicotine consumption

Data type

text

Alias
UMLS CUI [1]
C1519386
Medical history
Description

medical history

Data type

text

Alias
UMLS CUI [1]
C0262926
Medical Examination
Description

Medical Examination

Alias
UMLS CUI-1
C0582103
Physical examination carried out today?
Description

Physical examination

Data type

boolean

Alias
UMLS CUI [1]
C0031809
Physical examination
Description

Physical examination

Data type

text

Alias
UMLS CUI [1]
C0031809
Date of last physical examination
Description

date Physical examination

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0031809
Dermatological Diagnosis
Description

Dermatological Diagnosis

Alias
UMLS CUI-1
C0011900
UMLS CUI-2
C0011627
Principal diagnosis 1
Description

Location: Lips .0, Eye .1, Ear .2, Face .3, Scalp and neck .4, Trunk .5, Arm/ shoulder .6, Leg/ Hip .7, Several overlapping .8, Tumors (location independent) .9 Please fill in the diagnostics (A, V, G, Z, R, L, B) according to the ICD codes

Data type

text

Alias
UMLS CUI [1]
C0332137
Date of diagnosis
Description

date diagnosis

Data type

date

Alias
UMLS CUI [1]
C2316983
Principal diagnosis 2
Description

Location: Lips .0, Eye .1, Ear .2, Face .3, Scalp and neck .4, Trunk .5, Arm/ shoulder .6, Leg/ Hip .7, Several overlapping .8, Tumors (location independent) .9 Please fill in the diagnostics (A, V, G, Z, R, L, B) according to the ICD codes

Data type

text

Alias
UMLS CUI [1]
C0332137
Date of diagnosis
Description

date diagnosis

Data type

date

Alias
UMLS CUI [1]
C2316983
Procedure
Description

Procedure

Alias
UMLS CUI-1
C0184661
Procedure
Description

Procedure

Data type

text

Alias
UMLS CUI [1]
C0184661
Senior physician
Description

Senior physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Follow- up in (days/ weeks/ months)
Description

Follow- up

Data type

text

Alias
UMLS CUI [1]
C1522577
Follow- up
Description

Follow- up

Data type

text

Alias
UMLS CUI [1]
C1522577
Nursing measures and procedures
Description

Nursing procedure

Data type

text

Alias
UMLS CUI [1]
C0204636
Photograph instructed today?
Description

Photo

Data type

boolean

Alias
UMLS CUI [1]
C0441468
Last photo taken on
Description

date photo

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0441468
Other
Description

Other

Alias
UMLS CUI-1
C0205394
Study participation status
Description

study participation status

Data type

text

Alias
UMLS CUI [1]
C2348568
Studies
Description

Clinical trials

Data type

text

Alias
UMLS CUI [1]
C0008976
Memo (For letters and outdoor patient list e.g. addressees, etc.)
Description

Memo

Data type

text

Internal Notes
Description

Notes

Data type

text

Alias
UMLS CUI [1]
C0947611
Nursing notes
Description

Nursing notes

Data type

text

Alias
UMLS CUI [1]
C1718140
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Similar models

Outpatient Department Form Dermatology

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Principal diagnosis
C0332137 (UMLS CUI-1)
principal diagnosis
Item
Principal diagnosis 1
text
C0332137 (UMLS CUI [1])
date diagnosis
Item
Diagnosis unchanged since
date
C2316983 (UMLS CUI [1])
Principal diagnosis
Item
Principal diagnosis 2
text
C0332137 (UMLS CUI [1])
date diagnosis
Item
Diagnosis unchanged since
date
C2316983 (UMLS CUI [1])
attending physician
Item
Attending physician today
text
C2361125 (UMLS CUI [1])
Appointment
Item
Today's visit without appointment?
boolean
C0586344 (UMLS CUI [1])
important note
Item
Important note (e.g. Infection)
text
C1317574 (UMLS CUI [1])
Patient occupation
Item
Patient's occupation
text
C0421456 (UMLS CUI [1])
Item Group
Medical History
C0262926 (UMLS CUI-1)
Previous diseases
Item
Previous diseases
text
C0262926 (UMLS CUI [1])
date diagnosis
Item
Diagnosis unchanged
date
C2316983 (UMLS CUI [1])
long term medication
Item
Long- term medication
text
C2054144 (UMLS CUI [1])
date Medication commenced
Item
Medication unchanged since
date
C0011008 (UMLS CUI [1,1])
C0451613 (UMLS CUI [1,2])
Hypersensitivity
Item
Allergies
text
C0020517 (UMLS CUI [1])
date hypersensitivity
Item
Allergy unchanged since
date
C0011008 (UMLS CUI [1,1])
C0020517 (UMLS CUI [1,2])
Family medical history
Item
Medical history of family
text
C0241889 (UMLS CUI [1])
date family history
Item
Family history unchanged since
date
C0011008 (UMLS CUI [1,1])
C0241889 (UMLS CUI [1,2])
alcohol consumption
Item
Current average alcohol consumption
text
C0001948 (UMLS CUI [1])
nicotine consumption
Item
Current nicotine consumption
text
C1519386 (UMLS CUI [1])
medical history
Item
Medical history
text
C0262926 (UMLS CUI [1])
Item Group
Medical Examination
C0582103 (UMLS CUI-1)
Physical examination
Item
Physical examination carried out today?
boolean
C0031809 (UMLS CUI [1])
Physical examination
Item
Physical examination
text
C0031809 (UMLS CUI [1])
date Physical examination
Item
Date of last physical examination
date
C0011008 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Item Group
Dermatological Diagnosis
C0011900 (UMLS CUI-1)
C0011627 (UMLS CUI-2)
Principal diagnosis
Item
Principal diagnosis 1
text
C0332137 (UMLS CUI [1])
date diagnosis
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1])
Principal diagnosis
Item
Principal diagnosis 2
text
C0332137 (UMLS CUI [1])
date diagnosis
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1])
Item Group
Procedure
C0184661 (UMLS CUI-1)
Procedure
Item
Procedure
text
C0184661 (UMLS CUI [1])
Senior physician
Item
Senior physician
text
C0031831 (UMLS CUI [1])
Follow- up
Item
Follow- up in (days/ weeks/ months)
text
C1522577 (UMLS CUI [1])
Item
Follow- up
text
C1522577 (UMLS CUI [1])
Follow- up
Code List
Follow- up
CL Item
as required (1)
CL Item
by GP (2)
Nursing procedure
Item
Nursing measures and procedures
text
C0204636 (UMLS CUI [1])
Photo
Item
Photograph instructed today?
boolean
C0441468 (UMLS CUI [1])
date photo
Item
Last photo taken on
date
C0011008 (UMLS CUI [1,1])
C0441468 (UMLS CUI [1,2])
Item Group
Other
C0205394 (UMLS CUI-1)
Item
Study participation status
text
C2348568 (UMLS CUI [1])
study participation status
Code List
Study participation status
CL Item
previous study participation of the patient (1)
CL Item
current consultation is part of a study (2)
Clinical trials
Item
Studies
text
C0008976 (UMLS CUI [1])
Memo
Item
Memo (For letters and outdoor patient list e.g. addressees, etc.)
text
Notes
Item
Internal Notes
text
C0947611 (UMLS CUI [1])
Nursing notes
Item
Nursing notes
text
C1718140 (UMLS CUI [1])
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