ID

15007

Description

Request for iliac crest biopsy, Pathology UKM Please use this form for requests for iliac crest biopsy. Gerhard-Domagk-Institute of Pathology Univ.-Prof.Dr.med.Eva Wardelmann Albert-Schweitzer-Campus 1 Building D17 48149 Münster Phone:0251-83-57550 Fax:0251-83-55481 E-mail:pathologie@ukmuenster.de

Keywords

Versions (2)
  1. 5/11/16 5/11/16 -
  2. 5/11/16 5/11/16 -
Uploaded on

May 11, 2016

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License

Creative Commons BY-NC 3.0
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Request for iliac crest biopsy, Pathology UKM

German English

Request for iliac crest biopsy

1 forms  
Patient Data
Description

Patient Data

Patient Name
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Patient ID
Description

Patient ID

Data type

integer

Alias
UMLS CUI [1]
C1269815
Patient Birth Date
Description

Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Case ID
Description

Case ID

Data type

integer

Alias
UMLS CUI [1,1]
C0868928
UMLS CUI [1,2]
C0600091
Patient insurance
Description

Patient insurance

Data type

text

Alias
UMLS CUI [1]
C1548070
Request ID
Description

Request ID

Data type

text

Alias
UMLS CUI [1,1]
C1272683
UMLS CUI [1,2]
C1299222
Request status
Description

Request status

Data type

text

Alias
UMLS CUI [1]
C0586246
Urgency of procedure
Description

Urgency

Data type

text

Alias
UMLS CUI [1]
C2188402
Performing hospital department
Description

Performing hospital department

Data type

text

Alias
UMLS CUI [1,1]
C2986180
UMLS CUI [1,2]
C0019961
Date and time of request
Description

Date of request

Data type

datetime

Alias
UMLS CUI [1,1]
C1272683
UMLS CUI [1,2]
C0011008
Referring hospital department
Description

Referring hospital department

Data type

text

Alias
UMLS CUI [1,1]
C0019961
UMLS CUI [1,2]
C0205543
Referring medical department
Description

Referring medical department

Data type

text

Alias
UMLS CUI [1,1]
C0587450
UMLS CUI [1,2]
C0205543
Referring Physician name
Description

Referring Physician

Data type

text

Alias
UMLS CUI [1]
C1709880
Desired date
Description

Desired date

Data type

date

Alias
UMLS CUI [1]
C0011008
Comments
Description

Comments

Data type

text

Alias
UMLS CUI [1]
C0947611
Cave
Description

Cave

Data type

text

Alias
UMLS CUI [1]
C0871599
Mobility
Description

Mobility

Data type

text

Alias
UMLS CUI [1]
C0449580
Preliminary examination results
Description

Preliminary examination results

Data type

text

Alias
UMLS CUI [1]
C1548161
Infectivity
Description

Infectivity

Data type

integer

Alias
UMLS CUI [1]
C0030657
Infectivity:please specify other infectious disease
Description

Infectivity

Data type

text

Alias
UMLS CUI [1]
C0030657
Inpatient insurance status
Description

Inpatient insurance status

Data type

integer

Alias
UMLS CUI [1,1]
C0021562
UMLS CUI [1,2]
C0376629
Outpatient insurance status
Description

Outpatient insurance status

Data type

integer

Alias
UMLS CUI [1,1]
C0029921
UMLS CUI [1,2]
C0376629
Type of specimen
Description

Type of specimen

Data type

integer

Alias
UMLS CUI [1]
C0456204
Findings
Description

Findings

Clinical findings: Splenomegaly
Description

Clinical findings

Data type

boolean

Alias
UMLS CUI [1]
C0037088
Clinical findings: Hepatomegaly
Description

Clinical findings

Data type

boolean

Alias
UMLS CUI [1]
C0037088
Clinical findings:Lymphadenopathy
Description

Clinical findings

Data type

boolean

Alias
UMLS CUI [1]
C0037088
Localization of enlarged lymph node(s)
Description

Localization

Data type

text

Alias
UMLS CUI [1]
C0475264
Blood Count and Laboratory Tests
Description

Blood Count and Laboratory Tests

Erythrocyte Sedimentation Rate
Description

ESR

Data type

float

Alias
UMLS CUI [1]
C1176468
Lactate Dehydrogenase (LDH)
Description

LDH

Data type

float

Measurement units
  • U/L
Alias
UMLS CUI [1]
C0202113
U/L
Serum Iron
Description

Serum Iron

Data type

float

Alias
UMLS CUI [1]
C0036810
Ferritin
Description

Ferritin

Data type

float

Alias
UMLS CUI [1]
C0373607
Paraprotein
Description

Paraprotein

Data type

float

Measurement units
  • g/dl
Alias
UMLS CUI [1]
C0030490
g/dl
Hemoglobin
Description

Hemoglobin

Data type

float

Alias
UMLS CUI [1]
C0518015
Erythrocytes
Description

Erythrocytes

Data type

float

Alias
UMLS CUI [1]
C0014772
Reticulocytes
Description

Reticulocytes

Data type

float

Alias
UMLS CUI [1]
C0206161
Hematocrit
Description

Hematocrit

Data type

float

Alias
UMLS CUI [1]
C0518014
Mean Corpuscular Volume
Description

MCV

Data type

float

Alias
UMLS CUI [1]
C1948043
Leukocytes
Description

Leucocytes

Data type

float

Alias
UMLS CUI [1]
C0023508
Platelet count
Description

Platelets

Data type

float

Alias
UMLS CUI [1]
C0032181
ALP
Description

ALP

Data type

float

Alias
UMLS CUI [1]
C0201850
Peripheral blood analysis:other,please specify
Description

Peripheral blood analysis

Data type

text

Alias
UMLS CUI [1,1]
C0229664
UMLS CUI [1,2]
C0936012
Differential white blood count
Description

Differential white blood count

Band neutrophils
Description

Band neutrophils

Data type

integer

Measurement units
  • %
Alias
UMLS CUI [1]
C1882076
%
Segmented neutrophils
Description

Segmented neutrophils

Data type

integer

Measurement units
  • %
Alias
UMLS CUI [1]
C0942466
%
Eosinophils
Description

Eosinophils

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0200638
%
Basophils
Description

Basophils

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0200641
%
Monocytes
Description

Monocytes

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0200637
%
Lymphocytes
Description

Lymphocytes

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0200635
%
Blasts
Description

Blasts

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0523113
%
Plasma cells
Description

Plasma cells

Data type

integer

Measurement units
  • %
Alias
UMLS CUI [1]
C0581142
%
Please specify other
Description

Other

Data type

text

Alias
UMLS CUI [1]
C0205394
Diagnosis
Description

Diagnosis

Responsible physician name
Description

Responsible physician

Data type

text

Alias
UMLS CUI [1]
C1710470
Please enter a phone number for contact
Description

Phone contact

Data type

integer

Alias
UMLS CUI [1]
C3476398
Fax number
Description

Fax number

Data type

integer

Alias
UMLS CUI [1,1]
C1710470
UMLS CUI [1,2]
C1549619
Clinical Diagnosis
Description

Clinical Diagnosis

Data type

text

Alias
UMLS CUI [1]
C0332140
Specific prior treatment
Description

Specific prior treatment

Data type

text

Alias
UMLS CUI [1]
C1514463
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Similar models

Request for iliac crest biopsy

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient Data
Patient Name
Item
Patient Name
text
C1299487 (UMLS CUI [1])
Patient ID
Item
Patient ID
integer
C1269815 (UMLS CUI [1])
Birth Date
Item
Patient Birth Date
date
C0421451 (UMLS CUI [1])
Case ID
Item
Case ID
integer
C0868928 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Patient insurance
Item
Patient insurance
text
C1548070 (UMLS CUI [1])
Request ID
Item
Request ID
text
C1272683 (UMLS CUI [1,1])
C1299222 (UMLS CUI [1,2])
Request status
Item
Request status
text
C0586246 (UMLS CUI [1])
Urgency
Item
Urgency of procedure
text
C2188402 (UMLS CUI [1])
Performing hospital department
Item
Performing hospital department
text
C2986180 (UMLS CUI [1,1])
C0019961 (UMLS CUI [1,2])
Date of request
Item
Date and time of request
datetime
C1272683 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Referring hospital department
Item
Referring hospital department
text
C0019961 (UMLS CUI [1,1])
C0205543 (UMLS CUI [1,2])
Referring medical department
Item
Referring medical department
text
C0587450 (UMLS CUI [1,1])
C0205543 (UMLS CUI [1,2])
Referring Physician
Item
Referring Physician name
text
C1709880 (UMLS CUI [1])
Desired date
Item
Desired date
date
C0011008 (UMLS CUI [1])
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
Cave
Item
Cave
text
C0871599 (UMLS CUI [1])
Mobility
Item
Mobility
text
C0449580 (UMLS CUI [1])
Preliminary examination results
Item
Preliminary examination results
text
C1548161 (UMLS CUI [1])
Item
Infectivity
integer
C0030657 (UMLS CUI [1])
Infectivity
Code List
Infectivity
CL Item
None (1)
CL Item
Unknown (2)
CL Item
Hep B (3)
CL Item
Hep C (4)
CL Item
Tbc (5)
CL Item
HIV (6)
CL Item
VRE (7)
CL Item
MRSA (8)
CL Item
Other (9)
Infectivity
Item
Infectivity:please specify other infectious disease
text
C0030657 (UMLS CUI [1])
Item
Inpatient insurance status
integer
C0021562 (UMLS CUI [1,1])
C0376629 (UMLS CUI [1,2])
Inpatient insurance status
Code List
Inpatient insurance status
CL Item
Standard care (1)
CL Item
Elective care/ choice of physician (2)
Item
Outpatient insurance status
integer
C0029921 (UMLS CUI [1,1])
C0376629 (UMLS CUI [1,2])
Outpatient insurance status
Code List
Outpatient insurance status
CL Item
Beneficial insurance (1)
CL Item
Privat insurance (2)
Item
Type of specimen
integer
C0456204 (UMLS CUI [1])
Type of specimen
Code List
Type of specimen
CL Item
Frozen section (1)
CL Item
Tissue (2)
CL Item
Puncture fluid (3)
CL Item
Smear (4)
Item Group
Findings
Clinical findings
Item
Clinical findings: Splenomegaly
boolean
C0037088 (UMLS CUI [1])
Clinical findings
Item
Clinical findings: Hepatomegaly
boolean
C0037088 (UMLS CUI [1])
Clinical findings
Item
Clinical findings:Lymphadenopathy
boolean
C0037088 (UMLS CUI [1])
Localization
Item
Localization of enlarged lymph node(s)
text
C0475264 (UMLS CUI [1])
Item Group
Blood Count and Laboratory Tests
ESR
Item
Erythrocyte Sedimentation Rate
float
C1176468 (UMLS CUI [1])
LDH
Item
Lactate Dehydrogenase (LDH)
float
C0202113 (UMLS CUI [1])
Serum Iron
Item
Serum Iron
float
C0036810 (UMLS CUI [1])
Ferritin
Item
Ferritin
float
C0373607 (UMLS CUI [1])
Paraprotein
Item
Paraprotein
float
C0030490 (UMLS CUI [1])
Hemoglobin
Item
Hemoglobin
float
C0518015 (UMLS CUI [1])
Erythrocytes
Item
Erythrocytes
float
C0014772 (UMLS CUI [1])
Reticulocytes
Item
Reticulocytes
float
C0206161 (UMLS CUI [1])
Hematocrit
Item
Hematocrit
float
C0518014 (UMLS CUI [1])
MCV
Item
Mean Corpuscular Volume
float
C1948043 (UMLS CUI [1])
Leucocytes
Item
Leukocytes
float
C0023508 (UMLS CUI [1])
Platelets
Item
Platelet count
float
C0032181 (UMLS CUI [1])
ALP
Item
ALP
float
C0201850 (UMLS CUI [1])
Peripheral blood analysis
Item
Peripheral blood analysis:other,please specify
text
C0229664 (UMLS CUI [1,1])
C0936012 (UMLS CUI [1,2])
Item Group
Differential white blood count
Band neutrophils
Item
Band neutrophils
integer
C1882076 (UMLS CUI [1])
Segmented neutrophils
Item
Segmented neutrophils
integer
C0942466 (UMLS CUI [1])
Eosinophils
Item
Eosinophils
float
C0200638 (UMLS CUI [1])
Basophils
Item
Basophils
float
C0200641 (UMLS CUI [1])
Monocytes
Item
Monocytes
float
C0200637 (UMLS CUI [1])
Lymphocytes
Item
Lymphocytes
float
C0200635 (UMLS CUI [1])
Blasts
Item
Blasts
float
C0523113 (UMLS CUI [1])
Plasma cells
Item
Plasma cells
integer
C0581142 (UMLS CUI [1])
Other
Item
Please specify other
text
C0205394 (UMLS CUI [1])
Item Group
Diagnosis
Responsible physician
Item
Responsible physician name
text
C1710470 (UMLS CUI [1])
Phone contact
Item
Please enter a phone number for contact
integer
C3476398 (UMLS CUI [1])
Fax number
Item
Fax number
integer
C1710470 (UMLS CUI [1,1])
C1549619 (UMLS CUI [1,2])
Clinical Diagnosis
Item
Clinical Diagnosis
text
C0332140 (UMLS CUI [1])
Specific prior treatment
Item
Specific prior treatment
text
C1514463 (UMLS CUI [1])
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