German English

Request for general histologic assessment

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
Preliminary results
Description

Preliminary results

Clinical Diagnosis
Description

Clinical Diagnosis

Data type

text

Alias
UMLS CUI [1]
C0332140
Staining method
Description

Staining method

Data type

integer

Alias
UMLS CUI [1]
C0487602
Number of HE stainings
Description

Number of stainings

Data type

integer

Alias
UMLS CUI [1,1]
C0200673
UMLS CUI [1,2]
C0750480
Number of PAS stainings
Description

Number of stainings

Data type

integer

Alias
UMLS CUI [1,1]
C0523213
UMLS CUI [1,2]
C0750480
Number of Ma stainings
Description

Number of stainings

Data type

integer

Alias
UMLS CUI [1,1]
C0487602
UMLS CUI [1,2]
C0750480
Specific prior treatment
Description

Specific prior treatment

Data type

text

Alias
UMLS CUI [1]
C1514463
Current question
Description

Current question

Data type

text

Alias
UMLS CUI [1]
C1522634
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
Back to the top of the page

Similar models

Request for general histologic assessment

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
Preliminary results
Clinical Diagnosis
Item
Clinical Diagnosis
text
C0332140 (UMLS CUI [1])
Item
Staining method
integer
C0487602 (UMLS CUI [1])
Staining method
Code List
Staining method
CL Item
HE (1)
CL Item
PAS (2)
CL Item
Ma (3)
Number of stainings
Item
Number of HE stainings
integer
C0200673 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
Number of stainings
Item
Number of PAS stainings
integer
C0523213 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
Number of stainings
Item
Number of Ma stainings
integer
C0487602 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
Specific prior treatment
Item
Specific prior treatment
text
C1514463 (UMLS CUI [1])
Current question
Item
Current question
text
C1522634 (UMLS CUI [1])
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])
Back to the top of the page