ID

15368

Descripción

https://www.hope-clara.de/ The HOPE Hospice and Palliative Care Recording standard documentation is used for documentation of palliative care and as an instrument for quality assurance in pallatiave wards, hospices and oncological wards as well as in ambulatory services and palliative teams.

Link

https://www.hope-clara.de/

Palabras clave

Versiones (1)
  1. 28/5/16 28/5/16 -
Titular de derechos de autor

CC BY-NC 3.0

Subido en

28 de mayo de 2016

DOI

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Licencia

Creative Commons BY-NC 3.0
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Palliative and Hospice Care Emergency Form

Alemán Inglés

Palliative and Hospice Care Emergency Form

1 formularios  
Patient information
Descripción

Patient information

Alias
UMLS CUI-1
C1955348
Name
Descripción

Name

Tipo de datos

text

Alias
UMLS CUI [1]
C0027365
Date of birth
Descripción

Date of birth

Tipo de datos

date

Alias
UMLS CUI [1]
C0421451
Address
Descripción

Address

Tipo de datos

text

Alias
UMLS CUI [1]
C0421449
Diagnoses
Descripción

Diagnoses

Tipo de datos

text

Alias
UMLS CUI [1]
C0011900
Current issues
Descripción

Current issues

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0033213
UMLS CUI [1,2]
C0521116
Peculiarities
Descripción

Peculiarities

Tipo de datos

text

Alias
UMLS CUI [1]
C1704258
IMPORTANT contact persons / phone numbers
Descripción

IMPORTANT contact persons / phone numbers

closest relative
Descripción

closest relative

Tipo de datos

text

Alias
UMLS CUI [1]
C0080103
authorized person
Descripción

this authorized person has been appointed to implement my will that is determined in this instruction according to §1896 passage 2 BGB)

Tipo de datos

boolean

name
Descripción

name

Tipo de datos

text

Alias
UMLS CUI [1]
C0027365
date of birth
Descripción

date of birth

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0027361
UMLS CUI [1,3]
C0005615
address
Descripción

address

Tipo de datos

text

Alias
UMLS CUI [1]
C1442065
palliative team phone number
Descripción

palliative team phone number

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0030231
UMLS CUI [1,2]
C0086390
UMLS CUI [1,3]
C0237753
UMLS CUI [1,4]
C0039457
general practitioner phone number
Descripción

general practitioner phone number

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0017319
UMLS CUI [1,2]
C0237753
UMLS CUI [1,3]
C0039457
nursing care service phone number
Descripción

nursing care service phone number

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0019855
UMLS CUI [1,2]
C0237753
UMLS CUI [1,3]
C0039457
association of shi physicians emergency service phone number
Descripción

association of shi physicians emergency service phone number

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0013961
UMLS CUI [1,2]
C0237753
UMLS CUI [1,3]
C0039457
emergency physician
Descripción

emergency physician

Tipo de datos

integer

Alias
UMLS CUI [1]
C2065341
pastoral care phone number
Descripción

pastoral care phone number

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0030643
UMLS CUI [1,2]
C0237753
UMLS CUI [1,3]
C0039457
hospice phone number
Descripción

hospice phone number

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0085555
UMLS CUI [1,2]
C0237753
UMLS CUI [1,3]
C0039457
Requested procedures
Descripción

Requested procedures

heart lung rescucitation requested
Descripción

heart lung rescucitation requested

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0035273
UMLS CUI [1,2]
C1272683
hospital admission requested
Descripción

hospital admission requested

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0184666
UMLS CUI [1,2]
C1272683
information about the diagnosis/prognosis for the patient?
Descripción

information about the diagnosis/prognosis for the patient?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0033325
UMLS CUI [1,3]
C1533716
UMLS CUI [1,4]
C0030705
information about the diagnosis/prognosis for the relatives?
Descripción

information about the diagnosis/prognosis for the relatives?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0033325
UMLS CUI [1,3]
C1533716
UMLS CUI [1,4]
C0080103
living will
Descripción

living will

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0023914
health care proxy
Descripción

health care proxy

Tipo de datos

boolean

Alias
UMLS CUI [1]
C2029796
deposition of documents
Descripción

(for updates please see the back of the page; this emergency form accords to the existing law regarding living wills §1901a passage 1-5 BGB)

Tipo de datos

text

Alias
UMLS CUI [1]
C1301746
date
Descripción

date

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
name
Descripción

name

Tipo de datos

text

Alias
UMLS CUI [1]
C0027365
patient/representative signature
Descripción

patient/representative signature

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1519316
UMLS CUI [1,2]
C0030705
UMLS CUI [1,3]
C0030701
Further procedures
Descripción

Further procedures

refusal of further procedures
Descripción

(Possible consequences that result from refusing medical procedures were explained to the patient; during the issue of this document the patient was fully capable of understanding and agreeing)

Tipo de datos

text

Alias
UMLS CUI [1]
C0040809
last hospital stay
Descripción

last hospital stay

Tipo de datos

text

Alias
UMLS CUI [1,1]
C3489408
UMLS CUI [1,2]
C1517741
hospital / facility
Descripción

hospital / facility

Tipo de datos

text

Alias
UMLS CUI [1]
C0019994
UMLS CUI [2]
C0018704
date
Descripción

date

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
doctor's name
Descripción

information provided by

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0031831
UMLS CUI [1,2]
C0027365
signature
Descripción

signature

Tipo de datos

text

Alias
UMLS CUI [1]
C1519316
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Similar models

Palliative and Hospice Care Emergency Form

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Patient information
C1955348 (UMLS CUI-1)
Name
Item
Name
text
C0027365 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Address
Item
Address
text
C0421449 (UMLS CUI [1])
Diagnoses
Item
Diagnoses
text
C0011900 (UMLS CUI [1])
Current issues
Item
Current issues
text
C0033213 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Peculiarities
Item
Peculiarities
text
C1704258 (UMLS CUI [1])
Item Group
IMPORTANT contact persons / phone numbers
closest relative
Item
closest relative
text
C0080103 (UMLS CUI [1])
authorized person
Item
authorized person
boolean
name
Item
name
text
C0027365 (UMLS CUI [1])
date of birth
Item
date of birth
text
C0011008 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C0005615 (UMLS CUI [1,3])
address
Item
address
text
C1442065 (UMLS CUI [1])
palliative team phone number
Item
palliative team phone number
integer
C0030231 (UMLS CUI [1,1])
C0086390 (UMLS CUI [1,2])
C0237753 (UMLS CUI [1,3])
C0039457 (UMLS CUI [1,4])
general practitioner phone number
Item
general practitioner phone number
integer
C0017319 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C0039457 (UMLS CUI [1,3])
nursing care service phone number
Item
nursing care service phone number
integer
C0019855 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C0039457 (UMLS CUI [1,3])
association of shi physicians emergency service phone number
Item
association of shi physicians emergency service phone number
integer
C0013961 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C0039457 (UMLS CUI [1,3])
Item
emergency physician
integer
C2065341 (UMLS CUI [1])
emergency physician
Code List
emergency physician
CL Item
112 (1)
pastoral care phone number
Item
pastoral care phone number
integer
C0030643 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C0039457 (UMLS CUI [1,3])
hospice phone number
Item
hospice phone number
integer
C0085555 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C0039457 (UMLS CUI [1,3])
Item Group
Requested procedures
heart lung rescucitation requested
Item
heart lung rescucitation requested
boolean
C0035273 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
hospital admission requested
Item
hospital admission requested
boolean
C0184666 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
information about the diagnosis/prognosis for the patient?
Item
information about the diagnosis/prognosis for the patient?
boolean
C0011900 (UMLS CUI [1,1])
C0033325 (UMLS CUI [1,2])
C1533716 (UMLS CUI [1,3])
C0030705 (UMLS CUI [1,4])
information about the diagnosis/prognosis for the relatives?
Item
information about the diagnosis/prognosis for the relatives?
boolean
C0011900 (UMLS CUI [1,1])
C0033325 (UMLS CUI [1,2])
C1533716 (UMLS CUI [1,3])
C0080103 (UMLS CUI [1,4])
living will
Item
living will
boolean
C0023914 (UMLS CUI [1])
health care proxy
Item
health care proxy
boolean
C2029796 (UMLS CUI [1])
deposition of documents
Item
deposition of documents
text
C1301746 (UMLS CUI [1])
date
Item
date
date
C0011008 (UMLS CUI [1])
name
Item
name
text
C0027365 (UMLS CUI [1])
patient/representative signature
Item
patient/representative signature
text
C1519316 (UMLS CUI [1,1])
C0030705 (UMLS CUI [1,2])
C0030701 (UMLS CUI [1,3])
Item Group
Further procedures
refusal of further procedures
Item
refusal of further procedures
text
C0040809 (UMLS CUI [1])
last hospital stay
Item
last hospital stay
text
C3489408 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
hospital / facility
Item
hospital / facility
text
C0019994 (UMLS CUI [1])
C0018704 (UMLS CUI [2])
date
Item
date
date
C0011008 (UMLS CUI [1])
doctor name
Item
doctor's name
text
C0031831 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
signature
Item
signature
text
C1519316 (UMLS CUI [1])
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