ID

1543

Description

The collection of CDEs used in the Medical History module. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=47B2E622-7D02-2A12-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=47B2E622-7D02-2A12-E044-0003BA3F9857

Keywords

Versions (2)
  1. 8/27/12 8/27/12 -
  2. 7/14/17 7/14/17 - Martin Dugas
Uploaded on

August 27, 2012

DOI

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License

Creative Commons BY-NC 3.0
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COMMON - NCI Standard Medical History Template - 2733828v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: NCI Standard Medical History Template
    1. No Instruction available.
Mandatory Medical History Questions
Description

Mandatory Medical History Questions

Medical History Date (Enter the date that the medical history is collected.)
Description

PatientRelevantMedicalHistoryDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
Optional
Description

Optional

Ongoing (Enter whether the medical history condition is ongoing at the time of collection.)
Description

PersonalMedicalHistoryOngoingIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus Property
C53279
UMLS 2011AA Property
C0549178
NCI Thesaurus ObjectClass
C18772
UMLS 2011AA ObjectClass
C0262926
Description (Enter description of medical history at the time of collection.)
Description

MedicalHistoryDescription

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25401
UMLS 2011AA Property
C0205161
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Thesaurus ObjectClass
C25261
UMLS 2011AA ObjectClass
C0205476
Finding (Enter the result of the assessment for a particular body system.)
Description

MedicalHistoryReviewofSystemsFindingType

Data type

text

Alias
NCI Thesaurus ObjectClass
C95618
NCI Thesaurus ObjectClass
C25261
UMLS 2011AA ObjectClass
C0205476
NCI Thesaurus ObjectClass
C54625
UMLS 2011AA ObjectClass
C2004062
NCI Thesaurus Property
C3367
UMLS 2011AA Property
C0037088
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain
C95618
NCI Thesaurus ValueDomain
C61036
UMLS 2011AA ValueDomain
C0243095
Medical History System (Enter the body system.)
Description

MedicalHistoryReviewofSystemsCriteriaCategory

Data type

text

Alias
NCI Thesaurus ObjectClass
C95618
NCI Thesaurus ObjectClass
C25261
UMLS 2011AA ObjectClass
C0205476
NCI Thesaurus ObjectClass
C54625
UMLS 2011AA ObjectClass
C2004062
NCI Thesaurus Property
C25466
UMLS 2011AA Property
C0243161
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus ValueDomain
C95618
Other (Body) System/Site Text (Enter description of other body system/site.)
Description

OtherBodySystem/SiteText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C13041
UMLS 2011AA ObjectClass
C1268086
NCI Thesaurus Property
C25700
UMLS 2011AA Property
C0449913
Medical History Assessment Indicator (Enter whether the medical history was assessed/gathered.)
Description

PatientPersonalMedicalHistoryAssessmentIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C18772
UMLS 2011AA ObjectClass
C0262926
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Similar models

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1 forms
  1. StudyEvent: NCI Standard Medical History Template
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Mandatory Medical History Questions
PatientRelevantMedicalHistoryDate
Item
Medical History Date (Enter the date that the medical history is collected.)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
Item
Ongoing (Enter whether the medical history condition is ongoing at the time of collection.)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C53279 (NCI Thesaurus Property)
C0549178 (UMLS 2011AA Property)
C18772 (NCI Thesaurus ObjectClass)
C0262926 (UMLS 2011AA ObjectClass)
CL.1
Code List
Ongoing (Enter whether the medical history condition is ongoing at the time of collection.)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Not Applicable (N/A)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
MedicalHistoryDescription
Item
Description (Enter description of medical history at the time of collection.)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25401 (NCI Thesaurus Property)
C0205161 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C25261 (NCI Thesaurus ObjectClass)
C0205476 (UMLS 2011AA ObjectClass)
Item
Finding (Enter the result of the assessment for a particular body system.)
text
C95618 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus ObjectClass)
C0205476 (UMLS 2011AA ObjectClass)
C54625 (NCI Thesaurus ObjectClass)
C2004062 (UMLS 2011AA ObjectClass)
C3367 (NCI Thesaurus Property)
C0037088 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C95618 (NCI Thesaurus ValueDomain)
C61036 (NCI Thesaurus ValueDomain)
C0243095 (UMLS 2011AA ValueDomain)
CL.2
Code List
Finding (Enter the result of the assessment for a particular body system.)
CL Item
No Assessment (Not Assessed)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C25217 (NCI Thesaurus)
C1516048 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
Item
Medical History System (Enter the body system.)
text
C95618 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus ObjectClass)
C0205476 (UMLS 2011AA ObjectClass)
C54625 (NCI Thesaurus ObjectClass)
C2004062 (UMLS 2011AA ObjectClass)
C25466 (NCI Thesaurus Property)
C0243161 (UMLS 2011AA Property)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C95618 (NCI Thesaurus ValueDomain)
CL.3
Code List
Medical History System (Enter the body system.)
CL Item
Abdomen (Abdomen)
C25342 (NCI Thesaurus)
C0000726 (UMLS 2011AA)
CL Item
Breast (Breasts)
C12971 (NCI Thesaurus)
C0006141 (UMLS 2011AA)
CL Item
Cardiovascular System (Cardiovascular)
C12686 (NCI Thesaurus)
C0007226 (UMLS 2011AA)
CL Item
Dermatologic (Dermatologic)
C41128 (NCI Thesaurus)
C0205489 (UMLS 2011AA)
CL Item
Endocrine System (Endocrine/Metabolic)
C12705 (NCI Thesaurus)
C0014136 (UMLS 2011AA)
CL Item
Gastrointestinal System (Gastrointestinal)
C12378 (NCI Thesaurus)
C0012240 (UMLS 2011AA)
CL Item
Genitourinary System (Genitourinary)
C12810 (NCI Thesaurus)
C0042066 (UMLS 2011AA)
CL Item
Head, Ears, Eyes, Nose And Throat (HEENT)
C42300 (NCI Thesaurus)
C1512338 (UMLS 2011AA)
CL Item
Hematopoietic And Lymphatic System (Hematopoietic/Lymph Nodes(s))
C41165 (NCI Thesaurus)
C1512394 (UMLS 2011AA)
CL Item
Immune System (Immune)
C12735 (NCI Thesaurus)
C0020962 (UMLS 2011AA)
CL Item
Musculoskeletal System (Musculoskeletal)
C12754 (NCI Thesaurus)
C0026860 (UMLS 2011AA)
CL Item
Neck (Neck)
C13063 (NCI Thesaurus)
C0027530 (UMLS 2011AA)
CL Item
Neurologic Examination (Neurologic)
C81313 (NCI Thesaurus)
C0027853 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Pelvic Examination (Pelvis)
C38104 (NCI Thesaurus)
C0200045 (UMLS 2011AA)
CL Item
Psychological (Psychologic)
C94316 (NCI Thesaurus)
CL Item
Respiratory System (Respiratory)
C12779 (NCI Thesaurus)
C0035237 (UMLS 2011AA)
OtherBodySystem/SiteText
Item
Other (Body) System/Site Text (Enter description of other body system/site.)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C13041 (NCI Thesaurus ObjectClass)
C1268086 (UMLS 2011AA ObjectClass)
C25700 (NCI Thesaurus Property)
C0449913 (UMLS 2011AA Property)
Item
Medical History Assessment Indicator (Enter whether the medical history was assessed/gathered.)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C18772 (NCI Thesaurus ObjectClass)
C0262926 (UMLS 2011AA ObjectClass)
CL.4
Code List
Medical History Assessment Indicator (Enter whether the medical history was assessed/gathered.)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
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