English

Administrative Data

1 forms  
  1. StudyEvent: ODM
    1. Administrative Data
Administrative Data
Description

Administrative Data

Specify Name of study/ trial
Description

Study Name

Data type

text

Alias
UMLS CUI [1]
C2348560
Patient ID code:
Description

Complete the specific Patient ID code

Data type

text

Alias
UMLS CUI [1]
C1269815
Date of death
Description

The patient’s date of death should be recorded

Data type

date

Alias
UMLS CUI [1]
C1148348
Section 1 Background demographics
Description

Section 1 Background demographics

A. Year of birth:
Description

Year of birth

Data type

integer

Alias
UMLS CUI [1]
C2826771
B. Gender:
Description

Gender

Data type

text

Alias
UMLS CUI [1]
C0079399
C. Height (cm):
Description

Height

Data type

integer

Measurement units
  • cm
Alias
UMLS CUI [1]
C0005890
cm
D. Weight:
Description

Body weight (most recent before death)

Data type

float

Measurement units
  • kg
Alias
UMLS CUI [1]
C0005910
kg
E. Date Weight Measured
Description

(dd-mmm-yy; weight measured)

Data type

date

Alias
UMLS CUI [1,1]
C0005910
UMLS CUI [1,2]
C0011008
Section 2 Data Sources
Description

Section 2 Data Sources

A. Hospital files
Description

Hospital files

Data type

text

Alias
UMLS CUI [1]
C0019980
B. Outpatient clinic chart
Description

Outpatient clinic chart

Data type

text

Alias
UMLS CUI [1,1]
C0029916
UMLS CUI [1,2]
C0025102
C. Autopsy report
Description

Autopsy report

Data type

text

Alias
UMLS CUI [1]
C1548372
D. Registry
Description

If other, specify:

Data type

boolean

Alias
UMLS CUI [1]
C0034975
E. Obituary
Description

If other, specify:

Data type

boolean

Alias
UMLS CUI [1]
C3828738
F. Patients relatives or partner
Description

Patients relatives or partner

Data type

boolean

Alias
UMLS CUI [1]
C0015576
G. Patients medical provider
Description

Patients medical provider

Data type

boolean

Alias
UMLS CUI [1,1]
C1138603
UMLS CUI [1,2]
C0205476
H. Nursing home
Description

Nursing home

Data type

text

Alias
UMLS CUI [1]
C0028688
I. Other Source
Description

Other Source

Data type

text

Alias
UMLS CUI [1]
C0011001
Completed by
Description

Completed by

Completed by: Name (in print)
Description

Name

Data type

text

Alias
UMLS CUI [1]
C0027365
Position:
Description

Position

Data type

text

Alias
UMLS CUI [1]
C0018722
Other, describe
Description

If "Position" was "Other"

Data type

text

Alias
UMLS CUI [1,1]
C0018722
UMLS CUI [1,2]
C0205394
Directly involved in the medical care of the patient around the time of death?
Description

Involved in medical care

Data type

boolean

Alias
UMLS CUI [1,1]
C0496675
UMLS CUI [1,2]
C1314939
Date:
Description

Date (dd/mmm/yy) :

Data type

date

Alias
UMLS CUI [1]
C0011008
Signature:
Description

Signature

Data type

text

Alias
UMLS CUI [1]
C1519316
Back to the top of the page

Similar models

Administrative Data

1 forms
  1. StudyEvent: ODM
    1. Administrative Data
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
Study Name
Item
Specify Name of study/ trial
text
C2348560 (UMLS CUI [1])
Patient ID
Item
Patient ID code:
text
C1269815 (UMLS CUI [1])
Date of death
Item
Date of death
date
C1148348 (UMLS CUI [1])
Item Group
Section 1 Background demographics
Year of birth
Item
A. Year of birth:
integer
C2826771 (UMLS CUI [1])
Item
B. Gender:
text
C0079399 (UMLS CUI [1])
Gender
Code List
B. Gender:
CL Item
male (male)
CL Item
female (female)
Height
Item
C. Height (cm):
integer
C0005890 (UMLS CUI [1])
Weight
Item
D. Weight:
float
C0005910 (UMLS CUI [1])
Date
Item
E. Date Weight Measured
date
C0005910 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Section 2 Data Sources
Item
A. Hospital files
text
C0019980 (UMLS CUI [1])
Hospital files
Code List
A. Hospital files
CL Item
Yes, complete  (Yes, complete )
CL Item
Yes, incomplete (Yes, incomplete)
CL Item
No (No)
Item
B. Outpatient clinic chart
text
C0029916 (UMLS CUI [1,1])
C0025102 (UMLS CUI [1,2])
Outpatient clinic chart
Code List
B. Outpatient clinic chart
CL Item
Yes, complete  (Yes, complete )
CL Item
Yes, incomplete (Yes, incomplete)
CL Item
No (No)
Item
C. Autopsy report
text
C1548372 (UMLS CUI [1])
Autopsy report
Code List
C. Autopsy report
CL Item
Yes, complete  (Yes, complete )
CL Item
Yes, incomplete (Yes, incomplete)
CL Item
No (No)
Registry
Item
D. Registry
boolean
C0034975 (UMLS CUI [1])
Obituary
Item
E. Obituary
boolean
C3828738 (UMLS CUI [1])
Patients relatives or partner
Item
F. Patients relatives or partner
boolean
C0015576 (UMLS CUI [1])
Patients medical provider
Item
G. Patients medical provider
boolean
C1138603 (UMLS CUI [1,1])
C0205476 (UMLS CUI [1,2])
Nursing home
Item
H. Nursing home
text
C0028688 (UMLS CUI [1])
Other Source
Item
I. Other Source
text
C0011001 (UMLS CUI [1])
Item Group
Completed by
Name
Item
Completed by: Name (in print)
text
C0027365 (UMLS CUI [1])
Item
Position:
text
C0018722 (UMLS CUI [1])
Position
Code List
Position:
CL Item
Physician  (Physician )
CL Item
Nurse  (Nurse )
CL Item
Other, describe (Other, describe)
Other Position
Item
Other, describe
text
C0018722 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Involved in medical care
Item
Directly involved in the medical care of the patient around the time of death?
boolean
C0496675 (UMLS CUI [1,1])
C1314939 (UMLS CUI [1,2])
Date
Item
Date:
date
C0011008 (UMLS CUI [1])
Signature
Item
Signature:
text
C1519316 (UMLS CUI [1])
Back to the top of the page