ID
16491
Description
Medical history form, Study hospital, Medical Faculty Münster derived from Medical history form by Dr. Schusdziarra
Keywords
Versions (2)
- 7/18/16 7/18/16 -
- 7/19/16 7/19/16 -
Uploaded on
July 19, 2016
DOI
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License
Creative Commons BY-NC 3.0
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Medical History Form, Study Hospital of Medical Faculty Münster
Medical History Form
- StudyEvent: ODM
Description
Current medical complaints
Description
Symptoms
Data type
text
Alias
- UMLS CUI [1]
- C1457887
Description
Localization
Data type
text
Alias
- UMLS CUI [1]
- C0475264
Description
Onset of symptoms
Data type
text
Alias
- UMLS CUI [1]
- C0277793
Description
Occurence of symptoms
Data type
integer
Alias
- UMLS CUI [1,1]
- C2745955
- UMLS CUI [1,2]
- C0037088
Description
Minutes,Hours,Days,Weeks
Data type
text
Alias
- UMLS CUI [1,1]
- C0449238
- UMLS CUI [1,2]
- C0037088
- UMLS CUI [1,3]
- C1272706
Description
Intensity and character
Data type
text
Alias
- UMLS CUI [1,1]
- C0518690
- UMLS CUI [1,2]
- C0221563
Description
Deterioration/Improvement by change of position, activity, food consumption, day-/nighttime, temperature, breathing...
Data type
text
Alias
- UMLS CUI [1]
- C1701901
Description
Impairment of general health
Data type
text
Alias
- UMLS CUI [1,1]
- C0231171
- UMLS CUI [1,2]
- C0516984
Description
Diagnostic procedures
Data type
text
Alias
- UMLS CUI [1]
- C0430022
Description
Medical history
Description
Measles, Rubella, Mumps, Pertussis,...
Data type
text
Alias
- UMLS CUI [1]
- C0489532
Description
Diseases in adulthood
Data type
text
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0700597
Description
Hospitalization
Data type
text
Alias
- UMLS CUI [1]
- C0019993
Description
Surgery
Data type
text
Alias
- UMLS CUI [1]
- C0543467
Description
Injuries
Data type
text
Alias
- UMLS CUI [1]
- C3263723
Description
Mental disorders
Data type
text
Alias
- UMLS CUI [1]
- C0004936
Description
Immunization
Data type
text
Alias
- UMLS CUI [1]
- C0020971
Description
Explicitly ask for problems with heart, lungs, stomach, bowels, genitourinary system, high blood pressure, diabetes and other endocrinologic diseases.
Data type
text
Alias
- UMLS CUI [1]
- C3843040
Description
Medication history
Description
Tradename
Data type
text
Alias
- UMLS CUI [1]
- C0013227
Description
Dosage
Data type
text
Alias
- UMLS CUI [1]
- C0178602
Description
Duration
Data type
text
Alias
- UMLS CUI [1]
- C0449238
Description
Explicitly ask for medications taken previously (i.e some time ago)
Data type
text
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0205156
Description
Explicitly ask for OTC medication, especially sleeping pills or laxatives
Data type
text
Alias
- UMLS CUI [1,1]
- C2347852
- UMLS CUI [1,2]
- C0013231
Description
Antibiotics,...
Data type
text
Alias
- UMLS CUI [1,1]
- C0020517
- UMLS CUI [1,2]
- C0013227
Description
Patient social and occupation history
Description
Learned occupation
Data type
text
Alias
- UMLS CUI [1]
- C0421456
Description
Current occupation
Data type
text
Alias
- UMLS CUI [1]
- C0421456
Description
Occupational stressors
Data type
text
Alias
- UMLS CUI [1]
- C0597127
Description
Occupational exposure
Data type
text
Alias
- UMLS CUI [1]
- C0853965
Description
Occupational satisfaction
Data type
text
Alias
- UMLS CUI [1]
- C0683792
Description
Reliability of employment
Data type
text
Alias
- UMLS CUI [1,1]
- C0242271
- UMLS CUI [1,2]
- C2347947
Description
i.e Marriage, Children, Relatives, living circumstances like living alone or with family, home can be reached barrier free, by staircase or elevator...
Data type
text
Alias
- UMLS CUI [1]
- C0015576
Description
Family medical history
Description
Frequent diseases in family
Data type
text
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0439660
Description
Diabetes mellitus
Data type
text
Alias
- UMLS CUI [1]
- C0011849
Description
Hypertension
Data type
text
Alias
- UMLS CUI [1]
- C0020538
Description
Blood coagulation disorders
Data type
text
Alias
- UMLS CUI [1]
- C0005779
Description
Neoplasms
Data type
text
Alias
- UMLS CUI [1]
- C0027651
Description
Dyslipidemia
Data type
text
Alias
- UMLS CUI [1]
- C0242339
Description
Arteriosclerosis
Data type
text
Alias
- UMLS CUI [1]
- C0003850
Description
Autonomic function history
Description
Symptoms of hypersensitivity
Data type
text
Alias
- UMLS CUI [1]
- C0020517
Description
Allergy testing
Data type
text
Alias
- UMLS CUI [1]
- C0199747
Description
Hypersensitivity to contrast agents
Data type
text
Alias
- UMLS CUI [1,1]
- C0020517
- UMLS CUI [1,2]
- C0009924
Description
Antibiotics,...
Data type
text
Alias
- UMLS CUI [1,1]
- C0020517
- UMLS CUI [1,2]
- C0013227
Description
Appetite
Data type
integer
Alias
- UMLS CUI [1]
- C0003618
Description
Food consumption
Data type
integer
Alias
- UMLS CUI [1]
- C2983605
Description
Cravings
Data type
text
Alias
- UMLS CUI [1]
- C0870371
Description
Fluid intake
Data type
text
Alias
- UMLS CUI [1]
- C0429791
Description
What does the patient preferrably drink? (i.e: sugery drinks, water, tea,coffee,...)
Data type
text
Alias
- UMLS CUI [1,1]
- C0332307
- UMLS CUI [1,2]
- C2013463
Description
Vomiting
Data type
boolean
Alias
- UMLS CUI [1]
- C0042963
Description
Vomiting
Data type
text
Alias
- UMLS CUI [1]
- C0042963
Description
i.e bile, sour, colour,...
Data type
text
Alias
- UMLS CUI [1]
- C0042963
Description
Dieting
Data type
boolean
Alias
- UMLS CUI [1]
- C2945766
Description
Type of diet
Data type
text
Alias
- UMLS CUI [1]
- C1550392
Description
Reason for diet
Data type
text
Alias
- UMLS CUI [1,1]
- C0566251
- UMLS CUI [1,2]
- C2945766
Description
Micturition
Data type
text
Alias
- UMLS CUI [1]
- C2584336
Description
Urine colour
Data type
text
Alias
- UMLS CUI [1]
- C0278030
Description
Micturition disorders
Data type
text
Alias
- UMLS CUI [1]
- C0042035
Description
Urine amount
Data type
text
Alias
- UMLS CUI [1]
- C1822256
Description
Nocturia frequency
Data type
text
Alias
- UMLS CUI [1]
- C0028734
Description
Bowel movement frequency
Data type
text
Alias
- UMLS CUI [1]
- C0426642
Description
Amount of stool
Data type
text
Alias
- UMLS CUI [1]
- C4069675
Description
Consistency of stool
Data type
text
Alias
- UMLS CUI [1]
- C0426740
Description
Stool colour
Data type
text
Alias
- UMLS CUI [1]
- C0578538
Description
Appearance of stool
Data type
text
Alias
- UMLS CUI [1]
- C1286372
Description
i.e mucus, blood, ...
Data type
text
Alias
- UMLS CUI [1,1]
- C0426744
- UMLS CUI [1,2]
- C0205271
Description
First menstrual period
Data type
text
Alias
- UMLS CUI [1]
- C0025274
Description
Menstrual period
Data type
boolean
Alias
- UMLS CUI [1]
- C0025329
Description
Contraception
Data type
boolean
Alias
- UMLS CUI [1]
- C0700589
Description
Menopausal
Data type
boolean
Alias
- UMLS CUI [1]
- C0455962
Description
Parity
Data type
integer
Alias
- UMLS CUI [1]
- C0030563
Description
Pregnancy complications
Data type
text
Alias
- UMLS CUI [1]
- C0032962
Description
Abortion or miscarriage
Data type
text
Alias
- UMLS CUI [1]
- C0429914
Description
Preventive medical examination
Data type
text
Alias
- UMLS CUI [1]
- C0033144
Description
Patient Weight
Data type
float
Alias
- UMLS CUI [1]
- C0005910
Description
Height
Data type
float
Alias
- UMLS CUI [1]
- C0005890
Description
Weight gain
Data type
text
Alias
- UMLS CUI [1]
- C0043094
Description
Weight gain unintentional or intentional
Data type
integer
Alias
- UMLS CUI [1,1]
- C2367670
- UMLS CUI [1,2]
- C3714343
Description
Dietary treatment
Data type
text
Alias
- UMLS CUI [1]
- C1258068
Description
Weight loss
Data type
text
Alias
- UMLS CUI [1]
- C1262477
Description
Weight loss unintentional or intentional
Data type
integer
Alias
- UMLS CUI [1,1]
- C2169614
- UMLS CUI [1,2]
- C2363736
Description
Reducing diet
Data type
text
Alias
- UMLS CUI [1]
- C0012167
Description
General endurance
Data type
text
Alias
- UMLS CUI [1]
- C0518031
Description
i.e: problems to sleep through, or difficulties falling asleep
Data type
text
Alias
- UMLS CUI [1]
- C0037317
Description
Duration of sleep
Data type
text
Alias
- UMLS CUI [1]
- C0424574
Description
Sleeping behavior
Data type
text
Alias
- UMLS CUI [1]
- C0474396
Description
Cough
Data type
text
Alias
- UMLS CUI [1]
- C0010200
Description
Cough
Data type
text
Alias
- UMLS CUI [1]
- C0010200
Description
Sputum
Data type
text
Alias
- UMLS CUI [1]
- C0038056
Description
Sputum
Data type
text
Alias
- UMLS CUI [1]
- C0425519
Description
Expectoration
Data type
text
Alias
- UMLS CUI [1]
- C0038056
Description
Bloody sputum
Data type
boolean
Alias
- UMLS CUI [1]
- C0748941
Description
Productive cough frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C0239134
- UMLS CUI [1,2]
- C0422341
Description
Productive cough duration
Data type
text
Alias
- UMLS CUI [1,1]
- C0239134
- UMLS CUI [1,2]
- C0449238
Description
Fever duration
Data type
text
Alias
- UMLS CUI [1,1]
- C0015967
- UMLS CUI [1,2]
- C0449238
Description
Fever course
Data type
text
Alias
- UMLS CUI [1,1]
- C0015967
- UMLS CUI [1,2]
- C1292729
Description
Perspiration
Data type
boolean
Alias
- UMLS CUI [1]
- C0038990
Description
Perspiration
Data type
boolean
Alias
- UMLS CUI [1]
- C0038990
Description
Dyspnea at rest
Data type
boolean
Alias
- UMLS CUI [1]
- C0743330
Description
Dyspnea on exertion
Data type
boolean
Alias
- UMLS CUI [1]
- C0231807
Description
Nighttime dyspnea
Data type
text
Alias
- UMLS CUI [1]
- C2127200
Description
Pruritus
Data type
text
Alias
- UMLS CUI [1]
- C0033774
Description
Pruritus
Data type
text
Alias
- UMLS CUI [1]
- C0033774
Description
Seizures
Data type
text
Alias
- UMLS CUI [1]
- C0036572
Description
Sexually Transmitted Diseases
Data type
text
Alias
- UMLS CUI [1]
- C0036916
Description
Ask for type and amount of alcoholic beverages consumed and calculate daily/weekly consumption
Data type
text
Alias
- UMLS CUI [1]
- C0001948
Description
Ask for amount and duration of nicotine use. Cigarettes, Cigars, Pipe, chewing tobacco
Data type
text
Alias
- UMLS CUI [1]
- C0038586
Description
Invalidity
Data type
text
Alias
- UMLS CUI [1]
- C0012605
Similar models
Medical History Form
- StudyEvent: ODM
C0011008 (UMLS CUI [1,2])
C0037088 (UMLS CUI [1,2])
C0037088 (UMLS CUI [1,2])
C1272706 (UMLS CUI [1,3])
C0221563 (UMLS CUI [1,2])
C0516984 (UMLS CUI [1,2])
C0700597 (UMLS CUI [1,2])
C0205156 (UMLS CUI [1,2])
C0013231 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C2347947 (UMLS CUI [1,2])
C0439660 (UMLS CUI [1,2])
C0009924 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C2013463 (UMLS CUI [1,2])
C2945766 (UMLS CUI [1,2])
C0205271 (UMLS CUI [1,2])
C3714343 (UMLS CUI [1,2])
C2363736 (UMLS CUI [1,2])
C0422341 (UMLS CUI [1,2])
C0449238 (UMLS CUI [1,2])
C0449238 (UMLS CUI [1,2])
C1292729 (UMLS CUI [1,2])