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AAFP: DVT Discharge

1 Formulaires  
  1. StudyEvent: ODM
    1. AAFP: DVT Discharge
Default Itemgroup
Description

Default Itemgroup

Name
Description

Name

Type de données

text

Alias
UMLS CUI [1]
C0027365
Age
Description

Age

Type de données

integer

Alias
UMLS CUI [1]
C0001779
Date of Birth
Description

Date of Birth

Type de données

date

Alias
UMLS CUI [1]
C0421451
Medical record
Description

Medical record

Type de données

integer

Alias
UMLS CUI [1]
C1301894
Status
Description

Status

Discharge home
Description

Discharge

Type de données

boolean

Alias
UMLS CUI [1]
C0030685
If discharge home, please specify date
Description

Date of discharge

Type de données

date

Alias
UMLS CUI [1]
C2361123
Attending
Description

Attending

Name of attending physician
Description

Name of attending physician

Type de données

text

Alias
UMLS CUI [1]
C2361125
Phone number of attending physician
Description

Phone number of attending physician

Type de données

integer

Alias
UMLS CUI [1]
C3262226
Discharge Diagnosis
Description

Discharge Diagnosis

DVT___lower extremity
Description

DVT of lower extremity

Type de données

boolean

Alias
UMLS CUI [1]
C0340708
If DVT ___ lower extremity please specify
Description

If DVT ___ lower extremity please specify

Type de données

text

Alias
UMLS CUI [1,1]
C0340708
UMLS CUI [1,2]
C2348235
Other DVT
Description

Other DVT

Type de données

boolean

Alias
UMLS CUI [1,1]
C0149871
UMLS CUI [1,2]
C0205394
If Other, please specify
Description

If Other, please specify

Type de données

text

Alias
UMLS CUI [1,1]
C0149871
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C2348235
Status
Description

Status

Status
Description

Clinical Status

Type de données

text

Alias
UMLS CUI [1]
C0449440
Allergies
Description

Allergies

Allergies
Description

Allergies

Type de données

text

Alias
UMLS CUI [1]
C0020517
Diet
Description

Diet

Diet
Description

Diet

Type de données

text

Alias
UMLS CUI [1]
C0012155
Activity
Description

Activity

As tolerated
Description

Activity

Type de données

boolean

Alias
UMLS CUI [1]
C0026606
Elevate affected leg as much as possible
Description

Elevate affected leg as much as possible

Type de données

boolean

Alias
UMLS CUI [1]
C0204853
No driving or prolonged standing
Description

driving, prolonged standing

Type de données

boolean

Alias
UMLS CUI [1]
C0004379
UMLS CUI [2,1]
C0231472
UMLS CUI [2,2]
C0439590
Medications
Description

Medications

Lovenox___mg subcutaneously BID for ___days
Description

Provide patient with prescription for Lovenox or call the pharmacy. Lovenox is dispensed in prefilled syringes in the following doses: 30 mg, 40 mg, 60 mg, 80 mg, 100 mg. There are no pre-authorization requirements.

Type de données

boolean

Alias
UMLS CUI [1]
C0728963
If Lovenox, please specify amount
Description

Levonex drug dose

Type de données

integer

Unités de mesure
  • mg
Alias
UMLS CUI [1,1]
C0728963
UMLS CUI [1,2]
C0678766
mg
If Lovenox, please specify duration in days
Description

Lovenox duration

Type de données

integer

Alias
UMLS CUI [1,1]
C0728963
UMLS CUI [1,2]
C0449238
Coumadin__mg by mouth every day
Description

Coumadin

Type de données

boolean

Alias
UMLS CUI [1]
C0699129
If Coumadin, please specify amount
Description

Coumadin drug dose

Type de données

integer

Alias
UMLS CUI [1,1]
C0699129
UMLS CUI [1,2]
C0678766
Additional medications
Description

Medication

Type de données

boolean

Alias
UMLS CUI [1]
C0013227
If additional medications, please specify
Description

If additional medications, please specify

Type de données

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2348235
Patient Education
Description

Patient Education

Lovenox self-injection
Description

Lovenox self-injection

Type de données

boolean

Alias
UMLS CUI [1,1]
C0728963
UMLS CUI [1,2]
C3880392
Dietician counseling for food-drug interactions
Description

Dietician counseling for food-drug interactions

Type de données

boolean

Alias
UMLS CUI [1,1]
C0204932
UMLS CUI [1,2]
C0242785
Signs and symptoms of abnormal bleeding that need to be reported
Description

patient education of abnormal bleeding

Type de données

boolean

Alias
UMLS CUI [1,1]
C0030688
UMLS CUI [1,2]
C0019080
UMLS CUI [1,3]
C0205161
Avoidance of NSAID medications (aspirin, ibuprofen, Aleve, etc.)
Description

NSAID avoidance

Type de données

boolean

Alias
UMLS CUI [1,1]
C0030688
UMLS CUI [1,2]
C0003211
UMLS CUI [1,3]
C0870186
Follow-up
Description

Follow-up

Date and Time of Appointment already set
Description

Date and Time of follow-up

Type de données

boolean

Alias
UMLS CUI [1]
C2193198
If Appointment set, please specify date and time
Description

date and time of follow-up

Type de données

datetime

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C0040223
Call for an appointment in the next 3 days
Description

Call for an appointment

Type de données

boolean

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C0003629
Call for an appointment with Dr.____in the next ___days
Description

Call for an appointment with Dr.____in the next ___days

Type de données

boolean

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C0003629
Please specify name of doctor
Description

Name of doctor

Type de données

text

Alias
UMLS CUI [1]
C0027365
Please specify amount of days
Description

Amount of days

Type de données

integer

Alias
UMLS CUI [1,1]
C1265611
UMLS CUI [1,2]
C0439228
Other
Description

Other

Please fax the attached Coumadin Clinic Referral
Description

Please fax the attached Coumadin Clinic Referral

Type de données

boolean

Alias
UMLS CUI [1,1]
C0085205
UMLS CUI [1,2]
C1546430
UMLS CUI [1,3]
C0699129
Please fax the attached Discharge Summary
Description

Please fax the attached Discharge Summary

Type de données

boolean

Alias
UMLS CUI [1,1]
C0085205
UMLS CUI [1,2]
C0743221
Signature
Description

Signature

Type de données

text

Alias
UMLS CUI [1]
C1519316
Date and Time
Description

Date and Time

Type de données

datetime

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0040223
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Similar models

AAFP: DVT Discharge

1 Formulaires
  1. StudyEvent: ODM
    1. AAFP: DVT Discharge
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Name
Item
Name
text
C0027365 (UMLS CUI [1])
Age
Item
Age
integer
C0001779 (UMLS CUI [1])
Date of Birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
Medical record
Item
Medical record
integer
C1301894 (UMLS CUI [1])
Item Group
Status
Discharge
Item
Discharge home
boolean
C0030685 (UMLS CUI [1])
Date of discharge
Item
If discharge home, please specify date
date
C2361123 (UMLS CUI [1])
Item Group
Attending
Name of attending physician
Item
Name of attending physician
text
C2361125 (UMLS CUI [1])
Phone number of attending physician
Item
Phone number of attending physician
integer
C3262226 (UMLS CUI [1])
Item Group
Discharge Diagnosis
DVT of lower extremity
Item
DVT___lower extremity
boolean
C0340708 (UMLS CUI [1])
If DVT ___ lower extremity please specify
Item
If DVT ___ lower extremity please specify
text
C0340708 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Other DVT
Item
Other DVT
boolean
C0149871 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
If Other, please specify
Item
If Other, please specify
text
C0149871 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item Group
Status
Item
Status
text
C0449440 (UMLS CUI [1])
Status
Code List
Status
CL Item
Stable (1)
CL Item
Fair (2)
CL Item
Serious (3)
CL Item
Critical (4)
Item Group
Allergies
Allergies
Item
Allergies
text
C0020517 (UMLS CUI [1])
Item Group
Diet
Diet
Item
Diet
text
C0012155 (UMLS CUI [1])
Item Group
Activity
Activity
Item
As tolerated
boolean
C0026606 (UMLS CUI [1])
Elevate affected leg as much as possible
Item
Elevate affected leg as much as possible
boolean
C0204853 (UMLS CUI [1])
driving, prolonged standing
Item
No driving or prolonged standing
boolean
C0004379 (UMLS CUI [1])
C0231472 (UMLS CUI [2,1])
C0439590 (UMLS CUI [2,2])
Item Group
Medications
Lovenox
Item
Lovenox___mg subcutaneously BID for ___days
boolean
C0728963 (UMLS CUI [1])
Levonex drug dose
Item
If Lovenox, please specify amount
integer
C0728963 (UMLS CUI [1,1])
C0678766 (UMLS CUI [1,2])
Lovenox duration
Item
If Lovenox, please specify duration in days
integer
C0728963 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Coumadin
Item
Coumadin__mg by mouth every day
boolean
C0699129 (UMLS CUI [1])
Coumadin drug dose
Item
If Coumadin, please specify amount
integer
C0699129 (UMLS CUI [1,1])
C0678766 (UMLS CUI [1,2])
Medication
Item
Additional medications
boolean
C0013227 (UMLS CUI [1])
If additional medications, please specify
Item
If additional medications, please specify
text
C0013227 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item Group
Patient Education
Lovenox self-injection
Item
Lovenox self-injection
boolean
C0728963 (UMLS CUI [1,1])
C3880392 (UMLS CUI [1,2])
Dietician counseling for food-drug interactions
Item
Dietician counseling for food-drug interactions
boolean
C0204932 (UMLS CUI [1,1])
C0242785 (UMLS CUI [1,2])
patient education of abnormal bleeding
Item
Signs and symptoms of abnormal bleeding that need to be reported
boolean
C0030688 (UMLS CUI [1,1])
C0019080 (UMLS CUI [1,2])
C0205161 (UMLS CUI [1,3])
NSAID avoidance
Item
Avoidance of NSAID medications (aspirin, ibuprofen, Aleve, etc.)
boolean
C0030688 (UMLS CUI [1,1])
C0003211 (UMLS CUI [1,2])
C0870186 (UMLS CUI [1,3])
Item Group
Follow-up
Date and Time of follow-up
Item
Date and Time of Appointment already set
boolean
C2193198 (UMLS CUI [1])
date and time of follow-up
Item
If Appointment set, please specify date and time
datetime
C1522577 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Call for an appointment
Item
Call for an appointment in the next 3 days
boolean
C1522577 (UMLS CUI [1,1])
C0003629 (UMLS CUI [1,2])
Call for an appointment with Dr.____in the next ___days
Item
Call for an appointment with Dr.____in the next ___days
boolean
C1522577 (UMLS CUI [1,1])
C0003629 (UMLS CUI [1,2])
Name of doctor
Item
Please specify name of doctor
text
C0027365 (UMLS CUI [1])
Amount of days
Item
Please specify amount of days
integer
C1265611 (UMLS CUI [1,1])
C0439228 (UMLS CUI [1,2])
Item Group
Other
Please fax the attached Coumadin Clinic Referral
Item
Please fax the attached Coumadin Clinic Referral
boolean
C0085205 (UMLS CUI [1,1])
C1546430 (UMLS CUI [1,2])
C0699129 (UMLS CUI [1,3])
Please fax the attached Discharge Summary
Item
Please fax the attached Discharge Summary
boolean
C0085205 (UMLS CUI [1,1])
C0743221 (UMLS CUI [1,2])
Signature
Item
Signature
text
C1519316 (UMLS CUI [1])
Date and Time
Item
Date and Time
datetime
C0011008 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
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