ID

1712

Description

A brief description of major medical and surgical events during the patient's lifetime, excluding the events related to their cancer therapy. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACEA4A85-36E3-608D-E040-BB89AD4326AD

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACEA4A85-36E3-608D-E040-BB89AD4326AD

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 7/15/17 7/15/17 - Martin Dugas
Uploaded on

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0
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Follow-Up - Baseline Medical History - 3272558v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Baseline Medical History
    1. No Instruction available.
Baseline Medical History
Description

Baseline Medical History

Visit Date
Description

FormCompletionDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
Date of Examination (Enter the date that the patient was examined and the medical history was documented. Since only one Baseline Medical History form is used, if the information has been assembled over a period of time, enter the date of the latest examination.)
Description

EvaluationDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25214
UMLS 2011AA ObjectClass
C0220825
Medical History 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
Finding Result (Comments are required for abnormal finding results. - - Note: Do not select Normal if the body system was not specifically assessed i.e.: not mentioned in the progress note in the medical record. Not Assessed means a discussion on the body system was not raised or the body system was not assessed.)
Description

FindingResultIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C20200
UMLS 2011AA ValueDomain
C1274040
NCI Thesaurus ObjectClass
C3367
UMLS 2011AA ObjectClass
C0037088
NCI Metathesaurus Property
CL282989
Medical History If Abnormal
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
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Baseline Medical History
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Baseline Medical History
FormCompletionDate
Item
Visit Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
EvaluationDate
Item
Date of Examination (Enter the date that the patient was examined and the medical history was documented. Since only one Baseline Medical History form is used, if the information has been assembled over a period of time, enter the date of the latest examination.)
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
Item
Medical History 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.1
Code List
Medical History 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)
Item
Finding Result (Comments are required for abnormal finding results. - - Note: Do not select Normal if the body system was not specifically assessed i.e.: not mentioned in the progress note in the medical record. Not Assessed means a discussion on the body system was not raised or the body system was not assessed.)
text
C20200 (NCI Thesaurus ValueDomain)
C1274040 (UMLS 2011AA ValueDomain)
C3367 (NCI Thesaurus ObjectClass)
C0037088 (UMLS 2011AA ObjectClass)
CL282989 (NCI Metathesaurus Property)
CL.2
Code List
Finding Result (Comments are required for abnormal finding results. - - Note: Do not select Normal if the body system was not specifically assessed i.e.: not mentioned in the progress note in the medical record. Not Assessed means a discussion on the body system was not raised or the body system was not assessed.)
CL Item
Normal (N)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (A)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
Not Assessed (Z)
MedicalHistoryDescription
Item
Medical History If Abnormal
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)
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