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ID
17851
Description
Hospital Routine Documentation Form at the University Hospital Muenster. Original Form name: KIORTH CPChild MS. German description: CPChild Ein Index zur gesundheitsbezogenen Lebensqualität bei Menschen mit Behinderung
Keywords
Versions (5)
- 10/5/16 10/5/16 -
- 10/6/16 10/6/16 - Julian Varghese
- 12/5/16 12/5/16 -
- 4/13/21 4/13/21 - Dr. rer. medic Philipp Neuhaus
- 11/17/21 11/17/21 -
Uploaded on
October 5, 2016
DOI
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License
Creative Commons BY-NC 3.0
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KIORTH CPChild MS University Hospital Muenster (UKM)
KIORTH CPChild MS University Hospital Muenster (UKM)
- StudyEvent: ODM
Similar models
KIORTH CPChild MS University Hospital Muenster (UKM)
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Name of child
Item
Name des Kindes
text
Name of parents or caregiver
Item
Name der Eltern oder Pflegeperson, die den Bogen ausfüllt
text
Date
Item
date
Item Group
Teil 1: Körperpflege / Aktivitäten des täglichen Lebens
Item
1 Essen/Trinken oder gefüttert werden (wie im Alltag gemacht wird z.B. über den Mund oder über Sonde oder beides): Schwierigkeit
integer
Code List
1 Essen/Trinken oder gefüttert werden (wie im Alltag gemacht wird z.B. über den Mund oder über Sonde oder beides): Schwierigkeit
CL Item
nicht möglich (0 )
CL Item
sehr schwierig (1 )
CL Item
schwierig (2 )
CL Item
etwas schwierig (3 )
CL Item
leicht (4 )
CL Item
sehr leicht (5 )
CL Item
völlig unproblematisch (6 )
Item
1 Essen/Trinken oder gefüttert werden (wie im Alltag gemacht wird z.B. über den Mund oder über Sonde oder beides): Grad der Hilfestellung
integer
Code List
1 Essen/Trinken oder gefüttert werden (wie im Alltag gemacht wird z.B. über den Mund oder über Sonde oder beides): Grad der Hilfestellung
CL Item
vollständig (0 )
CL Item
mäßig (1 )
CL Item
gering/zuschauend (2 )
CL Item
unabhängig (3 )
CL Item
nicht möglich (0 )
CL Item
sehr schwierig (1 )
CL Item
schwierig (2 )
CL Item
etwas schwierig (3 )
CL Item
leicht (4 )
CL Item
sehr leicht (5 )
CL Item
völlig unproblematisch (6 )
Item
2 Mundhygiene (Zähne putzen): Grad der Hilfestellung
integer
Code List
2 Mundhygiene (Zähne putzen): Grad der Hilfestellung
CL Item
vollständig (0 )
CL Item
mäßig (1 )
CL Item
gering/zuschauend (2 )
CL Item
unabhängig (3 )
CL Item
nicht möglich (0 )
CL Item
sehr schwierig (1 )
CL Item
schwierig (2 )
CL Item
etwas schwierig (3 )
CL Item
leicht (4 )
CL Item
sehr leicht (5 )
CL Item
völlig unproblematisch (6 )
CL Item
nicht möglich (0 )
CL Item
sehr schwierig (1 )
CL Item
schwierig (2 )
CL Item
etwas schwierig (3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
5. changing diapers/underwear: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
Code List
6. putting on/taking off upper body clothing: difficulty
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
6. putting on/taking off upper body clothing: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
Code List
7. putting on/taking off lower body clothing: difficulty
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
7. putting on/taking off lower body clothing: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
8. putting on/wearing footwear: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
1A. other personal care activity
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
1A. other personal care activity: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
1B. other personal care activity
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
1B. other personal care activity: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
Part 1: difficulty score
Item
text
Part 1: level of assistance score
Item
text
Part 1: total score
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
Code List
11. transferring into /out of a wheelchair/chair: difficulty
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
11. transferring into /out of a wheelchair/chair: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
Code List
13. standing for exercise/transfers: difficulty
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
13. standing for exercise/transfers: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
14. moving about in the home: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
Code List
16. getting in and out of a motor vehicle: difficulty
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
Code List
16. getting in and out of a motor vehicle: level of assistance
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
2A. other activity
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
2B. other activity
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(6 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
Part 2: difficulty score
Item
text
Part 2: level of assistance score
Item
text
Part 2: total score
Item
text
Code List
18. while eating/drinking or being fed: frequency
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Code List
18. while eating/drinking or being fed: intensity
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
Code List
21. during transfers or position changes: frequency
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Code List
21. during transfers or position changes: intensity
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
3A. during other activity
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
3B. during other activity
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
Part 3: frequency score
Item
text
Part 3: intensity score
Item
text
Part 3: total score
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Code List
33. participating in recreational activities: difficulty
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
4A. other social activity
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
4B. other social activity
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Part 4: total score
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
36. List of medications
Item
text
Part 5: total score
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Part 6: total score
Item
text
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Code List
11. Transferring into / out of a wheel chair / chair
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Code List
21. Comfort during transfers or position changes
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Code List
33. Able to participate in recreational activities
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Code List
34. Minimizing doctor visits and hospitalization
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
CL Item
(0 )
CL Item
(1 )
CL Item
(2 )
CL Item
(3 )
CL Item
(4 )
CL Item
(5 )
Part 7: total score
Item
text
CL Item
(männlich)
CL Item
(weiblich)
Date of birth
Item
date
CL Item
(Kindergarten)
CL Item
(Vorschule)
CL Item
(1. Klasse)
CL Item
(2. Klasse)
CL Item
(3. Klasse)
CL Item
(4. Klasse)
CL Item
(5. Klasse)
CL Item
(6. Klasse)
CL Item
(7. Klasse)
CL Item
(8. Klasse)
CL Item
(9. Klasse)
CL Item
(10. Klasse)
CL Item
(11. Klasse)
CL Item
(12. Klasse)
CL Item
(Keine abgeschlossen)
If ungraded, how many years attended?
Item
text
CL Item
(männlich)
CL Item
(weiblich)
Date of birth
Item
date
Current work status: Not working due to child’s health
Item
boolean
Current work status: Not working for other reasons
Item
boolean
Current work status: Looking for work outside the home
Item
boolean
Current work status: Working full or part time
Item
boolean
Current work status: Full time homemaker
Item
boolean
Relationship to child: Biological Parent
Item
boolean
Relationship to child: Step Parent
Item
boolean
Relationship to child: Foster Parent
Item
boolean
Relationship to child: Adoptive Parent
Item
boolean
Relationship to child: Guardian
Item
boolean
Relationship to child: Professional caregiver
Item
boolean
Relationship to child: Other
Item
boolean
Relationship to child: Other (please explain)
Item
text
Care giving (days per week)
Item
integer
CL Item
(Hauptschulabschluss)
CL Item
(Realschulabschluss)
CL Item
(Abitur)
CL Item
(Fachschulabschluss)
CL Item
(Universitätsabschluss)
CPChild Result
Item
text