ID

18122

Description

Hospital Routine Documentation Form at the University Hospital Muenster. Original Form name: Fragebogen zur Phasenbeurteilung für die Neurologische Rehabilitation Phase B und C

Keywords

Versions (1)
  1. 10/21/16 10/21/16 -
Uploaded on

October 21, 2016

DOI

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License

Creative Commons BY-NC 3.0
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Questionnaire for the assessment of neurologic rehabilitation phases University Hospital Muenster (UKM)

German

Questionnaire for the assessment of neurologic rehabilitation phasesUniversity Hospital Muenster (UKM)

1 forms  
Demographische Informationen
Description

Demographische Informationen

Patientenname
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Geburtsdatum
Description

Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Geschlecht
Description

Gender

Data type

integer

Alias
UMLS CUI [1]
C0079399
Fall Nummer
Description

Case number

Data type

integer

Alias
UMLS CUI [1,1]
C1698493
UMLS CUI [1,2]
C0600091
Aufnahmedatum und Uhrzeit
Description

Date and time of admission

Data type

datetime

Alias
UMLS CUI [1,1]
C1302393
UMLS CUI [1,2]
C3854259
Klinik Fachrichtung
Description

Clinic / Center - Medical Specialty

Data type

text

Alias
UMLS CUI [1]
C1552531
Fragen zur Phasenbeurteilung
Description

Fragen zur Phasenbeurteilung

Ist der Patient kommunikations- und interaktionsfähig (ggf. unter Verwendung von Hilfsmitteln)?
Description

Ability to communicate and interact (with self-help devices)

Data type

boolean

Alias
UMLS CUI [1,1]
C0565998
UMLS CUI [1,2]
C0036605
UMLS CUI [2,1]
C0558182
UMLS CUI [2,2]
C0036605
Ist der Patient überwiegend bewusstseinsklar, kommt er einfachen Aufforderungen nach?
Description

Patient awake and able to follow simple requests?

Data type

boolean

Alias
UMLS CUI [1,1]
C0234425
UMLS CUI [1,2]
C1720622
Kann der Patient an mehreren Therapiemaßnahmen von je 30 Minuten Dauer täglich mitarbeiten?
Description

Ability to participate in several therapeutic interventions of 30 minutes each daily

Data type

boolean

Alias
UMLS CUI [1,1]
C0030699
UMLS CUI [1,2]
C0808232
UMLS CUI [1,3]
C0444921
Ist der Patient teilmobilisiert, kann er 2-4 Stunden im Rollstuhl verbringen?
Description

Partially mobile, ability to sit in a wheelchair for 2-4 hours

Data type

boolean

Alias
UMLS CUI [1,1]
C0578258
UMLS CUI [1,2]
C0578264
UMLS CUI [1,3]
C0449238
Bedarf der Patient noch intensivmedizinischer Überwachung oder Therapie?
Description

Need for critical care or surveillance

Data type

boolean

Alias
UMLS CUI [1,1]
C0199332
UMLS CUI [1,2]
C0993669
Ist der Patient noch beatmungspflichtig?
Description

Need for artificial ventilation

Data type

boolean

Alias
UMLS CUI [1,1]
C0035205
UMLS CUI [1,2]
C0686904
Wenn ja, wann ist die Beendigung der Beatmung geplant?
Description

Planned end of artificial respiration

Data type

date

Alias
UMLS CUI [1,1]
C0035205
UMLS CUI [1,2]
C1115730
Liegt noch ein Tracheostoma?
Description

Tracheostomy present?

Data type

boolean

Alias
UMLS CUI [1]
C0260682
Wann ist ggf. die Entnahme des Tracheostomas geplant?
Description

Planned removal of tracheostomy

Data type

date

Alias
UMLS CUI [1,1]
C0178148
UMLS CUI [1,2]
C1320712
Bestehen Begleiterkrankungen, die eine Mobilisierung verhindern?
Description

Comorbidities preventing mobilization

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0300926
Liegt Selbst- oder Fremdgefährdung vor?
Description

Self-Injurious Behavior or risk of violence or harm to others

Data type

boolean

Alias
UMLS CUI [1,1]
C0085271
UMLS CUI [1,2]
C0549013
Liegt Kleingruppenfähigkeit (3-5 Patienten) vor?
Description

Ability to participate in small group therapy

Data type

boolean

Alias
UMLS CUI [1,1]
C0029628
UMLS CUI [1,2]
C0679982
Liegen schwere, nur kurzfristige oder nicht beeinflussbare Verhaltensstörungen vor?
Description

Severe behavioral disorder short-term or can not be influenced

Data type

boolean

Alias
UMLS CUI [1,1]
C0556006
UMLS CUI [1,2]
C0392364
UMLS CUI [1,3]
C0436359
Wenn ja, welche Verhaltensstörungen?
Description

What type of behavior disorder

Data type

text

Alias
UMLS CUI [1,1]
C0004930
UMLS CUI [1,2]
C0457464
Liegt ein positiver MRSA-Nachweis oder sonstiger Keimnachweis vor?
Description

Infectious diseases

Data type

boolean

Alias
UMLS CUI [1]
C0009450
Telefon für Rückfragen
Description

Phone number for inquiries

Data type

integer

Alias
UMLS CUI [1,1]
C1515258
UMLS CUI [1,2]
C2987583
Ausfülldatum
Description

Date of completion

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0850287
Unterschrift des KH-Arztes
Description

Responsible physician signature

Data type

text

Alias
UMLS CUI [1]
C0807938
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Similar models

Questionnaire for the assessment of neurologic rehabilitation phasesUniversity Hospital Muenster (UKM)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Demographische Informationen
Patient Name
Item
Patientenname
text
C1299487 (UMLS CUI [1])
Birth Date
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Item
Geschlecht
integer
C0079399 (UMLS CUI [1])
Gender
Code List
Geschlecht
CL Item
M (1)
CL Item
W (2)
Case number
Item
Fall Nummer
integer
C1698493 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Date and time of admission
Item
Aufnahmedatum und Uhrzeit
datetime
C1302393 (UMLS CUI [1,1])
C3854259 (UMLS CUI [1,2])
Clinic / Center - Medical Specialty
Item
Klinik Fachrichtung
text
C1552531 (UMLS CUI [1])
Item Group
Fragen zur Phasenbeurteilung
Ability to communicate and interact (with self-help devices)
Item
Ist der Patient kommunikations- und interaktionsfähig (ggf. unter Verwendung von Hilfsmitteln)?
boolean
C0565998 (UMLS CUI [1,1])
C0036605 (UMLS CUI [1,2])
C0558182 (UMLS CUI [2,1])
C0036605 (UMLS CUI [2,2])
Patient awake and able to follow simple requests?
Item
Ist der Patient überwiegend bewusstseinsklar, kommt er einfachen Aufforderungen nach?
boolean
C0234425 (UMLS CUI [1,1])
C1720622 (UMLS CUI [1,2])
Ability to participate in several therapeutic interventions of 30 minutes each daily
Item
Kann der Patient an mehreren Therapiemaßnahmen von je 30 Minuten Dauer täglich mitarbeiten?
boolean
C0030699 (UMLS CUI [1,1])
C0808232 (UMLS CUI [1,2])
C0444921 (UMLS CUI [1,3])
Partially mobile, ability to sit in a wheelchair for 2-4 hours
Item
Ist der Patient teilmobilisiert, kann er 2-4 Stunden im Rollstuhl verbringen?
boolean
C0578258 (UMLS CUI [1,1])
C0578264 (UMLS CUI [1,2])
C0449238 (UMLS CUI [1,3])
Need for critical care or surveillance
Item
Bedarf der Patient noch intensivmedizinischer Überwachung oder Therapie?
boolean
C0199332 (UMLS CUI [1,1])
C0993669 (UMLS CUI [1,2])
Need for artificial ventilation
Item
Ist der Patient noch beatmungspflichtig?
boolean
C0035205 (UMLS CUI [1,1])
C0686904 (UMLS CUI [1,2])
Planned end of artificial respiration
Item
Wenn ja, wann ist die Beendigung der Beatmung geplant?
date
C0035205 (UMLS CUI [1,1])
C1115730 (UMLS CUI [1,2])
Tracheostomy present?
Item
Liegt noch ein Tracheostoma?
boolean
C0260682 (UMLS CUI [1])
Planned removal of tracheostomy
Item
Wann ist ggf. die Entnahme des Tracheostomas geplant?
date
C0178148 (UMLS CUI [1,1])
C1320712 (UMLS CUI [1,2])
Comorbidities preventing mobilization
Item
Bestehen Begleiterkrankungen, die eine Mobilisierung verhindern?
boolean
C0009488 (UMLS CUI [1,1])
C0300926 (UMLS CUI [1,2])
Self-Injurious Behavior or risk of violence or harm to others
Item
Liegt Selbst- oder Fremdgefährdung vor?
boolean
C0085271 (UMLS CUI [1,1])
C0549013 (UMLS CUI [1,2])
Ability to participate in small group therapy
Item
Liegt Kleingruppenfähigkeit (3-5 Patienten) vor?
boolean
C0029628 (UMLS CUI [1,1])
C0679982 (UMLS CUI [1,2])
Severe behavioral disorder short-term or can not be influenced
Item
Liegen schwere, nur kurzfristige oder nicht beeinflussbare Verhaltensstörungen vor?
boolean
C0556006 (UMLS CUI [1,1])
C0392364 (UMLS CUI [1,2])
C0436359 (UMLS CUI [1,3])
What type of behavior disorder
Item
Wenn ja, welche Verhaltensstörungen?
text
C0004930 (UMLS CUI [1,1])
C0457464 (UMLS CUI [1,2])
Infectious diseases
Item
Liegt ein positiver MRSA-Nachweis oder sonstiger Keimnachweis vor?
boolean
C0009450 (UMLS CUI [1])
Phone number for inquiries
Item
Telefon für Rückfragen
integer
C1515258 (UMLS CUI [1,1])
C2987583 (UMLS CUI [1,2])
Date of completion
Item
Ausfülldatum
date
C0011008 (UMLS CUI [1,1])
C0850287 (UMLS CUI [1,2])
Responsible physician signature
Item
Unterschrift des KH-Arztes
text
C0807938 (UMLS CUI [1])
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