ID

18566

Description

Hospital Routine Documentation Form at the University Hospital Muenster. Original Form name: Aerztl Hospizbesch SOZD UKM. (Aerztliche Bescheinigung zur Feststellung der Notwendigkeit vollstationaerer Hospizversorgung nach § 39a Abs. 1 SGB V)

Keywords

Versions (4)
  1. 9/30/16 9/30/16 -
  2. 11/9/16 11/9/16 -
  3. 11/9/16 11/9/16 -
  4. 11/11/16 11/11/16 -
Uploaded on

November 11, 2016

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Creative Commons BY-NC 3.0
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Aerztl Hospizbesch SOZD UKM University Hospital Muenster (UKM)

German

Aerztl Hospizbesch SOZD UKM University Hospital Muenster (UKM)

1 forms  
Allgemeine Information
Description

Allgemeine Information

Alias
UMLS CUI-1
C1508263
Name
Description

Patient name

Data type

text

Alias
UMLS CUI [1]
C1299487
geb.
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Fall-Nr.
Description

Case number

Data type

text

Alias
UMLS CUI [1,1]
C1698493
UMLS CUI [1,2]
C0600091
Aufnahme am
Description

Date of admission

Data type

date

Alias
UMLS CUI [1]
C1302393
Aufnahmezeit
Description

Time of admission

Data type

time

Alias
UMLS CUI [1]
C3854259
Anschrift der Krankenkasse
Description

Address of medical insurance company

Data type

text

Alias
UMLS CUI [1]
C1549448
Fax
Description

Fax

Data type

integer

Alias
UMLS CUI [1]
C1549619
KV-Nr.
Description

Insurance number

Data type

text

Alias
UMLS CUI [1]
C1549712
Zuständiger Mitarbeiter des Sozialdienst
Description

Social services staff member responsible

Data type

text

Alias
UMLS CUI [1]
C0037444
Zuständiger Arzt
Description

Physician responsible

Data type

text

Alias
UMLS CUI [1]
C0262720
Erstantrag
Description

First application

Data type

boolean

Alias
UMLS CUI [1,1]
C0185125
UMLS CUI [1,2]
C0583223
Folgeantrag
Description

Subsequent application

Data type

boolean

Alias
UMLS CUI [1,1]
C0185125
UMLS CUI [1,2]
C0583223
Die Hospiznotwendigkeit begründende Erkrankung / Diagnose
Description

Diagnosis justifying necessity of hospice

Data type

text

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0583223
Stadium ggf. Metastasierung / Prognose:
Description

State of metastasis / prognosis

Data type

text

Alias
UMLS CUI [1]
C0033325
Begrenzte Lebenserwartung (Tage bis Wochen)
Description

Limited life expectancy (days to weeks)

Data type

boolean

Alias
UMLS CUI [1]
C1504437
Kurze Angaben zum aktuellen Krankheitsbefund, zur bisherigen und aktuellen Therapie
Description

Current medical findings, earlier and current therapy

Data type

text

Alias
UMLS CUI [1]
C0679831
Zukünftige Therapie
Description

Zukünftige Therapie

Alias
UMLS CUI-1
C0087111
Körperliche Schwäche
Description

Bodily weakness

Data type

boolean

Alias
UMLS CUI [1]
C0542267
Kachexie
Description

Cachexia

Data type

boolean

Alias
UMLS CUI [1]
C0006625
Schmerzen
Description

Pain

Data type

boolean

Alias
UMLS CUI [1]
C0030193
Appetitlosigkeit
Description

Lack of appetite

Data type

boolean

Alias
UMLS CUI [1]
C0003618
(Lymph-) Ödem
Description

(Lymph) edema

Data type

boolean

Alias
UMLS CUI [1]
C0024236
Durchfall
Description

Diarrhea

Data type

boolean

Alias
UMLS CUI [1]
C0011991
Atemnot
Description

Shortness of breath

Data type

boolean

Alias
UMLS CUI [1]
C0013404
Husten
Description

Coughing

Data type

boolean

Alias
UMLS CUI [1]
C0010200
Blutungen
Description

Bleedings

Data type

boolean

Alias
UMLS CUI [1]
C0019080
Motorische Unruhe
Description

Agitation

Data type

boolean

Alias
UMLS CUI [1]
C0085631
Neurologische Symptome
Description

Neurological symptoms

Data type

boolean

Alias
UMLS CUI [1]
C0235031
Urologische Symptome
Description

Urological symptoms

Data type

boolean

Alias
UMLS CUI [1]
C0042075
Übelkeit / Erbrechen
Description

Nausea / Vomiting

Data type

boolean

Alias
UMLS CUI [1,1]
C0027497
UMLS CUI [1,2]
C0042963
Müdigkeit
Description

Fatigue

Data type

boolean

Alias
UMLS CUI [1]
C0015672
Schluckstörung
Description

Dysphagia

Data type

boolean

Alias
UMLS CUI [1]
C0011168
Mundtrockenheit
Description

Dry mouth

Data type

boolean

Alias
UMLS CUI [1]
C0043352
Aszites
Description

Ascites

Data type

boolean

Alias
UMLS CUI [1]
C0003962
Verstopfung
Description

Constipation

Data type

boolean

Alias
UMLS CUI [1]
C0009806
Dekubitus
Description

Decubitus

Data type

boolean

Alias
UMLS CUI [1]
C0011127
Exulcerationen
Description

Exulcerations

Data type

boolean

Alias
UMLS CUI [1]
C0041582
Niedergeschlagenheit
Description

Depression

Data type

boolean

Alias
UMLS CUI [1]
C0011581
Verwirrtheit
Description

Confusion

Data type

boolean

Alias
UMLS CUI [1]
C0009676
Angst
Description

Anxiety

Data type

boolean

Alias
UMLS CUI [1]
C0003467
Schlafstörung
Description

Insomnia

Data type

boolean

Alias
UMLS CUI [1]
C0917801
Spezieller Versorgungsbedarf besteht in Bezug auf
Description

Spezieller Versorgungsbedarf besteht in Bezug auf

Alias
UMLS CUI-1
C1718344
Psychosoziale / seelsorgliche Unterstützung
Description

Psychosocial / pastorial support

Data type

boolean

Alias
UMLS CUI [1]
C0600015
Überwachung von Schmerztherapie nach (WHO- Schema)
Description

Monitoring of pain therapy (WHO)

Data type

boolean

Alias
UMLS CUI [1]
C0513566
s.c.- oder i.v.- Flüssigkeitssubstitution
Description

Substitution of liquids

Data type

boolean

Alias
UMLS CUI [1,1]
C0302908
UMLS CUI [1,2]
C0814761
s.c.- oder i.v.- Infusionen mit Medikamenten
Description

Infusions of medication

Data type

boolean

Alias
UMLS CUI [1]
C0013227
UMLS CUI [2]
C0554778
UMLS CUI [3]
C0683092
Versorgung von Port- bzw. Pumpensystemen
Description

Care of port or pump systems

Data type

boolean

Alias
UMLS CUI [1]
C1706409
UMLS CUI [2]
C0182537
Wundversorgung (Dekubitus, exulcerierende Tumore, Fisteln)
Description

Wound care

Data type

boolean

Alias
UMLS CUI [1]
C0886052
Versorgung von Kathetern und Drainagen
Description

Catheters and drainages

Data type

boolean

Alias
UMLS CUI [1]
C0085590
Versorgung von (Tracheo-, Uro-, Ileo-, Kolo-) Stomata
Description

Ostomy care

Data type

boolean

Alias
UMLS CUI [1]
C1955856
Krisenintervention / Symptomkontrolle
Description

Crisis intervention / symptom control

Data type

boolean

Alias
UMLS CUI [1]
C0010332
Spezielle Wundversorgung
Description

Special wound care

Data type

boolean

Alias
UMLS CUI [1]
C0150408
Enterale Ernährung (PEG)
Description

PEG = Perkutane endoskopische Gastrostomie

Data type

boolean

Alias
UMLS CUI [1]
C0176751
Parenterale Ernährung
Description

Parenteral nutrition

Data type

boolean

Alias
UMLS CUI [1]
C0030547
Checkliste
Description

Checkliste

Alias
UMLS CUI-1
C1707357
Es liegen Hinweise auf eine Infektionserkrankung vor
Description

Evidence for infectious disease

Data type

boolean

Alias
UMLS CUI [1]
C0009450
Der Patient / die Patientin leidet an einer Suchterkrankung
Description

Addiction

Data type

boolean

Alias
UMLS CUI [1]
C0085281
Häusliche Versorgung ist gewährleistet
Description

Home care ensured

Data type

boolean

Alias
UMLS CUI [1]
C0204977
Überforderung der pflegenden Angehörigen / Patient ist alleinlebend
Description

Excessive demands on relatives / patient lives alone

Data type

boolean

Alias
UMLS CUI [1]
C1406940
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Similar models

Aerztl Hospizbesch SOZD UKM University Hospital Muenster (UKM)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Allgemeine Information
C1508263 (UMLS CUI-1)
Patient name
Item
Name
text
C1299487 (UMLS CUI [1])
Date of birth
Item
geb.
date
C0421451 (UMLS CUI [1])
Case number
Item
Fall-Nr.
text
C1698493 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Date of admission
Item
Aufnahme am
date
C1302393 (UMLS CUI [1])
Time of admission
Item
Aufnahmezeit
time
C3854259 (UMLS CUI [1])
Address of medical insurance company
Item
Anschrift der Krankenkasse
text
C1549448 (UMLS CUI [1])
Fax
Item
Fax
integer
C1549619 (UMLS CUI [1])
Insurance number
Item
KV-Nr.
text
C1549712 (UMLS CUI [1])
Social services staff member responsible
Item
Zuständiger Mitarbeiter des Sozialdienst
text
C0037444 (UMLS CUI [1])
Physician responsible
Item
Zuständiger Arzt
text
C0262720 (UMLS CUI [1])
First application
Item
Erstantrag
boolean
C0185125 (UMLS CUI [1,1])
C0583223 (UMLS CUI [1,2])
Subsequent application
Item
Folgeantrag
boolean
C0185125 (UMLS CUI [1,1])
C0583223 (UMLS CUI [1,2])
Diagnosis justifying necessity of hospice
Item
Die Hospiznotwendigkeit begründende Erkrankung / Diagnose
text
C0011900 (UMLS CUI [1,1])
C0583223 (UMLS CUI [1,2])
State of metastasis / prognosis
Item
Stadium ggf. Metastasierung / Prognose:
text
C0033325 (UMLS CUI [1])
Limited life expectancy (days to weeks)
Item
Begrenzte Lebenserwartung (Tage bis Wochen)
boolean
C1504437 (UMLS CUI [1])
Current medical findings, earlier and current therapy
Item
Kurze Angaben zum aktuellen Krankheitsbefund, zur bisherigen und aktuellen Therapie
text
C0679831 (UMLS CUI [1])
Item Group
Zukünftige Therapie
C0087111 (UMLS CUI-1)
Bodily weakness
Item
Körperliche Schwäche
boolean
C0542267 (UMLS CUI [1])
Cachexia
Item
Kachexie
boolean
C0006625 (UMLS CUI [1])
Pain
Item
Schmerzen
boolean
C0030193 (UMLS CUI [1])
Lack of appetite
Item
Appetitlosigkeit
boolean
C0003618 (UMLS CUI [1])
(Lymph) edema
Item
(Lymph-) Ödem
boolean
C0024236 (UMLS CUI [1])
Diarrhea
Item
Durchfall
boolean
C0011991 (UMLS CUI [1])
Shortness of breath
Item
Atemnot
boolean
C0013404 (UMLS CUI [1])
Coughing
Item
Husten
boolean
C0010200 (UMLS CUI [1])
Bleedings
Item
Blutungen
boolean
C0019080 (UMLS CUI [1])
Agitation
Item
Motorische Unruhe
boolean
C0085631 (UMLS CUI [1])
Neurological symptoms
Item
Neurologische Symptome
boolean
C0235031 (UMLS CUI [1])
Urological symptoms
Item
Urologische Symptome
boolean
C0042075 (UMLS CUI [1])
Nausea / Vomiting
Item
Übelkeit / Erbrechen
boolean
C0027497 (UMLS CUI [1,1])
C0042963 (UMLS CUI [1,2])
Fatigue
Item
Müdigkeit
boolean
C0015672 (UMLS CUI [1])
Dysphagia
Item
Schluckstörung
boolean
C0011168 (UMLS CUI [1])
Dry mouth
Item
Mundtrockenheit
boolean
C0043352 (UMLS CUI [1])
Ascites
Item
Aszites
boolean
C0003962 (UMLS CUI [1])
Constipation
Item
Verstopfung
boolean
C0009806 (UMLS CUI [1])
Decubitus
Item
Dekubitus
boolean
C0011127 (UMLS CUI [1])
Exulcerations
Item
Exulcerationen
boolean
C0041582 (UMLS CUI [1])
Depression
Item
Niedergeschlagenheit
boolean
C0011581 (UMLS CUI [1])
Confusion
Item
Verwirrtheit
boolean
C0009676 (UMLS CUI [1])
Anxiety
Item
Angst
boolean
C0003467 (UMLS CUI [1])
Insomnia
Item
Schlafstörung
boolean
C0917801 (UMLS CUI [1])
Item Group
Spezieller Versorgungsbedarf besteht in Bezug auf
C1718344 (UMLS CUI-1)
Psychosocial / pastorial support
Item
Psychosoziale / seelsorgliche Unterstützung
boolean
C0600015 (UMLS CUI [1])
Monitoring of pain therapy (WHO)
Item
Überwachung von Schmerztherapie nach (WHO- Schema)
boolean
C0513566 (UMLS CUI [1])
Substitution of liquids
Item
s.c.- oder i.v.- Flüssigkeitssubstitution
boolean
C0302908 (UMLS CUI [1,1])
C0814761 (UMLS CUI [1,2])
Infusions of medication
Item
s.c.- oder i.v.- Infusionen mit Medikamenten
boolean
C0013227 (UMLS CUI [1])
C0554778 (UMLS CUI [2])
C0683092 (UMLS CUI [3])
Care of port or pump systems
Item
Versorgung von Port- bzw. Pumpensystemen
boolean
C1706409 (UMLS CUI [1])
C0182537 (UMLS CUI [2])
Wound care
Item
Wundversorgung (Dekubitus, exulcerierende Tumore, Fisteln)
boolean
C0886052 (UMLS CUI [1])
Catheters and drainages
Item
Versorgung von Kathetern und Drainagen
boolean
C0085590 (UMLS CUI [1])
Ostomy care
Item
Versorgung von (Tracheo-, Uro-, Ileo-, Kolo-) Stomata
boolean
C1955856 (UMLS CUI [1])
Crisis intervention / symptom control
Item
Krisenintervention / Symptomkontrolle
boolean
C0010332 (UMLS CUI [1])
Special wound care
Item
Spezielle Wundversorgung
boolean
C0150408 (UMLS CUI [1])
Enteral nutrition (PEG)
Item
Enterale Ernährung (PEG)
boolean
C0176751 (UMLS CUI [1])
Parenteral nutrition
Item
Parenterale Ernährung
boolean
C0030547 (UMLS CUI [1])
Item Group
Checkliste
C1707357 (UMLS CUI-1)
Evidence for infectious disease
Item
Es liegen Hinweise auf eine Infektionserkrankung vor
boolean
C0009450 (UMLS CUI [1])
Addiction
Item
Der Patient / die Patientin leidet an einer Suchterkrankung
boolean
C0085281 (UMLS CUI [1])
Home care ensured
Item
Häusliche Versorgung ist gewährleistet
boolean
C0204977 (UMLS CUI [1])
Excessive demands on relatives / patient lives alone
Item
Überforderung der pflegenden Angehörigen / Patient ist alleinlebend
boolean
C1406940 (UMLS CUI [1])
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