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General request form, Oncology Tumor Board, University Hospital Cologne

1 forms  
CIO Thorax Tumor Board Request
Description

CIO Thorax Tumor Board Request

Alias
UMLS CUI-1
C0805438
UMLS CUI-2
C1272683
Patient name
Description

Patient name

Data type

text

Alias
UMLS CUI [1]
C1299487
Diagnosis ICD Code
Description

Diagnosis ICD Code

Data type

text

Alias
UMLS CUI [1]
C2598420
Diagnosis (free text)
Description

Diagnosis (free text)

Data type

text

Alias
UMLS CUI [1]
C0011900
Date of diagnosis
Description

Date of diagnosis

Data type

date

Measurement units
  • mm/yyyy
Alias
UMLS CUI [1]
C2316983
mm/yyyy
ECOG Performance Status
Description

ECOG Performance Status

Data type

integer

Alias
UMLS CUI [1]
C1520224
Clinical course
Description

Clinical course

Data type

text

Alias
UMLS CUI [1]
C0449259
Age
Description

Age

Data type

integer

Measurement units
  • yy
Alias
UMLS CUI [1]
C0001779
yy
Body height
Description

Body height

Data type

float

Measurement units
  • m
Alias
UMLS CUI [1]
C0005890
m
Body weight
Description

Body weight

Data type

float

Measurement units
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Tobacco use
Description

Tobacco use

Data type

integer

Alias
UMLS CUI [1]
C0543414
Treatment plan
Description

Treatment plan

Data type

integer

Alias
UMLS CUI [1]
C0599880
Prior therapy
Description

Prior therapy

Data type

integer

Alias
UMLS CUI [1]
C1514463
Question
Description

Question

Data type

text

Alias
UMLS CUI [1,1]
C1522634
UMLS CUI [1,2]
C0805438
Contact person
Description

Contact person

Data type

text

Measurement units
  • Name
Alias
UMLS CUI [1]
C0337611
Name
Requested service
Description

Requested service

Alias
UMLS CUI-1
C1272683
UMLS CUI-2
C0557854
Type of request
Description

Type of request

Data type

text

Alias
UMLS CUI [1,1]
C1272683
UMLS CUI [1,2]
C2348235
Service
Description

Service

Data type

text

Alias
UMLS CUI [1]
C0199168
Quantity of requested services
Description

Quantity of requested services

Data type

integer

Alias
UMLS CUI [1,1]
C1265611
UMLS CUI [1,2]
C1272683
UMLS CUI [1,3]
C0557854
Request data
Description

Request data

Alias
UMLS CUI-1
C1272683
UMLS CUI-2
C1511726
Request identification number
Description

Request identification number

Data type

integer

Alias
UMLS CUI [1,1]
C1300638
UMLS CUI [1,2]
C1272683
Order status
Description

Order status

Data type

text

Alias
UMLS CUI [1]
C1550341
Urgency
Description

Urgency

Data type

text

Alias
UMLS CUI [1]
C4049774
Date of order
Description

Date of order

Data type

date

Measurement units
  • dd.mm.yyyy
Alias
UMLS CUI [1,1]
C1549499
UMLS CUI [1,2]
C0011008
dd.mm.yyyy
Time of order
Description

Time of order

Data type

time

Measurement units
  • hh:mm
Alias
UMLS CUI [1,1]
C1549499
UMLS CUI [1,2]
C0040223
hh:mm
Department performing service
Description

Department performing service

Alias
UMLS CUI-1
C0557854
UMLS CUI-2
C1550369
UMLS CUI-3
C0019961
Department performing service
Description

Department performing service

Data type

text

Alias
UMLS CUI [1]
C0019961
Department requesting service
Description

Department requesting service

Alias
UMLS CUI-1
C1272683
UMLS CUI-2
C1550369
UMLS CUI-3
C0019961
Department
Description

Department

Data type

text

Alias
UMLS CUI [1]
C0019961
Name of requesting physician
Description

Name of requesting physician

Data type

text

Measurement units
  • Name
Alias
UMLS CUI [1]
C0686901
Name
Further information
Description

Further information

Alias
UMLS CUI-1
C1533716
Wanted date of appointment
Description

Wanted date of appointment

Data type

date

Measurement units
  • dd.mm.yyyy
Alias
UMLS CUI [1,1]
C1444647
UMLS CUI [1,2]
C0011008
dd.mm.yyyy
Wanted time of appointment
Description

Wanted time of appointment

Data type

time

Measurement units
  • hh:mm
Alias
UMLS CUI [1,1]
C1444647
UMLS CUI [1,2]
C0040223
hh:mm
Comment
Description

Comment

Data type

text

Alias
UMLS CUI [1]
C0947611
Mobility
Description

Mobility

Data type

text

Alias
UMLS CUI [1]
C0449580
Previous finding
Description

Previous finding

Data type

text

Alias
UMLS CUI [1,1]
C0243095
UMLS CUI [1,2]
C0205156
Diagnostic imaging
Description

Diagnostic imaging

Data type

text

Alias
UMLS CUI [1]
C0011923
Pulmonary function tests
Description

Pulmonary function tests

Alias
UMLS CUI-1
C0024119
Exercise load
Description

Exercise load

Data type

integer

Measurement units
  • W/kg
Alias
UMLS CUI [1,1]
C0015259
UMLS CUI [1,2]
C2020707
W/kg
VO2 max
Description

VO2 max

Data type

float

Measurement units
  • ml/(kg * min)
Alias
UMLS CUI [1]
C1305742
ml/(kg * min)
Lung functional tests requested
Description

Lung functional tests requested

Data type

boolean

Alias
UMLS CUI [1,1]
C1272683
UMLS CUI [1,2]
C0024119
BGA at rest
Description

BGA at rest

Alias
UMLS CUI-1
C0005800
UMLS CUI-2
C0035253
Blood oxygen partial pressure
Description

Blood oxygen partial pressure

Data type

float

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C1291013
mmHg
Blood carbon dioxide partial pressure
Description

Blood carbon dioxide partial pressure

Data type

float

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0201931
mmHg
pH
Description

pH

Data type

float

Alias
UMLS CUI [1]
C0202165
BGA during exercise
Description

BGA during exercise

Alias
UMLS CUI-1
C0005800
UMLS CUI-2
C0015259
Blood oxygen partial pressure
Description

Blood oxygen partial pressure

Data type

float

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C1291013
mmHg
Blood carbon dioxide partial pressure
Description

Blood carbon dioxide partial pressure

Data type

float

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0201930
mmHg
pH
Description

pH

Data type

float

Alias
UMLS CUI [1]
C0202165
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Similar models

General request form, Oncology Tumor Board, University Hospital Cologne

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
C0805438 (UMLS CUI-1)
C1272683 (UMLS CUI-2)
Patient name
Item
text
C1299487 (UMLS CUI [1])
Diagnosis ICD Code
Item
text
C2598420 (UMLS CUI [1])
Diagnosis (free text)
Item
text
C0011900 (UMLS CUI [1])
Date of diagnosis
Item
date
C2316983 (UMLS CUI [1])
ECOG Performance Status
Item
integer
C1520224 (UMLS CUI [1])
Clinical course
Item
text
C0449259 (UMLS CUI [1])
Age
Item
integer
C0001779 (UMLS CUI [1])
Body height
Item
float
C0005890 (UMLS CUI [1])
Body weight
Item
float
C0005910 (UMLS CUI [1])
Item
integer
C0543414 (UMLS CUI [1])
Tobacco use
Code List
Tobacco use
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
Item
integer
C0599880 (UMLS CUI [1])
Treatment plan
Code List
Treatment plan
CL Item
 (1)
CL Item
 (2)
Item
integer
C1514463 (UMLS CUI [1])
Prior therapy
Code List
Prior therapy
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
Question
Item
text
C1522634 (UMLS CUI [1,1])
C0805438 (UMLS CUI [1,2])
Contact person
Item
text
C0337611 (UMLS CUI [1])
Item Group
C1272683 (UMLS CUI-1)
C0557854 (UMLS CUI-2)
Type of request
Item
text
C1272683 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Service
Item
text
C0199168 (UMLS CUI [1])
Quantity of requested services
Item
integer
C1265611 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
C0557854 (UMLS CUI [1,3])
Item Group
C1272683 (UMLS CUI-1)
C1511726 (UMLS CUI-2)
Request identification number
Item
integer
C1300638 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
Order status
Item
text
C1550341 (UMLS CUI [1])
Urgency
Item
text
C4049774 (UMLS CUI [1])
Date of order
Item
date
C1549499 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Time of order
Item
time
C1549499 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Item Group
C0557854 (UMLS CUI-1)
C1550369 (UMLS CUI-2)
C0019961 (UMLS CUI-3)
Department performing service
Item
text
C0019961 (UMLS CUI [1])
Item Group
C1272683 (UMLS CUI-1)
C1550369 (UMLS CUI-2)
C0019961 (UMLS CUI-3)
Department
Item
text
C0019961 (UMLS CUI [1])
Name of requesting physician
Item
text
C0686901 (UMLS CUI [1])
Item Group
C1533716 (UMLS CUI-1)
Wanted date of appointment
Item
date
C1444647 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Wanted time of appointment
Item
time
C1444647 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Comment
Item
text
C0947611 (UMLS CUI [1])
Mobility
Item
text
C0449580 (UMLS CUI [1])
Previous finding
Item
text
C0243095 (UMLS CUI [1,1])
C0205156 (UMLS CUI [1,2])
Diagnostic imaging
Item
text
C0011923 (UMLS CUI [1])
Item Group
C0024119 (UMLS CUI-1)
Exercise load
Item
integer
C0015259 (UMLS CUI [1,1])
C2020707 (UMLS CUI [1,2])
VO2 max
Item
float
C1305742 (UMLS CUI [1])
Lung functional tests requested
Item
boolean
C1272683 (UMLS CUI [1,1])
C0024119 (UMLS CUI [1,2])
Item Group
C0005800 (UMLS CUI-1)
C0035253 (UMLS CUI-2)
Blood oxygen partial pressure
Item
float
C1291013 (UMLS CUI [1])
Blood carbon dioxide partial pressure
Item
float
C0201931 (UMLS CUI [1])
pH
Item
float
C0202165 (UMLS CUI [1])
Item Group
C0005800 (UMLS CUI-1)
C0015259 (UMLS CUI-2)
Blood oxygen partial pressure
Item
float
C1291013 (UMLS CUI [1])
Blood carbon dioxide partial pressure
Item
float
C0201930 (UMLS CUI [1])
pH
Item
float
C0202165 (UMLS CUI [1])
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