ID

21684

Description

Hospital Routine Documentation Subform at the University Hospital Cologne Original Form name: Allgemeine Anforderung_Strahlen

Keywords

Versions (2)
  1. 4/13/17 4/13/17 -
  2. 4/27/17 4/27/17 -
Uploaded on

April 27, 2017

DOI

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License

Creative Commons BY-NC 3.0
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General request form, Therapeutic radiology, University Hospital Cologne

German

General request form, Therapeutic radiology, University Hospital Cologne

1 forms  
Strahlentherapie Anforderung
Description

Strahlentherapie Anforderung

Alias
UMLS CUI-1
C1522449
UMLS CUI-2
C1705175
Patient
Description

Patient name

Data type

text

Alias
UMLS CUI [1]
C1299487
Geburtsdatum
Description

Birth Date

Data type

date

Measurement units
  • dd.mm.yyyy
Alias
UMLS CUI [1]
C0421451
dd.mm.yyyy
Geschlecht
Description

Gender

Data type

integer

Alias
UMLS CUI [1]
C0079399
Fall-Nr.
Description

Case ID

Data type

integer

Alias
UMLS CUI [1,1]
C1698493
UMLS CUI [1,2]
C1300638
Krankenkasse
Description

Health insurance

Data type

text

Alias
UMLS CUI [1]
C0021682
PID
Description

Patient ID

Data type

integer

Alias
UMLS CUI [1,1]
C0030705
UMLS CUI [1,2]
C1300638
Gewünschte Leistung/Untersuchung
Description

Ordered examination/service

Data type

text

Alias
UMLS CUI [1,1]
C1705175
UMLS CUI [1,2]
C0199168
UMLS CUI [1,3]
C2348235
Auftragsnummer
Description

Request identification number

Data type

integer

Alias
UMLS CUI [1,1]
C1300638
UMLS CUI [1,2]
C1705175
Terminwunsch Datum
Description

Wanted date of examination

Data type

date

Measurement units
  • dd.mm.yyyy
Alias
UMLS CUI [1,1]
C1444647
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C0043299
dd.mm.yyyy
Terminwunsch Uhrzeit
Description

Wanted time of examination

Data type

time

Measurement units
  • hh:mm
Alias
UMLS CUI [1,1]
C1444647
UMLS CUI [1,2]
C0040223
UMLS CUI [1,3]
C0043299
hh:mm
Auftragsstatus
Description

Order status

Data type

text

Alias
UMLS CUI [1]
C1550341
Dringlichkeit
Description

Urgency

Data type

text

Alias
UMLS CUI [1]
C4049774
Auftragsdatum
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
Auftragszeit
Description

Time of order

Data type

time

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

Procedure type

Data type

integer

Alias
UMLS CUI [1]
C0455713
Art der Untersuchung
Description

Indication for examination

Data type

integer

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C0043299
Zielvolumen/Feldgrenzen
Description

Target tumor area

Data type

text

Alias
UMLS CUI [1,1]
C2986546
UMLS CUI [1,2]
C0205146
Anzahl Zielvolumen
Description

Quantity of target areas

Data type

integer

Alias
UMLS CUI [1,1]
C1265611
UMLS CUI [1,2]
C2986546
UMLS CUI [1,3]
C0205146
Lagerungswunsch
Description

Wanted patient position

Data type

text

Alias
UMLS CUI [1,1]
C1444647
UMLS CUI [1,2]
C1561964
UMLS CUI [1,3]
C0043299
Medikament erforderlich
Description

Necessary medication

Data type

boolean

Alias
UMLS CUI [1]
C0013227
Einverständnis liegt unterschrieben der Akte bei
Description

Informed consent

Data type

boolean

Alias
UMLS CUI [1]
C0021430
Kontrastmittel erforderlich
Description

Contrast media

Data type

boolean

Alias
UMLS CUI [1]
C0009924
Art der Kontrastmittelgabe
Description

Contrast media administration

Data type

integer

Alias
UMLS CUI [1,1]
C0009924
UMLS CUI [1,2]
C0013153
Falls i.v. KM Gabe, bitte gegebene Menge spezifizieren:
Description

Contrast media intravenous, administered volume

Data type

integer

Alias
UMLS CUI [1,1]
C0009924
UMLS CUI [1,2]
C0013125
UMLS CUI [1,3]
C2349139
Falls orale KM Gabe, bitte gegebene Menge spezifizieren:
Description

Contrast media oral, administered volume

Data type

integer

Alias
UMLS CUI [1,1]
C0009924
UMLS CUI [1,2]
C0001563
UMLS CUI [1,3]
C2349139
Falls orale KM Gabe: Zeitpunkt der Einnahme vor Untersuchung
Description

Contrast media oral, time of administration before examination

Data type

integer

Measurement units
  • min
Alias
UMLS CUI [1,1]
C0009924
UMLS CUI [1,2]
C0001563
UMLS CUI [1,3]
C0040223
min
Falls rektale KM Gabe, bitte gegebene Menge spezifizieren:
Description

Contrast media rectal, administered volume

Data type

integer

Measurement units
  • ml
Alias
UMLS CUI [1,1]
C0009924
UMLS CUI [1,2]
C1527425
UMLS CUI [1,3]
C2349139
ml
Laborwerte
Description

Laboratory results

Data type

integer

Alias
UMLS CUI [1]
C1254595
eGFR
Description

eGFR

Data type

float

Measurement units
  • ml/min/1,73m2
Alias
UMLS CUI [1]
C3811844
ml/min/1,73m2
TSH
Description

TSH

Data type

float

Measurement units
  • mU/L
Alias
UMLS CUI [1]
C0202230
mU/L
Bemerkung/Information
Description

Information

Data type

integer

Alias
UMLS CUI [1]
C1533716
Kommentar
Description

Comment

Data type

text

Alias
UMLS CUI [1]
C0947611
Mobilität
Description

Mobility

Data type

text

Alias
UMLS CUI [1]
C0449580
Vorbefunde
Description

Previous findings

Data type

text

Alias
UMLS CUI [1,1]
C0243095
UMLS CUI [1,2]
C0205156
Diagnose(n)
Description

Diagnosis

Data type

text

Alias
UMLS CUI [1]
C0011900
Fragestellung
Description

Question

Data type

text

Alias
UMLS CUI [1,1]
C1522634
UMLS CUI [1,2]
C0043299
Leistungserbringer
Description

Department performing service

Data type

text

Alias
UMLS CUI [1,1]
C2986180
UMLS CUI [1,2]
C0199168
UMLS CUI [1,3]
C0019961
Leistungsanforderer: Orgaeinheit
Description

Department

Data type

text

Alias
UMLS CUI [1,1]
C1705175
UMLS CUI [1,2]
C2986180
UMLS CUI [1,3]
C0019961
Leistungsanforderer: Arzt
Description

Ordering physician

Data type

text

Measurement units
  • Name
Alias
UMLS CUI [1]
C1709334
Name
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Similar models

General request form, Therapeutic radiology, University Hospital Cologne

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Strahlentherapie Anforderung
C1522449 (UMLS CUI-1)
C1705175 (UMLS CUI-2)
Patient name
Item
Patient
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
männlich (1)
CL Item
weiblich (2)
Case ID
Item
Fall-Nr.
integer
C1698493 (UMLS CUI [1,1])
C1300638 (UMLS CUI [1,2])
Health insurance
Item
Krankenkasse
text
C0021682 (UMLS CUI [1])
Patient ID
Item
PID
integer
C0030705 (UMLS CUI [1,1])
C1300638 (UMLS CUI [1,2])
Ordered examination/service
Item
Gewünschte Leistung/Untersuchung
text
C1705175 (UMLS CUI [1,1])
C0199168 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Request identification number
Item
Auftragsnummer
integer
C1300638 (UMLS CUI [1,1])
C1705175 (UMLS CUI [1,2])
Wanted date of examination
Item
Terminwunsch Datum
date
C1444647 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0043299 (UMLS CUI [1,3])
Wanted time of examination
Item
Terminwunsch Uhrzeit
time
C1444647 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
C0043299 (UMLS CUI [1,3])
Order status
Item
Auftragsstatus
text
C1550341 (UMLS CUI [1])
Urgency
Item
Dringlichkeit
text
C4049774 (UMLS CUI [1])
Date of order
Item
Auftragsdatum
date
C1549499 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Time of order
Item
Auftragszeit
time
C1549499 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Item
Terminierung
integer
C0455713 (UMLS CUI [1])
Termination
Code List
Terminierung
CL Item
Planung (1)
CL Item
Bestrahlung (2)
Item
Art der Untersuchung
integer
C3146298 (UMLS CUI [1,1])
C0043299 (UMLS CUI [1,2])
Indication for examination
Code List
Art der Untersuchung
CL Item
Bestrahlungsplanung (1)
CL Item
Feldkontrolle (2)
CL Item
Boost (3)
CL Item
Verlauf (4)
Target tumor area
Item
Zielvolumen/Feldgrenzen
text
C2986546 (UMLS CUI [1,1])
C0205146 (UMLS CUI [1,2])
Quantity of target areas
Item
Anzahl Zielvolumen
integer
C1265611 (UMLS CUI [1,1])
C2986546 (UMLS CUI [1,2])
C0205146 (UMLS CUI [1,3])
Wanted patient position
Item
Lagerungswunsch
text
C1444647 (UMLS CUI [1,1])
C1561964 (UMLS CUI [1,2])
C0043299 (UMLS CUI [1,3])
Necessary medication
Item
Medikament erforderlich
boolean
C0013227 (UMLS CUI [1])
Informed consent
Item
Einverständnis liegt unterschrieben der Akte bei
boolean
C0021430 (UMLS CUI [1])
Contrast media
Item
Kontrastmittel erforderlich
boolean
C0009924 (UMLS CUI [1])
Item
Art der Kontrastmittelgabe
integer
C0009924 (UMLS CUI [1,1])
C0013153 (UMLS CUI [1,2])
Contrast media administration
Code List
Art der Kontrastmittelgabe
CL Item
i.v. Accupaque 300 (1)
CL Item
oral Gastrolux (2)
CL Item
Tampon (mit KM benetzt) (3)
CL Item
Rektal-Darmrohr (4)
Item
Falls i.v. KM Gabe, bitte gegebene Menge spezifizieren:
integer
C0009924 (UMLS CUI [1,1])
C0013125 (UMLS CUI [1,2])
C2349139 (UMLS CUI [1,3])
Contrast media intravenous, administered volume
Code List
Falls i.v. KM Gabe, bitte gegebene Menge spezifizieren:
CL Item
80ml (1)
CL Item
Stereotaxieprotokoll 2x40ml (2)
CL Item
andere Menge, bitte spezifieren (3)
Item
Falls orale KM Gabe, bitte gegebene Menge spezifizieren:
integer
C0009924 (UMLS CUI [1,1])
C0001563 (UMLS CUI [1,2])
C2349139 (UMLS CUI [1,3])
Contrast media, oral administration
Code List
Falls orale KM Gabe, bitte gegebene Menge spezifizieren:
CL Item
20ml/1L Wasser (1)
CL Item
andere Menge, bitte spezifizieren (2)
Contrast media oral, time of administration before examination
Item
Falls orale KM Gabe: Zeitpunkt der Einnahme vor Untersuchung
integer
C0009924 (UMLS CUI [1,1])
C0001563 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Contrast media rectal, administered volume
Item
Falls rektale KM Gabe, bitte gegebene Menge spezifizieren:
integer
C0009924 (UMLS CUI [1,1])
C1527425 (UMLS CUI [1,2])
C2349139 (UMLS CUI [1,3])
Item
Laborwerte
integer
C1254595 (UMLS CUI [1])
Laboratory results
Code List
Laborwerte
CL Item
ja, ORBIS (1)
CL Item
nein (2)
CL Item
in Akte (3)
CL Item
wird mitgebracht (4)
eGFR
Item
eGFR
float
C3811844 (UMLS CUI [1])
TSH
Item
TSH
float
C0202230 (UMLS CUI [1])
Item
Bemerkung/Information
integer
C1533716 (UMLS CUI [1])
Information
Code List
Bemerkung/Information
CL Item
Arzt vorher dazuholen (1)
CL Item
Patientenunterschrift auf Einverständniserklärung fehlt noch (2)
CL Item
mit Dolmetscher (3)
CL Item
Pat. nach Befunden fragen  (4)
CL Item
Narbe/n markieren (5)
CL Item
DIBH (6)
CL Item
sonstiges (7)
Comment
Item
Kommentar
text
C0947611 (UMLS CUI [1])
Mobility
Item
Mobilität
text
C0449580 (UMLS CUI [1])
Previous findings
Item
Vorbefunde
text
C0243095 (UMLS CUI [1,1])
C0205156 (UMLS CUI [1,2])
Diagnosis
Item
Diagnose(n)
text
C0011900 (UMLS CUI [1])
Question
Item
Fragestellung
text
C1522634 (UMLS CUI [1,1])
C0043299 (UMLS CUI [1,2])
Department performing service
Item
Leistungserbringer
text
C2986180 (UMLS CUI [1,1])
C0199168 (UMLS CUI [1,2])
C0019961 (UMLS CUI [1,3])
Department
Item
Leistungsanforderer: Orgaeinheit
text
C1705175 (UMLS CUI [1,1])
C2986180 (UMLS CUI [1,2])
C0019961 (UMLS CUI [1,3])
Ordering physician
Item
Leistungsanforderer: Arzt
text
C1709334 (UMLS CUI [1])
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