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14 forms  
Patient identification
Description

Patient identification

Alias
UMLS CUI-1
C1269815
Birth name
Description

Birth name

Data type

text

Alias
UMLS CUI [1]
C1549652
Surname
Description

Surname

Data type

text

Alias
UMLS CUI [1]
C0421448
First name
Description

First name

Data type

text

Alias
UMLS CUI [1]
C1443235
Date of birth
Description

Date of birth

Data type

date

Measurement units
  • JJ/MM/AA
Alias
UMLS CUI [1]
C0421451
JJ/MM/AA
Address
Description

Address

Data type

text

Alias
UMLS CUI [1]
C0421449
Telephone number
Description

Telephone number

Data type

text

Alias
UMLS CUI [1]
C1515258
Emergency contact
Description

Emergency contact

Alias
UMLS CUI-1
C1552023
Relationship to patient
Description

Relationship to patient

Data type

text

Alias
UMLS CUI [1]
C0015608
Emergency contact telephone
Description

Emergency contact telephone

Data type

text

Alias
UMLS CUI [1]
C2735132
Administrative information
Description

Administrative information

Alias
UMLS CUI-1
C3845829
Treating physician
Description

Treating physician

Data type

text

Alias
UMLS CUI [1]
C1710470
General practitioner
Description

General practitioner

Data type

text

Alias
UMLS CUI [1]
C0017319
Place of care at the time of the described episode
Description

Place of care at the time of the described episode

Data type

text

Alias
UMLS CUI [1]
C0018704
Document validation date
Description

Document validation date

Data type

date

Alias
UMLS CUI [1,1]
C1519941
UMLS CUI [1,2]
C0011008
Responsible person
Description

Responsible person

Data type

text

Alias
UMLS CUI [1]
C0680379
Medical History of disease
Description

Medical History of disease

Alias
UMLS CUI-1
C0683519
Symptom onset
Description

Symptom onset

Data type

datetime

Alias
UMLS CUI [1]
C1320528
Date and time of symptom finding
Description

Date and time of symptom finding

Data type

datetime

Alias
UMLS CUI [1,1]
C0586400
UMLS CUI [1,2]
C1264639
Symptoms seen on waking or in the night
Description

Symptoms seen on waking or in the night

Data type

integer

Alias
UMLS CUI [1]
C0586400
Last contact without symptoms
Description

Last contact without symptoms

Data type

datetime

Alias
UMLS CUI [1,1]
C0231221
UMLS CUI [1,2]
C0804762
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Similar models

Header

14 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
C1269815 (UMLS CUI-1)
Birth name
Item
text
C1549652 (UMLS CUI [1])
Surname
Item
text
C0421448 (UMLS CUI [1])
First name
Item
text
C1443235 (UMLS CUI [1])
Date of birth
Item
date
C0421451 (UMLS CUI [1])
Address
Item
text
C0421449 (UMLS CUI [1])
Telephone number
Item
text
C1515258 (UMLS CUI [1])
Item Group
C1552023 (UMLS CUI-1)
Relationship to patient
Item
text
C0015608 (UMLS CUI [1])
Emergency contact telephone
Item
text
C2735132 (UMLS CUI [1])
Item Group
C3845829 (UMLS CUI-1)
Treating physician
Item
text
C1710470 (UMLS CUI [1])
General practitioner
Item
text
C0017319 (UMLS CUI [1])
Place of care at the time of the described episode
Item
text
C0018704 (UMLS CUI [1])
Document validation date
Item
date
C1519941 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Responsible person
Item
text
C0680379 (UMLS CUI [1])
Item Group
C0683519 (UMLS CUI-1)
Symptom onset
Item
datetime
C1320528 (UMLS CUI [1])
Date and time of symptom finding
Item
datetime
C0586400 (UMLS CUI [1,1])
C1264639 (UMLS CUI [1,2])
Item
integer
C0586400 (UMLS CUI [1])
Symptoms seen on waking or in the night
Code List
Symptoms seen on waking or in the night
CL Item
 (1)
C1170730 (UMLS CUI-1)
CL Item
 (2)
C0240526 (UMLS CUI-1)
Last contact without symptoms
Item
datetime
C0231221 (UMLS CUI [1,1])
C0804762 (UMLS CUI [1,2])
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