ID

23851

Description

A brief description of major medical and surgical events during the patient's lifetime, excluding the events related to their cancer therapy. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACEA4A85-36E3-608D-E040-BB89AD4326AD

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACEA4A85-36E3-608D-E040-BB89AD4326AD

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 7/15/17 7/15/17 - Martin Dugas
Uploaded on

July 15, 2017

DOI

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License

Creative Commons BY-NC 3.0
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CCR 2011 Template

English

No Instruction available.

1 forms  
  1. StudyEvent: Baseline Medical History
    1. No Instruction available.
Baseline Medical History
Description

Baseline Medical History

Alias
UMLS CUI-1
C0262926
Date form originally completed
Description

Form Completion Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
UMLS CUI [1]
C1549507
Date of Examination
Description

(Enter the date that the patient was examined and the medical history was documented. Since only one Baseline Medical History form is used, if the information has been assembled over a period of time, enter the date of the latest examination.)

Data type

date

Alias
NCI Thesaurus Property
C25164
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C25214
UMLS CUI [1]
C2985720
Medical History System
Description

Medical History System

Data type

text

Alias
NCI Thesaurus ObjectClass
C95618
NCI Thesaurus ObjectClass-2
C25261
NCI Thesaurus ObjectClass-3
C54625
NCI Thesaurus Property
C25466
NCI Thesaurus ValueDomain
C25372
NCI Thesaurus ValueDomain-2
C95618
UMLS CUI [1]
C0489634
Finding Result
Description

(Comments are required for abnormal finding results. - - Note: Do not select Normal if the body system was not specifically assessed i.e.: not mentioned in the progress note in the medical record. Not Assessed means a discussion on the body system was not raised or the body system was not assessed.)

Data type

text

Alias
NCI Thesaurus ValueDomain
C20200
NCI Thesaurus ObjectClass
C3367
NCI Metathesaurus Property
CL282989
UMLS CUI [1,1]
C0031809
UMLS CUI [1,2]
C0243095
Medical History If Abnormal
Description

Medical History Description

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus Property
C25401
NCI Thesaurus Property-2
C18772
NCI Thesaurus ObjectClass
C25261
UMLS CUI [1]
C0262926
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Baseline Medical History
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Baseline Medical History
C0262926 (UMLS CUI-1)
Form Completion Date
Item
Date form originally completed
date
C25164 (NCI Thesaurus ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C1549507 (UMLS CUI [1])
Evaluation Date
Item
Date of Examination
date
C25164 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C2985720 (UMLS CUI [1])
Item
Medical History System
text
C95618 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus ObjectClass-2)
C54625 (NCI Thesaurus ObjectClass-3)
C25466 (NCI Thesaurus Property)
C25372 (NCI Thesaurus ValueDomain)
C95618 (NCI Thesaurus ValueDomain-2)
C0489634 (UMLS CUI [1])
CL.1
Code List
Medical History System
CL Item
Abdomen (Abdomen)
C25342 (NCI Thesaurus)
C0000726 (UMLS CUI-1)
CL Item
Breast (Breasts)
C12971 (NCI Thesaurus)
C0006141 (UMLS CUI-1)
CL Item
Cardiovascular System (Cardiovascular)
C12686 (NCI Thesaurus)
C0007226 (UMLS CUI-1)
CL Item
Dermatologic (Dermatologic)
C41128 (NCI Thesaurus)
C0205489 (UMLS CUI-1)
CL Item
Endocrine System (Endocrine/Metabolic)
C12705 (NCI Thesaurus)
C0014136 (UMLS CUI-1)
CL Item
Gastrointestinal System (Gastrointestinal)
C12378 (NCI Thesaurus)
C0012240 (UMLS CUI-1)
CL Item
Genitourinary System (Genitourinary)
C12810 (NCI Thesaurus)
C0042066 (UMLS CUI-1)
CL Item
Head, Ears, Eyes, Nose And Throat (HEENT)
C42300 (NCI Thesaurus)
C1512338 (UMLS CUI-1)
CL Item
Immune System (Immune)
C12735 (NCI Thesaurus)
C0020962 (UMLS CUI-1)
CL Item
Musculoskeletal System (Musculoskeletal)
C12754 (NCI Thesaurus)
C0026860 (UMLS CUI-1)
CL Item
Neck (Neck)
C13063 (NCI Thesaurus)
C0027530 (UMLS CUI-1)
CL Item
Neurologic Examination (Neurologic)
C81313 (NCI Thesaurus)
C0027853 (UMLS CUI-1)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
CL Item
Pelvic Examination (Pelvis)
C38104 (NCI Thesaurus)
C0200045 (UMLS CUI-1)
CL Item
Psychological (Psychologic)
C94316 (NCI Thesaurus)
C0205486 (UMLS CUI-1)
CL Item
Respiratory System (Respiratory)
C12779 (NCI Thesaurus)
C0035237 (UMLS CUI-1)
CL Item
Hematopoietic And Lymphatic System (Hematopoietic/Lymph Nodes(s)
C0229601 (UMLS CUI-1)
C0024202 (UMLS CUI-2)
Item
Finding Result
text
C20200 (NCI Thesaurus ValueDomain)
C3367 (NCI Thesaurus ObjectClass)
CL282989 (NCI Metathesaurus Property)
C0031809 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
CL.2
Code List
Finding Result
CL Item
Normal (N)
C14165 (NCI Thesaurus)
C0205307 (UMLS CUI-1)
CL Item
Abnormal (A)
C25401 (NCI Thesaurus)
C0205161 (UMLS CUI-1)
CL Item
Not Assessed (Z)
C3846720 (UMLS CUI-1)
Medical History Description
Item
Medical History If Abnormal
text
C25704 (NCI Thesaurus ValueDomain)
C25401 (NCI Thesaurus Property)
C18772 (NCI Thesaurus Property-2)
C25261 (NCI Thesaurus ObjectClass)
C0262926 (UMLS CUI [1])
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