English

Visit data CRF ImproveCareNow

1 forms  
Assessment
Description

Assessment

Alias
UMLS CUI-1
C1516048
Date of assessment
Description

Date of assessment

Data type

date

Alias
UMLS CUI [1]
C2985720
Since the last visit documented in the database were there any visits that were not captured?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0545082
Number of visits not captured
Description

Number of visits

Data type

integer

Alias
UMLS CUI [1,1]
C0449788
UMLS CUI [1,2]
C0545082
Current visit data entered by
Description

data entry person

Data type

text

Alias
UMLS CUI [1]
C1550483
Primary Attending Gastroenterologist
Description

Gastroenterologist

Data type

text

Alias
UMLS CUI [1]
C0259901
Secondary provider
Description

provider secondary

Data type

text

Alias
UMLS CUI [1,1]
C1138603
UMLS CUI [1,2]
C0175668
Colectomy/Ostomy
Description

Colectomy/Ostomy

Alias
UMLS CUI-1
C0009274
UMLS CUI-3
C0029473
Has the patient had a colectomy? (If Yes, and the patient's diagnosis is UC, the patient should be inactivated)
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0009274
Date of colectomy
Description

Date colectomy

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0009274
Does the Patient currently have an ileostomy or colostomy?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0455661
UMLS CUI [2]
C0481493
What is the patient's current diagnosis?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0011900
In the following set of questions, describe the symptoms on the worst day in the last 7 days
Description

In the following set of questions, describe the symptoms on the worst day in the last 7 days

Alias
UMLS CUI-1
C1457887
General well-being related to IBD
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C1286942
Limitations in daily activities related to IBD
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0740765
Abdominal pain due to IBD
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0000737
In the following set of questions, describe the patient's stools on the worst day in the last 7 days
Description

In the following set of questions, describe the patient's stools on the worst day in the last 7 days

Alias
UMLS CUI-1
C0015733
Total number of stools per day (enter 0 if none)
Description

Total number stools per day

Data type

integer

Alias
UMLS CUI [1,1]
C4288115
UMLS CUI [1,2]
C0015733
UMLS CUI [1,3]
C0439505
Not Assessed
Description

Not Assessed

Data type

boolean

Alias
UMLS CUI [1]
C3846720
Most stools were
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0015733
UMLS CUI [1,2]
C0332307
Number of liquid/watery stools per day (enter 0 if none)
Description

Number of watery stools

Data type

integer

Alias
UMLS CUI [1,1]
C0237753
UMLS CUI [1,2]
C2129214
Not Assessed
Description

Not Assessed

Data type

boolean

Alias
UMLS CUI [1]
C3846720
Did the patient report bloody stools?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0018932
If blood was present, the typical amount was
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C1265611
UMLS CUI [1,2]
C1321898
Nocturnal diarrhea
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0859975
Extraintestinal Manifestations
Description

Extraintestinal Manifestations

Alias
UMLS CUI-1
C1280464
UMLS CUI-2
C4062672
Fever 38.5 degrees C (101.3 degrees F) for 3 of last 7 days?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0015967
Definite arthritis?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0003864
Uveitis?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0042164
Erythema nodosum?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0014743
Pyoderma gangrenosum?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0085652
Exam
Description

Exam

Alias
UMLS CUI-1
C0582103
Abdominal exam
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0438120
Perirectal disease at current exam
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C1550291
Current Height: Unit
Description

Height unit

Data type

text

Alias
UMLS CUI [1,1]
C0005890
UMLS CUI [1,2]
C0439148
Current Height
Description

Height

Data type

integer

Alias
UMLS CUI [1]
C0005890
Not Assessed
Description

Not Assessed

Data type

boolean

Alias
UMLS CUI [1]
C3846720
Current Weight: Unit
Description

Weight Unit

Data type

text

Alias
UMLS CUI [1,1]
C0005910
UMLS CUI [1,2]
C0439148
Current Weight
Description

Weight

Data type

float

Alias
UMLS CUI [1]
C0005910
Not Assessed
Description

Not Assessed

Data type

boolean

Alias
UMLS CUI [1]
C3846720
Current BMI
Description

BMI

Data type

float

Alias
UMLS CUI [1]
C1305855
For patients less than 18 years old, has height, weight and BMI been plotted on a growth chart?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0005890
UMLS CUI [2]
C0005910
UMLS CUI [3]
C1305855
Disease Assessment
Description

Disease Assessment

Alias
UMLS CUI-1
C0421175
Physicians Global Assessment of current disease status
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0220825
UMLS CUI [1,2]
C0012634
UMLS CUI [1,3]
C0449438
Extent of Disease: Crohn's Disease/Indeterminate Colitis patients only (select one for each category)
Description

Extent of Disease: Crohn's Disease/Indeterminate Colitis patients only (select one for each category)

Alias
UMLS CUI-1
C0449279
UMLS CUI-2
C0010346
UMLS CUI-3
C0341332
Macroscopic Lower GI Disease?
Description

GIT disease lower macroscopic

Data type

integer

Alias
UMLS CUI [1,1]
C0012242
UMLS CUI [1,2]
C1548802
UMLS CUI [1,3]
C1551402
Macroscopic Upper GI Disease proximal to the ligament of Treitz?
Description

GIT disease macroscopic ligament of Treitz proximal

Data type

integer

Alias
UMLS CUI [1,1]
C0012242
UMLS CUI [1,2]
C1551402
UMLS CUI [1,3]
C1261087
UMLS CUI [1,4]
C0205107
Macroscopic Upper GI Disease distal to the ligament of Treitz?
Description

GIT disease macroscopic ligament of Treitz distal

Data type

integer

Alias
UMLS CUI [1,1]
C0012242
UMLS CUI [1,2]
C1551402
UMLS CUI [1,3]
C1261087
UMLS CUI [1,4]
C0205108
For CD/IC patients only: Current Crohn's Disease Phenotype
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0010346
UMLS CUI [1,2]
C0031437
For CD/IC patients only: Perianal Phenotype?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0747465
UMLS CUI [1,2]
C0031437
Extent of Disease: Ulcerative Colitis subjects only
Description

Extent of Disease: Ulcerative Colitis subjects only

Alias
UMLS CUI-1
C0449279
UMLS CUI-2
C0009324
Extent of Disease: Ulcerative Colitis subjects only
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0449279
For UC patients only: Ulcerative Colitis Behavior: Has the patient ever had severe disease?
Description

Ulcerative Colitis Behavior

Data type

integer

Alias
UMLS CUI [1,1]
C0009324
UMLS CUI [1,2]
C0004927
Nutritional and Growth Status
Description

Nutritional and Growth Status

Alias
UMLS CUI-1
C0392209
UMLS CUI-2
C0943912
Nutritional Status
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0392209
For patients less than 18 years old: Growth Status
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0943912
Since the last visit, has the patient been in continuous remission?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0544452
Since the last visit, has the patient had a serious infection? (Note: A serious infection is one that requires hospitalization or IV therapy)
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0009450
UMLS CUI [1,2]
C0019993
If yes, indicate infection
Description

infection

Data type

text

Alias
UMLS CUI [1]
C0009450
Are there psychosocial risk factors that are felt to significantly impact the patient's medical care?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0035648
UMLS CUI [1,2]
C0542298
Laboratory Analysis
Description

Laboratory Analysis

Alias
UMLS CUI-1
C0936012
UMLS CUI-2
C0022877
Was a blood sample drawn for laboratory analysis?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C1277698
Date of lab sample
Description

Date of blood sample

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0178913
C-Reactive Protein
Description

crp

Data type

integer

Alias
UMLS CUI [1]
C0201657
Date of sample
Description

Date of sample

Data type

date

Alias
UMLS CUI [1]
C1317250
Result
Description

Result

Data type

text

Alias
UMLS CUI [1]
C1274040
Outside quantifiable range
Description

Sample Range

Data type

boolean

Alias
UMLS CUI [1]
C2348147
If result is outside the quantifiable range, select one:
Description

Sample Range

Data type

integer

Alias
UMLS CUI [1]
C2348147
Lab?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0022877
Hematocrit
Description

Hematocrit

Data type

integer

Alias
UMLS CUI [1]
C0018935
Hematocrite Date of sample
Description

Date of sample Hematocrite

Data type

date

Alias
UMLS CUI [1,1]
C1317250
UMLS CUI [1,2]
C0018935
Result
Description

Result

Data type

text

Alias
UMLS CUI [1]
C1274040
Outside quantifiable range
Description

Sample Range

Data type

boolean

Alias
UMLS CUI [1]
C2348147
If result is outside the quantifiable range, select one
Description

Sample Range

Data type

integer

Alias
UMLS CUI [1]
C2348147
Albumin
Description

Albumin

Data type

integer

Alias
UMLS CUI [1]
C0201838
Date of sample
Description

Date of sample

Data type

date

Alias
UMLS CUI [1]
C1317250
Result
Description

Result

Data type

text

Alias
UMLS CUI [1]
C1274040
Medications
Description

Medications

Alias
UMLS CUI-1
C0013227
Is the patient currently taking any non-biologic prescription medications for IBD?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0013227
Aminosalicylates
Description

Aminosalicylates

Alias
UMLS CUI-1
C0368663
Sulfasalazine
Description

Sulfasalazine

Data type

boolean

Alias
UMLS CUI [1]
C0036078
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Pentasa
Description

Pentasa

Data type

boolean

Alias
UMLS CUI [1]
C0678171
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
Asacol
Description

Asacol

Data type

boolean

Alias
UMLS CUI [1]
C0678172
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Apriso
Description

Apriso

Data type

boolean

Alias
UMLS CUI [1]
C2586541
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Lialda
Description

Lialda

Data type

boolean

Alias
UMLS CUI [1]
C1873792
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Colazal
Description

Colazal

Data type

boolean

Alias
UMLS CUI [1]
C0939297
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Delzicol
Description

Delzicol

Data type

boolean

Alias
UMLS CUI [1]
C3535792
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Rectal Therapy
Description

Rectal Therapy

Alias
UMLS CUI-1
C0087111
UMLS CUI-2
C0205052
Is the patient taking any rectal therapy?
Description

Therapy Rectal

Data type

integer

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0205052
Rowasa
Description

Rowasa

Data type

boolean

Alias
UMLS CUI [1]
C0699623
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Canasa
Description

Canasa

Data type

boolean

Alias
UMLS CUI [1]
C0678169
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Hydrocortisone enema/suppository
Description

Hydrocortisone enema

Data type

boolean

Alias
UMLS CUI [1]
C1246471
Dose
Description

Dose

Data type

text

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Corticosteroids
Description

Corticosteroids

Alias
UMLS CUI-1
C0001617
Is the patient taking any corticosteroids?
Description

corticosteroids

Data type

integer

Alias
UMLS CUI [1]
C0001617
Prednisone
Description

Prednisone

Data type

boolean

Alias
UMLS CUI [1]
C0032952
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Budesonide
Description

Budesonide

Data type

boolean

Alias
UMLS CUI [1]
C0054201
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Methylprednisolone
Description

Methylprednisolone

Data type

boolean

Alias
UMLS CUI [1]
C0025815
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Immunomodulators
Description

Immunomodulators

Alias
UMLS CUI-1
C1527392
Is the patient taking any immunomodulators?
Description

Immunomodulators

Data type

integer

Alias
UMLS CUI [1]
C1527392
6MP
Description

mercaptopurine

Data type

boolean

Alias
UMLS CUI [1]
C0000618
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Azathioprine
Description

Azathioprine

Data type

boolean

Alias
UMLS CUI [1]
C0004482
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Allopurinol
Description

Allopurinol

Data type

boolean

Alias
UMLS CUI [1]
C0002144
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Methotrexate
Description

Methotrexate

Data type

boolean

Alias
UMLS CUI [1]
C0025677
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/week
Alias
UMLS CUI [1]
C3174092
mg/week
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Methotrexate Route
Description

medication route

Data type

integer

Alias
UMLS CUI [1]
C0013153
Folic Acid
Description

Folic Acid

Data type

boolean

Alias
UMLS CUI [1]
C0016410
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Other Immune Suppressants
Description

Other Immune Suppressants

Alias
UMLS CUI-1
C0021081
Is the patient taking cyclosporine or tacrolimus?
Description

cyclosporine; tacrolimus

Data type

integer

Alias
UMLS CUI [1]
C0010592
UMLS CUI [2]
C0085149
Cyclosporine
Description

Cyclosporine

Data type

boolean

Alias
UMLS CUI [1]
C0010592
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Tacrolimus
Description

Tacrolimus

Data type

boolean

Alias
UMLS CUI [1]
C0085149
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Antibiotics for IBD
Description

Antibiotics for IBD

Alias
UMLS CUI-1
C0003232
UMLS CUI-2
C0021390
Is the patient taking any antibiotic for IBD?
Description

Antibiotics IBD

Data type

integer

Alias
UMLS CUI [1,1]
C0003232
UMLS CUI [1,2]
C0021390
Cipro
Description

Cipro

Data type

boolean

Alias
UMLS CUI [1]
C0701042
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Flagyl
Description

Flagyl

Data type

integer

Alias
UMLS CUI [1]
C0699678
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Rifaximin
Description

Rifaximin

Data type

boolean

Alias
UMLS CUI [1]
C0073374
Dose
Description

Dose

Data type

integer

Measurement units
  • mg/day
Alias
UMLS CUI [1]
C3174092
mg/day
New Medication Today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

medication intake

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1512806
Biologics Information
Description

Biologics Information

Alias
UMLS CUI-1
C0005515
Since the last visit, was an induction dose given for any biologic?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C0857127
Date of first induction dose
Description

date dose induction

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C3174092
UMLS CUI [1,3]
C0857127
Which biologic was initiated at this induction dose?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0005515
Reasons for initiation of biologics (*Note: these questions will only appear for new biologic agents)
Description

Reasons for initiation of biologics (*Note: these questions will only appear for new biologic agents)

Alias
UMLS CUI-1
C0392360
UMLS CUI-2
C0005515
Steroid dependence?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0749010
Toxicity of Immunomodulator?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0013221
UMLS CUI [1,2]
C1527392
Lack of response to immunomodulator?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C1320680
Failure of other biologic?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0162643
Growth failure?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0878787
Perianal disease?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0341395
Severity of endoscopic findings?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0014245
Postsurgical prophylaxis?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0199176
UMLS CUI [1,2]
C0231287
No other treatment attempted?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C1516084
Other
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0205394
Specify
Description

Specify

Data type

text

Alias
UMLS CUI [1]
C1521902
Biologic regimen following today's visit, starting with next dose
Description

Biologic regimen following today's visit, starting with next dose

Alias
UMLS CUI-1
C0087111
UMLS CUI-2
C0005515
Remicade
Description

Remicade

Data type

boolean

Alias
UMLS CUI [1]
C0723012
Dose
Description

Dose

Data type

integer

Measurement units
  • mg
Alias
UMLS CUI [1]
C3174092
mg
Treatment Period
Description

Period therapy

Data type

integer

Alias
UMLS CUI [1,1]
C1948053
UMLS CUI [1,2]
C0087111
Dosing Interval (for maintenance medications only)
Description

dose interval

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C1272706
weeks
Cimzia
Description

Cimzia

Data type

boolean

Alias
UMLS CUI [1]
C2343521
Dose
Description

Dose

Data type

integer

Measurement units
  • mg
Alias
UMLS CUI [1]
C3174092
mg
Treatment Period
Description

Period therapy

Data type

integer

Alias
UMLS CUI [1,1]
C1948053
UMLS CUI [1,2]
C0087111
Dosing Interval (for maintenance medications only)
Description

dose interval

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C1272706
weeks
Humira
Description

Humira

Data type

boolean

Alias
UMLS CUI [1]
C1171255
Dose
Description

Dose

Data type

integer

Measurement units
  • mg
Alias
UMLS CUI [1]
C3174092
mg
Treatment Period
Description

Period therapy

Data type

integer

Alias
UMLS CUI [1,1]
C1948053
UMLS CUI [1,2]
C0087111
Dosing Interval (for maintenance medications only)
Description

dose interval

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C1272706
weeks
Tysabri
Description

Tysabri

Data type

boolean

Alias
UMLS CUI [1]
C1529600
Dose
Description

Dose

Data type

integer

Measurement units
  • mg
Alias
UMLS CUI [1]
C3174092
mg
Treatment Period
Description

Period therapy

Data type

integer

Alias
UMLS CUI [1,1]
C1948053
UMLS CUI [1,2]
C0087111
Dosing Interval (for maintenance medications only)
Description

dose interval

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C1272706
weeks
Simponi
Description

Simponi

Data type

boolean

Alias
UMLS CUI [1]
C2684024
Dose
Description

Dose

Data type

integer

Measurement units
  • mg
Alias
UMLS CUI [1]
C3174092
mg
Treatment Period
Description

Period therapy

Data type

integer

Alias
UMLS CUI [1,1]
C1948053
UMLS CUI [1,2]
C0087111
Dosing Interval (for maintenance medications only)
Description

dose interval

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C1272706
weeks
Stelera
Description

Stelera

Data type

boolean

Alias
UMLS CUI [1]
C4292395
Dose
Description

Dose

Data type

integer

Measurement units
  • mg
Alias
UMLS CUI [1]
C3174092
mg
Treatment Period
Description

Period therapy

Data type

integer

Alias
UMLS CUI [1,1]
C1948053
UMLS CUI [1,2]
C0087111
Dosing Interval (for maintenance medications only)
Description

dose interval

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C1272706
weeks
Entyvio
Description

Entyvio

Data type

boolean

Alias
UMLS CUI [1]
C3715224
Dose
Description

Dose

Data type

integer

Measurement units
  • mg
Alias
UMLS CUI [1]
C3174092
mg
Treatment Period
Description

Period therapy

Data type

integer

Alias
UMLS CUI [1,1]
C1948053
UMLS CUI [1,2]
C0087111
Dosing Interval (for maintenance medications only)
Description

dose interval

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C1272706
weeks
Other prescription medications for IBD (per site discretion)
Description

Other prescription medications for IBD (per site discretion)

Alias
UMLS CUI-1
C1521941
Medication
Description

Medication

Data type

text

Alias
UMLS CUI [1]
C0013227
Dose
Description

Dose

Data type

integer

Measurement units
  • mg
Alias
UMLS CUI [1]
C3174092
mg
New Medication today?
Description

Medication New

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0205314
If No, started:
Description

Start of medication

Data type

integer

Alias
UMLS CUI [1]
C0451613
Is the patient currently taking the following?
Description

Is the patient currently taking the following?

Alias
UMLS CUI-1
C0014327
An enteral caloric intake supplement?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0014327
Enteral nutrition as primary therapy?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C1708063
UMLS CUI [1,2]
C0014327
If Yes, when was enteral therapy started?
Description

therapy start

Data type

integer

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0439659
Is enteral therapy being used generally based on the ICN protocol?
Description

protocol

Data type

integer

Alias
UMLS CUI [1]
C1507394
TPMT
Description

TPMT

Alias
UMLS CUI-1
C1336737
Has the TPMT been measured?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C1336663
TPMT Genotype
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C1336663
TPMT Genotype date
Description

date TPMT

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1336663
TPMT Phenotype
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0031437
UMLS CUI [1,2]
C1336737
TPMT Phenotype date
Description

date Phenotype TPMT

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0031437
UMLS CUI [1,3]
C1336737
6MP/AZA
Description

6MP/AZA

Alias
UMLS CUI-1
C0000618
UMLS CUI-3
C0004482
Has the patient had 6MP metabolites measured more recently than the test indicated above?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0000618
UMLS CUI [1,2]
C0870883
If Yes, most recent measurement date
Description

date mercaptopurine

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0000618
Most recent 6-TGN level
Description

6-TGN

Data type

text

Alias
UMLS CUI [1]
C1315134
Outside quantifiable range
Description

Range

Data type

boolean

Alias
UMLS CUI [1]
C1514721
If result is outside the quantifiable range, select one:
Description

Range

Data type

integer

Alias
UMLS CUI [1]
C1514721
Most recent 6-MMPN
Description

thiopurines metabolite

Data type

text

Alias
UMLS CUI [1,1]
C0597573
UMLS CUI [1,2]
C0870883
Outside quantifiable range
Description

Range

Data type

boolean

Alias
UMLS CUI [1]
C1514721
If result is outside the quantifiable range, select one:
Description

Range

Data type

integer

Alias
UMLS CUI [1]
C1514721
Remicade, Humira, Cimzia, Tysabri Patients
Description

Remicade, Humira, Cimzia, Tysabri Patients

Alias
UMLS CUI-1
C0030705
UMLS CUI-2
C0723012
UMLS CUI-3
C1171255
UMLS CUI-4
C2343521
UMLS CUI-5
C1529600
If a chest x-ray has been done more recently than the test indicated above, please provide the result
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0039985
Date of last CXR
Description

date chest x-ray

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0039985
If a PPD has been placed more recently than the test indicated above, please provide the result
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0041290
Date of last PPD
Description

date PPD test

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0041290
Quantiferon Gold test
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C3161222
Date of last Quantiferon Gold test
Description

date Quantiferon Gold test

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C3161222
Remicade Patients
Description

Remicade Patients

Alias
UMLS CUI-1
C0030705
UMLS CUI-2
C0723012
Has the patient had Remicade trough level measured more recently than the test above?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0242485
UMLS CUI [1,2]
C0723012
Remicade trough level
Description

measurement Remicade

Data type

text

Alias
UMLS CUI [1,1]
C0242485
UMLS CUI [1,2]
C0723012
If result is outside the quantifiable range, select one:
Description

Range

Data type

integer

Alias
UMLS CUI [1]
C1514721
Date of Remicade trough level measurement
Description

date measurement Remicade

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0242485
UMLS CUI [1,3]
C0723012
Remicade Trough Lab?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1]
C0723012
Has the patient had Remicade antibody levels measured more recently than the test above?
Description

(select one)

Data type

integer

Alias
UMLS CUI [1,1]
C0003241
UMLS CUI [1,2]
C0723012
Remicade antibody level
Description

Antibody Remicade

Data type

text

Alias
UMLS CUI [1,1]
C0003241
UMLS CUI [1,2]
C0723012
If result is outside the quantifiable range, select one:
Description

Range

Data type

integer

Alias
UMLS CUI [1]
C1514721
Date of Remicade antibody level measurement
Description

date Antibody Remicade

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0003241
UMLS CUI [1,3]
C0723012
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Similar models

Visit data CRF ImproveCareNow

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Assessment
C1516048 (UMLS CUI-1)
Date of assessment
Item
Date of assessment
date
C2985720 (UMLS CUI [1])
Item
Since the last visit documented in the database were there any visits that were not captured?
integer
C0545082 (UMLS CUI [1])
s_visotdoc
Code List
Since the last visit documented in the database were there any visits that were not captured?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Number of visits
Item
Number of visits not captured
integer
C0449788 (UMLS CUI [1,1])
C0545082 (UMLS CUI [1,2])
data entry person
Item
Current visit data entered by
text
C1550483 (UMLS CUI [1])
Gastroenterologist
Item
Primary Attending Gastroenterologist
text
C0259901 (UMLS CUI [1])
provider secondary
Item
Secondary provider
text
C1138603 (UMLS CUI [1,1])
C0175668 (UMLS CUI [1,2])
Item Group
Colectomy/Ostomy
C0009274 (UMLS CUI-1)
C0029473 (UMLS CUI-3)
Item
Has the patient had a colectomy? (If Yes, and the patient's diagnosis is UC, the patient should be inactivated)
integer
C0009274 (UMLS CUI [1])
s_colectomy
Code List
Has the patient had a colectomy? (If Yes, and the patient's diagnosis is UC, the patient should be inactivated)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Date colectomy
Item
Date of colectomy
date
C0011008 (UMLS CUI [1,1])
C0009274 (UMLS CUI [1,2])
Item
Does the Patient currently have an ileostomy or colostomy?
integer
C0455661 (UMLS CUI [1])
C0481493 (UMLS CUI [2])
s_ileocolo
Code List
Does the Patient currently have an ileostomy or colostomy?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
What is the patient's current diagnosis?
integer
C0011900 (UMLS CUI [1])
s_currdx
Code List
What is the patient's current diagnosis?
CL Item
Crohn's Disease (1)
C0010346 (UMLS CUI-1)
(Comment:en)
CL Item
Ulcerative Colitis (2)
C0009324 (UMLS CUI-1)
(Comment:en)
CL Item
Indeterminate Colitis (3)
C0341332 (UMLS CUI-1)
(Comment:en)
Item Group
In the following set of questions, describe the symptoms on the worst day in the last 7 days
C1457887 (UMLS CUI-1)
Item
General well-being related to IBD
integer
C1286942 (UMLS CUI [1])
s_wellbeing
Code List
General well-being related to IBD
CL Item
Well/Normal (7)
CL Item
Fair (8)
CL Item
Poor (3)
CL Item
Don't Know/Not Assessed (6)
Item
Limitations in daily activities related to IBD
integer
C0740765 (UMLS CUI [1])
s_limitdact
Code List
Limitations in daily activities related to IBD
CL Item
None (1)
CL Item
Occasional (2)
CL Item
Frequent (3)
CL Item
Don't Know/Not Assessed (4)
Item
Abdominal pain due to IBD
integer
C0000737 (UMLS CUI [1])
s_abdpain
Code List
Abdominal pain due to IBD
CL Item
None (1)
CL Item
Mild (2)
CL Item
Moderate to Severe (6)
CL Item
Don't Know/Not Assessed (5)
Item Group
In the following set of questions, describe the patient's stools on the worst day in the last 7 days
C0015733 (UMLS CUI-1)
Total number stools per day
Item
Total number of stools per day (enter 0 if none)
integer
C4288115 (UMLS CUI [1,1])
C0015733 (UMLS CUI [1,2])
C0439505 (UMLS CUI [1,3])
Not Assessed
Item
Not Assessed
boolean
C3846720 (UMLS CUI [1])
Item
Most stools were
integer
C0015733 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
s_moststool
Code List
Most stools were
CL Item
Formed (1)
CL Item
Partially Formed (2)
CL Item
Liquid (3)
CL Item
Don't Know/Not Assessed (4)
Number of watery stools
Item
Number of liquid/watery stools per day (enter 0 if none)
integer
C0237753 (UMLS CUI [1,1])
C2129214 (UMLS CUI [1,2])
Not Assessed
Item
Not Assessed
boolean
C3846720 (UMLS CUI [1])
Item
Did the patient report bloody stools?
integer
C0018932 (UMLS CUI [1])
s_bloodystool
Code List
Did the patient report bloody stools?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If blood was present, the typical amount was
integer
C1265611 (UMLS CUI [1,1])
C1321898 (UMLS CUI [1,2])
bloodamt
Code List
If blood was present, the typical amount was
CL Item
Small amount in less than 50% of stools (5)
CL Item
Small amount in greater than 50% of stools (6)
CL Item
Large amount (2)
CL Item
Not available/assessed (4)
Item
Nocturnal diarrhea
integer
C0859975 (UMLS CUI [1])
s_nocdia
Code List
Nocturnal diarrhea
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
Item Group
Extraintestinal Manifestations
C1280464 (UMLS CUI-1)
C4062672 (UMLS CUI-2)
Item
Fever 38.5 degrees C (101.3 degrees F) for 3 of last 7 days?
integer
C0015967 (UMLS CUI [1])
s_fever
Code List
Fever 38.5 degrees C (101.3 degrees F) for 3 of last 7 days?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
Item
Definite arthritis?
integer
C0003864 (UMLS CUI [1])
s_arth
Code List
Definite arthritis?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
Item
Uveitis?
integer
C0042164 (UMLS CUI [1])
s_uveitis
Code List
Uveitis?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
Item
Erythema nodosum?
integer
C0014743 (UMLS CUI [1])
s_eryth
Code List
Erythema nodosum?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
Item
Pyoderma gangrenosum?
integer
C0085652 (UMLS CUI [1])
s_pyoderm
Code List
Pyoderma gangrenosum?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
Item Group
Exam
C0582103 (UMLS CUI-1)
Item
Abdominal exam
integer
C0438120 (UMLS CUI [1])
s_abdexam
Code List
Abdominal exam
CL Item
No tenderness, no mass (1)
CL Item
Mild tenderness or questionable mass without tenderness (2)
CL Item
Moderate to severe tenderness, involuntary guarding, definite mass (3)
CL Item
Don't Know (4)
CL Item
Not Assessed (5)
Item
Perirectal disease at current exam
integer
C0012634 (UMLS CUI [1,1])
C1550291 (UMLS CUI [1,2])
s_peridis
Code List
Perirectal disease at current exam
CL Item
Normal or asymptomatic tag, non-draining fistula without tenderness, no deep fissuring or abscess (1)
CL Item
Mildly inflamed skin tag(s), 1 to 2 indolent fistulas with scant drainage (NO tenderness, deep fissures or abscess (2)
CL Item
Severely inflamed tag(s), active fistula with drainage, tenderness, abscess, or deep fissure (3)
CL Item
Don't Know (4)
CL Item
Not Assessed (5)
Item
Current Height: Unit
text
C0005890 (UMLS CUI [1,1])
C0439148 (UMLS CUI [1,2])
s_ht unit
Code List
Current Height: Unit
CL Item
cm (cm)
CL Item
in (in)
Height
Item
Current Height
integer
C0005890 (UMLS CUI [1])
Not Assessed
Item
Not Assessed
boolean
C3846720 (UMLS CUI [1])
Item
Current Weight: Unit
text
C0005910 (UMLS CUI [1,1])
C0439148 (UMLS CUI [1,2])
s_wt unit
Code List
Current Weight: Unit
CL Item
kg (kg)
CL Item
lb (lb)
Weight
Item
Current Weight
float
C0005910 (UMLS CUI [1])
Not Assessed
Item
Not Assessed
boolean
C3846720 (UMLS CUI [1])
BMI
Item
Current BMI
float
C1305855 (UMLS CUI [1])
Item
For patients less than 18 years old, has height, weight and BMI been plotted on a growth chart?
integer
C0005890 (UMLS CUI [1])
C0005910 (UMLS CUI [2])
C1305855 (UMLS CUI [3])
s_plotvitals
Code List
For patients less than 18 years old, has height, weight and BMI been plotted on a growth chart?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item Group
Disease Assessment
C0421175 (UMLS CUI-1)
Item
Physicians Global Assessment of current disease status
integer
C0220825 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C0449438 (UMLS CUI [1,3])
s_pga
Code List
Physicians Global Assessment of current disease status
CL Item
Quiescent (1)
CL Item
Mild (2)
CL Item
Moderate (3)
CL Item
Severe (4)
CL Item
Don't Know/Not Assessed (5)
Item Group
Extent of Disease: Crohn's Disease/Indeterminate Colitis patients only (select one for each category)
C0449279 (UMLS CUI-1)
C0010346 (UMLS CUI-2)
C0341332 (UMLS CUI-3)
Item
Macroscopic Lower GI Disease?
integer
C0012242 (UMLS CUI [1,1])
C1548802 (UMLS CUI [1,2])
C1551402 (UMLS CUI [1,3])
s_exchrn_lower
Code List
Macroscopic Lower GI Disease?
CL Item
None (0)
CL Item
Ileal only (1)
CL Item
Colonic only (2)
CL Item
Ileocolonic (3)
CL Item
Not Assessed (8)
CL Item
Don't Know (9)
Item
Macroscopic Upper GI Disease proximal to the ligament of Treitz?
integer
C0012242 (UMLS CUI [1,1])
C1551402 (UMLS CUI [1,2])
C1261087 (UMLS CUI [1,3])
C0205107 (UMLS CUI [1,4])
s_exchrn_upper_prox
Code List
Macroscopic Upper GI Disease proximal to the ligament of Treitz?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not Assessed (8)
CL Item
Don't Know (99)
Item
Macroscopic Upper GI Disease distal to the ligament of Treitz?
integer
C0012242 (UMLS CUI [1,1])
C1551402 (UMLS CUI [1,2])
C1261087 (UMLS CUI [1,3])
C0205108 (UMLS CUI [1,4])
s_exchrn_upper_dist
Code List
Macroscopic Upper GI Disease distal to the ligament of Treitz?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not Assessed (8)
CL Item
Don't Know (99)
Item
For CD/IC patients only: Current Crohn's Disease Phenotype
integer
C0010346 (UMLS CUI [1,1])
C0031437 (UMLS CUI [1,2])
s_cdpheno
Code List
For CD/IC patients only: Current Crohn's Disease Phenotype
CL Item
Inflammatory, non-penetrating, non-stricturing (1)
CL Item
Stricturing (2)
CL Item
Penetrating (3)
CL Item
Both Stricturing and Penetrating (4)
CL Item
Don't Know (5)
Item
For CD/IC patients only: Perianal Phenotype?
integer
C0747465 (UMLS CUI [1,1])
C0031437 (UMLS CUI [1,2])
s_peipheno
Code List
For CD/IC patients only: Perianal Phenotype?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item Group
Extent of Disease: Ulcerative Colitis subjects only
C0449279 (UMLS CUI-1)
C0009324 (UMLS CUI-2)
Item
Extent of Disease: Ulcerative Colitis subjects only
integer
C0449279 (UMLS CUI [1])
s_extdisuc
Code List
Extent of Disease: Ulcerative Colitis subjects only
CL Item
Ulcerative Proctitis (rectum only (1)
CL Item
Left sided Ulcerative Colitis (2)
CL Item
Extensive Ulcerative Colitis (3)
CL Item
Pancolitis (the entire colon (4)
CL Item
Not assessed completely (5)
CL Item
Don't Know (6)
Item
For UC patients only: Ulcerative Colitis Behavior: Has the patient ever had severe disease?
integer
C0009324 (UMLS CUI [1,1])
C0004927 (UMLS CUI [1,2])
s_ucbehavior
Code List
For UC patients only: Ulcerative Colitis Behavior: Has the patient ever had severe disease?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item Group
Nutritional and Growth Status
C0392209 (UMLS CUI-1)
C0943912 (UMLS CUI-2)
Item
Nutritional Status
integer
C0392209 (UMLS CUI [1])
s_nutrstatus
Code List
Nutritional Status
CL Item
Satisfactory (1)
CL Item
At Risk (2)
CL Item
In failure (3)
CL Item
Not Assessed (5)
Item
For patients less than 18 years old: Growth Status
integer
C0943912 (UMLS CUI [1])
s_growthstatus
Code List
For patients less than 18 years old: Growth Status
CL Item
Satisfactory (1)
CL Item
At Risk (2)
CL Item
In failure (3)
CL Item
Not Assessed (5)
Item
Since the last visit, has the patient been in continuous remission?
integer
C0544452 (UMLS CUI [1])
remission
Code List
Since the last visit, has the patient been in continuous remission?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Since the last visit, has the patient had a serious infection? (Note: A serious infection is one that requires hospitalization or IV therapy)
integer
C0009450 (UMLS CUI [1,1])
C0019993 (UMLS CUI [1,2])
s_infec
Code List
Since the last visit, has the patient had a serious infection? (Note: A serious infection is one that requires hospitalization or IV therapy)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
infection
Item
If yes, indicate infection
text
C0009450 (UMLS CUI [1])
Item
Are there psychosocial risk factors that are felt to significantly impact the patient's medical care?
integer
C0035648 (UMLS CUI [1,1])
C0542298 (UMLS CUI [1,2])
s_adherence
Code List
Are there psychosocial risk factors that are felt to significantly impact the patient's medical care?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item Group
Laboratory Analysis
C0936012 (UMLS CUI-1)
C0022877 (UMLS CUI-2)
Item
Was a blood sample drawn for laboratory analysis?
integer
C1277698 (UMLS CUI [1])
bldsample
Code List
Was a blood sample drawn for laboratory analysis?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Date of blood sample
Item
Date of lab sample
date
C0011008 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
Item
C-Reactive Protein
integer
C0201657 (UMLS CUI [1])
crp
Code List
C-Reactive Protein
CL Item
Not Done (0)
CL Item
Done on same date as above (1)
CL Item
Done on different date than above (2)
Date of sample
Item
Date of sample
date
C1317250 (UMLS CUI [1])
Result
Item
Result
text
C1274040 (UMLS CUI [1])
Sample Range
Item
Outside quantifiable range
boolean
C2348147 (UMLS CUI [1])
Item
If result is outside the quantifiable range, select one:
integer
C2348147 (UMLS CUI [1])
s_crpunkn specification
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
Item
Lab?
integer
C0022877 (UMLS CUI [1])
s_crplab
Code List
Lab?
CL Item
LabCorp (1)
CL Item
Quest (2)
CL Item
In-house (3)
CL Item
Other (4)
Item
Hematocrit
integer
C0018935 (UMLS CUI [1])
hem
Code List
Hematocrit
CL Item
Not Done (0)
CL Item
Done on same date as above (1)
CL Item
Done on different date than above (2)
Date of sample Hematocrite
Item
Hematocrite Date of sample
date
C1317250 (UMLS CUI [1,1])
C0018935 (UMLS CUI [1,2])
Result
Item
Result
text
C1274040 (UMLS CUI [1])
Sample Range
Item
Outside quantifiable range
boolean
C2348147 (UMLS CUI [1])
Item
If result is outside the quantifiable range, select one
integer
C2348147 (UMLS CUI [1])
s_esrunkn specification
Code List
If result is outside the quantifiable range, select one
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
Item
Albumin
integer
C0201838 (UMLS CUI [1])
alb
Code List
Albumin
CL Item
Not Done (0)
CL Item
Done on same date as above (1)
CL Item
Done on different date than above (2)
Date of sample
Item
Date of sample
date
C1317250 (UMLS CUI [1])
Result
Item
Result
text
C1274040 (UMLS CUI [1])
Item Group
Medications
C0013227 (UMLS CUI-1)
Item
Is the patient currently taking any non-biologic prescription medications for IBD?
integer
C0013227 (UMLS CUI [1])
ibdmed
Code List
Is the patient currently taking any non-biologic prescription medications for IBD?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item Group
Aminosalicylates
C0368663 (UMLS CUI-1)
Sulfasalazine
Item
Sulfasalazine
boolean
C0036078 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
azulnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
azulstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Pentasa
Item
Pentasa
boolean
C0678171 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
pntnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
penstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Asacol
Item
Asacol
boolean
C0678172 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
asanew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
asastart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Apriso
Item
Apriso
boolean
C2586541 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
aprnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
aprstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Lialda
Item
Lialda
boolean
C1873792 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
lianew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
liastart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Colazal
Item
Colazal
boolean
C0939297 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
colanew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
colastart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Delzicol
Item
Delzicol
boolean
C3535792 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
delznew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
delzstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item Group
Rectal Therapy
C0087111 (UMLS CUI-1)
C0205052 (UMLS CUI-2)
Item
Is the patient taking any rectal therapy?
integer
C0087111 (UMLS CUI [1,1])
C0205052 (UMLS CUI [1,2])
rectaking
Code List
Is the patient taking any rectal therapy?
CL Item
Yes (0)
CL Item
No (1)
Rowasa
Item
Rowasa
boolean
C0699623 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
rwsnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
rwsstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Canasa
Item
Canasa
boolean
C0678169 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
cannew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
canstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Hydrocortisone enema
Item
Hydrocortisone enema/suppository
boolean
C1246471 (UMLS CUI [1])
Dose
Item
Dose
text
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
hdrnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
hdrstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item Group
Corticosteroids
C0001617 (UMLS CUI-1)
Item
Is the patient taking any corticosteroids?
integer
C0001617 (UMLS CUI [1])
cortaking
Code List
Is the patient taking any corticosteroids?
CL Item
Yes (1)
CL Item
No (2)
Prednisone
Item
Prednisone
boolean
C0032952 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
bdsnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
bdsstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Budesonide
Item
Budesonide
boolean
C0054201 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
mprednew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
mpredstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Methylprednisolone
Item
Methylprednisolone
boolean
C0025815 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
mprednew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
mpredstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item Group
Immunomodulators
C1527392 (UMLS CUI-1)
Item
Is the patient taking any immunomodulators?
integer
C1527392 (UMLS CUI [1])
imodtaking
Code List
Is the patient taking any immunomodulators?
CL Item
Yes (1)
CL Item
No (2)
mercaptopurine
Item
6MP
boolean
C0000618 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
6mpnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
6mpstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Azathioprine
Item
Azathioprine
boolean
C0004482 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
azanew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
azastart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Allopurinol
Item
Allopurinol
boolean
C0002144 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
mthnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
mthstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Methotrexate
Item
Methotrexate
boolean
C0025677 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
mthnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
mthstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item
Methotrexate Route
integer
C0013153 (UMLS CUI [1])
s_methroute
Code List
Methotrexate Route
CL Item
Subcutaneous (1)
CL Item
PO (2)
CL Item
IM (5)
CL Item
Don't Know (4)
Folic Acid
Item
Folic Acid
boolean
C0016410 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
folicnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
folicstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item Group
Other Immune Suppressants
C0021081 (UMLS CUI-1)
Item
Is the patient taking cyclosporine or tacrolimus?
integer
C0010592 (UMLS CUI [1])
C0085149 (UMLS CUI [2])
suprntaking
Code List
Is the patient taking cyclosporine or tacrolimus?
CL Item
Yes (1)
CL Item
No (2)
Cyclosporine
Item
Cyclosporine
boolean
C0010592 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
cyclonew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
cyclostart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Tacrolimus
Item
Tacrolimus
boolean
C0085149 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
tacronew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
tacrostart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item Group
Antibiotics for IBD
C0003232 (UMLS CUI-1)
C0021390 (UMLS CUI-2)
Item
Is the patient taking any antibiotic for IBD?
integer
C0003232 (UMLS CUI [1,1])
C0021390 (UMLS CUI [1,2])
antbiotaking
Code List
Is the patient taking any antibiotic for IBD?
CL Item
Yes (1)
CL Item
No (2)
Cipro
Item
Cipro
boolean
C0701042 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
cipronew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
ciprostart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Flagyl
Item
Flagyl
integer
C0699678 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
flaglnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
flaglstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Rifaximin
Item
Rifaximin
boolean
C0073374 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication Today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
rifaxnew
Code List
New Medication Today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0013227 (UMLS CUI [1,1])
C1512806 (UMLS CUI [1,2])
rifaxstart
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item Group
Biologics Information
C0005515 (UMLS CUI-1)
Item
Since the last visit, was an induction dose given for any biologic?
integer
C3174092 (UMLS CUI [1,1])
C0857127 (UMLS CUI [1,2])
s_biologicsyn
Code List
Since the last visit, was an induction dose given for any biologic?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
date dose induction
Item
Date of first induction dose
date
C0011008 (UMLS CUI [1,1])
C3174092 (UMLS CUI [1,2])
C0857127 (UMLS CUI [1,3])
Item
Which biologic was initiated at this induction dose?
integer
C0005515 (UMLS CUI [1])
s_biologicind
Code List
Which biologic was initiated at this induction dose?
CL Item
Cimzia (1)
CL Item
Entyvio (7)
CL Item
Humira (2)
CL Item
Remicade (3)
CL Item
Simponi (5)
CL Item
Stelera (6)
CL Item
Tysabri (4)
Item Group
Reasons for initiation of biologics (*Note: these questions will only appear for new biologic agents)
C0392360 (UMLS CUI-1)
C0005515 (UMLS CUI-2)
Item
Steroid dependence?
integer
C0749010 (UMLS CUI [1])
steroid
Code List
Steroid dependence?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Toxicity of Immunomodulator?
integer
C0013221 (UMLS CUI [1,1])
C1527392 (UMLS CUI [1,2])
toxim
Code List
Toxicity of Immunomodulator?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Lack of response to immunomodulator?
integer
C1320680 (UMLS CUI [1])
lackim
Code List
Lack of response to immunomodulator?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Failure of other biologic?
integer
C0162643 (UMLS CUI [1])
failure
Code List
Failure of other biologic?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Growth failure?
integer
C0878787 (UMLS CUI [1])
growth
Code List
Growth failure?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Perianal disease?
integer
C0341395 (UMLS CUI [1])
personal
Code List
Perianal disease?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Severity of endoscopic findings?
integer
C0014245 (UMLS CUI [1])
endoscopy
Code List
Severity of endoscopic findings?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Postsurgical prophylaxis?
integer
C0199176 (UMLS CUI [1,1])
C0231287 (UMLS CUI [1,2])
prophyl
Code List
Postsurgical prophylaxis?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
No other treatment attempted?
integer
C0087111 (UMLS CUI [1,1])
C1516084 (UMLS CUI [1,2])
othtmt
Code List
No other treatment attempted?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Other
integer
C0205394 (UMLS CUI [1])
othbiologic
Code List
Other
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Specify
Item
Specify
text
C1521902 (UMLS CUI [1])
Item Group
Biologic regimen following today's visit, starting with next dose
C0087111 (UMLS CUI-1)
C0005515 (UMLS CUI-2)
Remicade
Item
Remicade
boolean
C0723012 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
Treatment Period
integer
C1948053 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
infmabtrt
Code List
Treatment Period
CL Item
Maintenance (1)
CL Item
Induction (2)
dose interval
Item
Dosing Interval (for maintenance medications only)
integer
C3174092 (UMLS CUI [1,1])
C1272706 (UMLS CUI [1,2])
Cimzia
Item
Cimzia
boolean
C2343521 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
Treatment Period
integer
C1948053 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
cimztrt
Code List
Treatment Period
CL Item
Maintenance (1)
CL Item
Induction (2)
dose interval
Item
Dosing Interval (for maintenance medications only)
integer
C3174092 (UMLS CUI [1,1])
C1272706 (UMLS CUI [1,2])
Humira
Item
Humira
boolean
C1171255 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
Treatment Period
integer
C1948053 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
hmratrt
Code List
Treatment Period
CL Item
Maintenance (1)
CL Item
Induction (2)
dose interval
Item
Dosing Interval (for maintenance medications only)
integer
C3174092 (UMLS CUI [1,1])
C1272706 (UMLS CUI [1,2])
Tysabri
Item
Tysabri
boolean
C1529600 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
Treatment Period
integer
C1948053 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
tysabrtrt
Code List
Treatment Period
CL Item
Maintenance (1)
CL Item
Induction (2)
dose interval
Item
Dosing Interval (for maintenance medications only)
integer
C3174092 (UMLS CUI [1,1])
C1272706 (UMLS CUI [1,2])
Simponi
Item
Simponi
boolean
C2684024 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
Treatment Period
integer
C1948053 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
steltrt
Code List
Treatment Period
CL Item
Maintenance (1)
CL Item
Induction (2)
dose interval
Item
Dosing Interval (for maintenance medications only)
integer
C3174092 (UMLS CUI [1,1])
C1272706 (UMLS CUI [1,2])
Stelera
Item
Stelera
boolean
C4292395 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
Treatment Period
integer
C1948053 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
steltrt
Code List
Treatment Period
CL Item
Maintenance (1)
CL Item
Induction (2)
dose interval
Item
Dosing Interval (for maintenance medications only)
integer
C3174092 (UMLS CUI [1,1])
C1272706 (UMLS CUI [1,2])
Entyvio
Item
Entyvio
boolean
C3715224 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
Treatment Period
integer
C1948053 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
entyvtrt
Code List
Treatment Period
CL Item
Maintenance (1)
CL Item
Induction (2)
dose interval
Item
Dosing Interval (for maintenance medications only)
integer
C3174092 (UMLS CUI [1,1])
C1272706 (UMLS CUI [1,2])
Item Group
Other prescription medications for IBD (per site discretion)
C1521941 (UMLS CUI-1)
Medication
Item
Medication
text
C0013227 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
Item
New Medication today?
integer
C0013227 (UMLS CUI [1,1])
C0205314 (UMLS CUI [1,2])
New Medication today
Code List
New Medication today?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If No, started:
integer
C0451613 (UMLS CUI [1])
Start of medication
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item Group
Is the patient currently taking the following?
C0014327 (UMLS CUI-1)
Item
An enteral caloric intake supplement?
integer
C0014327 (UMLS CUI [1])
s_entsupr
Code List
An enteral caloric intake supplement?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
Enteral nutrition as primary therapy?
integer
C1708063 (UMLS CUI [1,1])
C0014327 (UMLS CUI [1,2])
s_enthupr
Code List
Enteral nutrition as primary therapy?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item
If Yes, when was enteral therapy started?
integer
C0087111 (UMLS CUI [1,1])
C0439659 (UMLS CUI [1,2])
s_entstart
Code List
If Yes, when was enteral therapy started?
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item
Is enteral therapy being used generally based on the ICN protocol?
integer
C1507394 (UMLS CUI [1])
s_entprot
Code List
Is enteral therapy being used generally based on the ICN protocol?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Item Group
TPMT
C1336737 (UMLS CUI-1)
Item
Has the TPMT been measured?
integer
C1336663 (UMLS CUI [1])
s_tpmtmeasured
Code List
Has the TPMT been measured?
CL Item
Yes (1)
CL Item
No (0)
Item
TPMT Genotype
integer
C1336663 (UMLS CUI [1])
s_tpmtgeno
Code List
TPMT Genotype
CL Item
Normal (1)
(Comment:en)
CL Item
Heterozygous (2)
C0019425 (UMLS CUI-1)
(Comment:en)
CL Item
Homozygous recessive (3)
(Comment:en)
CL Item
Not Done (4)
(Comment:en)
date TPMT
Item
TPMT Genotype date
date
C0011008 (UMLS CUI [1,1])
C1336663 (UMLS CUI [1,2])
Item
TPMT Phenotype
integer
C0031437 (UMLS CUI [1,1])
C1336737 (UMLS CUI [1,2])
s_tpmtpheno
Code List
TPMT Phenotype
CL Item
Normal/High (5)
CL Item
Intermediate (1)
CL Item
Low (3)
CL Item
Not Done (4)
date Phenotype TPMT
Item
TPMT Phenotype date
date
C0011008 (UMLS CUI [1,1])
C0031437 (UMLS CUI [1,2])
C1336737 (UMLS CUI [1,3])
Item Group
6MP/AZA
C0000618 (UMLS CUI-1)
C0004482 (UMLS CUI-3)
Item
Has the patient had 6MP metabolites measured more recently than the test indicated above?
integer
C0000618 (UMLS CUI [1,1])
C0870883 (UMLS CUI [1,2])
Recent measurement 6MP metabolites
Code List
Has the patient had 6MP metabolites measured more recently than the test indicated above?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
date mercaptopurine
Item
If Yes, most recent measurement date
date
C0011008 (UMLS CUI [1,1])
C0000618 (UMLS CUI [1,2])
6-TGN
Item
Most recent 6-TGN level
text
C1315134 (UMLS CUI [1])
Range
Item
Outside quantifiable range
boolean
C1514721 (UMLS CUI [1])
Item
If result is outside the quantifiable range, select one:
integer
C1514721 (UMLS CUI [1])
6tgunkn specification
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
thiopurines metabolite
Item
Most recent 6-MMPN
text
C0597573 (UMLS CUI [1,1])
C0870883 (UMLS CUI [1,2])
Range
Item
Outside quantifiable range
boolean
C1514721 (UMLS CUI [1])
Item
If result is outside the quantifiable range, select one:
integer
C1514721 (UMLS CUI [1])
6mpunkn specification
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
Item Group
Remicade, Humira, Cimzia, Tysabri Patients
C0030705 (UMLS CUI-1)
C0723012 (UMLS CUI-2)
C1171255 (UMLS CUI-3)
C2343521 (UMLS CUI-4)
C1529600 (UMLS CUI-5)
Item
If a chest x-ray has been done more recently than the test indicated above, please provide the result
integer
C0039985 (UMLS CUI [1])
s_cxr
Code List
If a chest x-ray has been done more recently than the test indicated above, please provide the result
CL Item
Positive (1)
CL Item
Negative (2)
CL Item
Not Done (3)
date chest x-ray
Item
Date of last CXR
date
C0011008 (UMLS CUI [1,1])
C0039985 (UMLS CUI [1,2])
Item
If a PPD has been placed more recently than the test indicated above, please provide the result
integer
C0041290 (UMLS CUI [1])
s_ppd
Code List
If a PPD has been placed more recently than the test indicated above, please provide the result
CL Item
Positive (1)
CL Item
Negative (2)
CL Item
Not Done (3)
date PPD test
Item
Date of last PPD
date
C0011008 (UMLS CUI [1,1])
C0041290 (UMLS CUI [1,2])
Item
Quantiferon Gold test
integer
C3161222 (UMLS CUI [1])
goldtest
Code List
Quantiferon Gold test
CL Item
Positive (1)
CL Item
Negative (0)
CL Item
Indeterminate (2)
CL Item
Not Done (99)
date Quantiferon Gold test
Item
Date of last Quantiferon Gold test
date
C0011008 (UMLS CUI [1,1])
C3161222 (UMLS CUI [1,2])
Item Group
Remicade Patients
C0030705 (UMLS CUI-1)
C0723012 (UMLS CUI-2)
Item
Has the patient had Remicade trough level measured more recently than the test above?
integer
C0242485 (UMLS CUI [1,1])
C0723012 (UMLS CUI [1,2])
s_inflixtroughmeas
Code List
Has the patient had Remicade trough level measured more recently than the test above?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
measurement Remicade
Item
Remicade trough level
text
C0242485 (UMLS CUI [1,1])
C0723012 (UMLS CUI [1,2])
Item
If result is outside the quantifiable range, select one:
integer
C1514721 (UMLS CUI [1])
inflixtroughqnt
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (0)
CL Item
Above level of quantification (1)
date measurement Remicade
Item
Date of Remicade trough level measurement
date
C0011008 (UMLS CUI [1,1])
C0242485 (UMLS CUI [1,2])
C0723012 (UMLS CUI [1,3])
Item
Remicade Trough Lab?
integer
C0723012 (UMLS CUI [1])
s_inflixtroughlab
Code List
Remicade Trough Lab?
CL Item
LabCorp (Esoterix (1)
CL Item
Prometheus (2)
CL Item
MAYO (3)
CL Item
ARUP (4)
Item
Has the patient had Remicade antibody levels measured more recently than the test above?
integer
C0003241 (UMLS CUI [1,1])
C0723012 (UMLS CUI [1,2])
s_inflixantibodymeas
Code List
Has the patient had Remicade antibody levels measured more recently than the test above?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
Antibody Remicade
Item
Remicade antibody level
text
C0003241 (UMLS CUI [1,1])
C0723012 (UMLS CUI [1,2])
Item
If result is outside the quantifiable range, select one:
integer
C1514721 (UMLS CUI [1])
inftrrange
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (0)
CL Item
Above level of quantification (1)
date Antibody Remicade
Item
Date of Remicade antibody level measurement
date
C0011008 (UMLS CUI [1,1])
C0003241 (UMLS CUI [1,2])
C0723012 (UMLS CUI [1,3])
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