Informatie:
Fout:
ID
24299
Beschrijving
Type of information collected in the ICN2 Database for the scientific infrastructure "ImproveCareNow" (http://www.improvecarenow.org/) to improve health outcome of chrildren and adolescents with IBD.
Link
http://www.improvecarenow.org/
Trefwoorden
Versies (3)
- 2017-07-16 2017-07-16 -
- 2017-07-16 2017-07-16 -
- 2017-07-29 2017-07-29 -
Geüploaded op
29 juli 2017
DOI
Voor een aanvraag inloggen.
Licentie
Creative Commons BY-NC 3.0
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Visit data CRF ImproveCareNow
Visit data CRF ImproveCareNow
- StudyEvent: ODM
Similar models
Visit data CRF ImproveCareNow
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
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])
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])
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])
C0175668 (UMLS CUI [1,2])
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])
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])
C0009274 (UMLS CUI [1,2])
Item
Does the Patient currently have an ileostomy or colostomy?
integer
C0455661 (UMLS CUI [1])
C0481493 (UMLS CUI [2])
C0481493 (UMLS CUI [2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Crohn's Disease (1)
C0010346 (UMLS CUI-1)
(Comment:en)
(Comment:en)
CL Item
Ulcerative Colitis (2)
C0009324 (UMLS CUI-1)
(Comment:en)
(Comment:en)
CL Item
Indeterminate Colitis (3)
C0341332 (UMLS CUI-1)
(Comment:en)
(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)
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])
CL Item
None (1)
CL Item
Occasional (2)
CL Item
Frequent (3)
CL Item
Don't Know/Not Assessed (4)
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])
C0015733 (UMLS CUI [1,2])
C0439505 (UMLS CUI [1,3])
Not Assessed
Item
Not Assessed
boolean
C3846720 (UMLS CUI [1])
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])
C2129214 (UMLS CUI [1,2])
Not Assessed
Item
Not Assessed
boolean
C3846720 (UMLS CUI [1])
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])
C1321898 (UMLS CUI [1,2])
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)
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)
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])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not available/assessed (2)
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])
C1550291 (UMLS CUI [1,2])
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)
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])
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])
C0005910 (UMLS CUI [2])
C1305855 (UMLS CUI [3])
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
Physicians Global Assessment of current disease status
integer
C0220825 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C0449438 (UMLS CUI [1,3])
C0012634 (UMLS CUI [1,2])
C0449438 (UMLS CUI [1,3])
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)
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])
C1548802 (UMLS CUI [1,2])
C1551402 (UMLS CUI [1,3])
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])
C1551402 (UMLS CUI [1,2])
C1261087 (UMLS CUI [1,3])
C0205107 (UMLS CUI [1,4])
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])
C1551402 (UMLS CUI [1,2])
C1261087 (UMLS CUI [1,3])
C0205108 (UMLS CUI [1,4])
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])
C0031437 (UMLS CUI [1,2])
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])
C0031437 (UMLS CUI [1,2])
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)
C0009324 (UMLS CUI-2)
Item
Extent of Disease: Ulcerative Colitis subjects only
integer
C0449279 (UMLS CUI [1])
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])
C0004927 (UMLS CUI [1,2])
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)
C0943912 (UMLS CUI-2)
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])
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])
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])
C0019993 (UMLS CUI [1,2])
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])
C0542298 (UMLS CUI [1,2])
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)
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])
C0178913 (UMLS CUI [1,2])
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])
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
CL Item
LabCorp (1)
CL Item
Quest (2)
CL Item
In-house (3)
CL Item
Other (4)
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])
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])
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
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
Is the patient currently taking any non-biologic prescription medications for IBD?
integer
C0013227 (UMLS CUI [1])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item
Is the patient taking any rectal therapy?
integer
C0087111 (UMLS CUI [1,1])
C0205052 (UMLS CUI [1,2])
C0205052 (UMLS CUI [1,2])
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item
Is the patient taking cyclosporine or tacrolimus?
integer
C0010592 (UMLS CUI [1])
C0085149 (UMLS CUI [2])
C0085149 (UMLS CUI [2])
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item
Is the patient taking any antibiotic for IBD?
integer
C0003232 (UMLS CUI [1,1])
C0021390 (UMLS CUI [1,2])
C0021390 (UMLS CUI [1,2])
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
Item
Since the last visit, was an induction dose given for any biologic?
integer
C3174092 (UMLS CUI [1,1])
C0857127 (UMLS CUI [1,2])
C0857127 (UMLS CUI [1,2])
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])
C3174092 (UMLS CUI [1,2])
C0857127 (UMLS CUI [1,3])
Item
Which biologic was initiated at this induction dose?
integer
C0005515 (UMLS CUI [1])
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)
C0005515 (UMLS CUI-2)
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])
C1527392 (UMLS CUI [1,2])
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])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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])
C0231287 (UMLS CUI [1,2])
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])
C1516084 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
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)
C0005515 (UMLS CUI-2)
Remicade
Item
Remicade
boolean
C0723012 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
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])
C1272706 (UMLS CUI [1,2])
Cimzia
Item
Cimzia
boolean
C2343521 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
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])
C1272706 (UMLS CUI [1,2])
Humira
Item
Humira
boolean
C1171255 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
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])
C1272706 (UMLS CUI [1,2])
Tysabri
Item
Tysabri
boolean
C1529600 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
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])
C1272706 (UMLS CUI [1,2])
Simponi
Item
Simponi
boolean
C2684024 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
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])
C1272706 (UMLS CUI [1,2])
Stelera
Item
Stelera
boolean
C4292395 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
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])
C1272706 (UMLS CUI [1,2])
Entyvio
Item
Entyvio
boolean
C3715224 (UMLS CUI [1])
Dose
Item
Dose
integer
C3174092 (UMLS CUI [1])
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])
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])
C0205314 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
CL Item
Don't Know (2)
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])
C0014327 (UMLS CUI [1,2])
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])
C0439659 (UMLS CUI [1,2])
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])
CL Item
Yes (1)
CL Item
No (0)
CL Item
Don't Know (2)
CL Item
Yes (1)
CL Item
No (0)
CL Item
Normal (1)
(Comment:en)
CL Item
Heterozygous (2)
C0019425 (UMLS CUI-1)
(Comment:en)
(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])
C1336663 (UMLS CUI [1,2])
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])
C0031437 (UMLS CUI [1,2])
C1336737 (UMLS CUI [1,3])
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])
C0870883 (UMLS CUI [1,2])
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])
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])
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])
C0870883 (UMLS CUI [1,2])
Range
Item
Outside quantifiable range
boolean
C1514721 (UMLS CUI [1])
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)
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])
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])
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])
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])
C0041290 (UMLS CUI [1,2])
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])
C3161222 (UMLS CUI [1,2])
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])
C0723012 (UMLS CUI [1,2])
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])
C0723012 (UMLS CUI [1,2])
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])
C0242485 (UMLS CUI [1,2])
C0723012 (UMLS CUI [1,3])
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])
C0723012 (UMLS CUI [1,2])
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])
C0723012 (UMLS CUI [1,2])
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])
C0003241 (UMLS CUI [1,2])
C0723012 (UMLS CUI [1,3])