English

Screening; Significant medical/surgical history and physical examination

1 forms  
Administrative Documentation
Description

Administrative Documentation

Alias
UMLS CUI-1
C1320722
Subject Number
Description

Subject Number

Data type

text

Alias
UMLS CUI [1]
C2348585
Visit Date
Description

Visit Date

Data type

date

Alias
UMLS CUI [1]
C1320303
Significant medical/surgical history and physical examination
Description

Significant medical/surgical history and physical examination

Alias
UMLS CUI-1
C0262926
UMLS CUI-2
C0031809
Is the subject suffering from or has he/she ever suffered from any significant medical or surgical condition? List below one diagnosis per line. (Please print clearly) Only in the absence of a diagnosis, record the signs and symptoms on separate lines.
Description

Medical History

Data type

boolean

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0750502
Significant medical/surgical history and physical examination
Description

Significant medical/surgical history and physical examination

Alias
UMLS CUI-1
C0262926
UMLS CUI-2
C0031809
Diagnosis
Description

Diagnosis

Data type

text

Alias
UMLS CUI [1]
C0011900
GSK Use
Description

GSK Use

Data type

text

Year of first diagnosis
Description

Year of first diagnosis

Data type

partialDate

Alias
UMLS CUI [1,1]
C0439234
UMLS CUI [1,2]
C0011900
Past
Description

Past disease

Data type

boolean

Alias
UMLS CUI [1,1]
C1444637
UMLS CUI [1,2]
C0012634
Ongoing
Description

Ongoing Disease

Data type

boolean

Alias
UMLS CUI [1,1]
C0549178
UMLS CUI [1,2]
C0012634
For GSK
Description

GSK Use

Data type

text

Semi-Supine Vital Signs
Description

Semi-Supine Vital Signs

Alias
UMLS CUI-1
C0518766
Study Time
Description

Study Time

Data type

text

Alias
UMLS CUI [1,1]
C2348563
UMLS CUI [1,2]
C0040223
Date
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Actual Time
Description

Time

Data type

time

Measurement units
  • 24hr:min
Alias
UMLS CUI [1]
C0040223
24hr:min
Standing BP (mmHg) Systolic
Description

Systolic Blood Pressure

Data type

text

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Standing BP (mmHg) Diastolic
Description

Diastolic Blood Pressure

Data type

text

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
12-Lead ECG Monitoring
Description

12-Lead ECG Monitoring

Alias
UMLS CUI-1
C0430456
Study Time
Description

Study Time

Data type

text

Alias
UMLS CUI [1,1]
C2348563
UMLS CUI [1,2]
C0040223
Date
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Actual Time
Description

Time

Data type

time

Measurement units
  • 24hr:min
Alias
UMLS CUI [1]
C0040223
24hr:min
Heart Rate (bpm)
Description

Heart Rate

Data type

text

Measurement units
  • bpm
Alias
UMLS CUI [1]
C0018810
bpm
PR
Description

PR

Data type

text

Measurement units
  • msec
Alias
UMLS CUI [1]
C0429087
msec
QRS
Description

QRS

Data type

text

Measurement units
  • msec
Alias
UMLS CUI [1]
C1880451
msec
QT
Description

QT

Data type

text

Measurement units
  • msec
Alias
UMLS CUI [1]
C1287082
msec
QTc
Description

QTc

Data type

text

Measurement units
  • msec
Alias
UMLS CUI [1]
C0489625
msec
ECG normal
Description

ECG normal

Data type

boolean

Alias
UMLS CUI [1]
C0522054
Comments
Description

Comments

Data type

text

Alias
UMLS CUI [1]
C0947611
12-Lead Continous Electrocardiographic Monitoring
Description

12-Lead Continous Electrocardiographic Monitoring

Alias
UMLS CUI-1
C0430456
UMLS CUI-2
C4055630
Monitoring Start date
Description

Start Date

Data type

date

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C4055630
Monitoring Start Time
Description

Start time

Data type

time

Measurement units
  • 24hr:min
Alias
UMLS CUI [1,1]
C1301880
UMLS CUI [1,2]
C4055630
24hr:min
Monitoring Stop Date
Description

Stop Date

Data type

date

Alias
UMLS CUI [1,1]
C0806020
UMLS CUI [1,2]
C4055630
Monitoring Stop Time
Description

Stop Time

Data type

time

Measurement units
  • 24hr:min
Alias
UMLS CUI [1,1]
C1522314
UMLS CUI [1,2]
C4055630
24hr:min
Rhythms of Concern
Description

Rhythms of Concern

Data type

boolean

Alias
UMLS CUI [1,1]
C0420200
UMLS CUI [1,2]
C0871269
UMLS CUI [1,3]
C2699424
Describe Rhythm
Description

Rhythm of Concern Description

Data type

text

Alias
UMLS CUI [1,1]
C0420200
UMLS CUI [1,2]
C0871269
UMLS CUI [1,3]
C2699424
UMLS CUI [1,4]
C0678257
Back to the top of the page

Similar models

Screening; Significant medical/surgical history and physical examination

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Documentation
C1320722 (UMLS CUI-1)
Subject Number
Item
Subject Number
text
C2348585 (UMLS CUI [1])
Visit Date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Item Group
Significant medical/surgical history and physical examination
C0262926 (UMLS CUI-1)
C0031809 (UMLS CUI-2)
Medical History
Item
Is the subject suffering from or has he/she ever suffered from any significant medical or surgical condition? List below one diagnosis per line. (Please print clearly) Only in the absence of a diagnosis, record the signs and symptoms on separate lines.
boolean
C0262926 (UMLS CUI [1,1])
C0750502 (UMLS CUI [1,2])
Item Group
Significant medical/surgical history and physical examination
C0262926 (UMLS CUI-1)
C0031809 (UMLS CUI-2)
Diagnosis
Item
Diagnosis
text
C0011900 (UMLS CUI [1])
GSK Use
Item
GSK Use
text
Year of first diagnosis
Item
Year of first diagnosis
partialDate
C0439234 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
Past disease
Item
Past
boolean
C1444637 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
Ongoing Disease
Item
Ongoing
boolean
C0549178 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
GSK Use
Item
For GSK
text
Item Group
Semi-Supine Vital Signs
C0518766 (UMLS CUI-1)
Item
Study Time
text
C2348563 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Study Time
Code List
Study Time
CL Item
Screening (Screening)
CL Item
Unscheduled (Unscheduled)
CL Item
Unscheduled (Unscheduled)
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Time
Item
Actual Time
time
C0040223 (UMLS CUI [1])
Systolic Blood Pressure
Item
Standing BP (mmHg) Systolic
text
C0871470 (UMLS CUI [1])
Diastolic Blood Pressure
Item
Standing BP (mmHg) Diastolic
text
C0428883 (UMLS CUI [1])
Item Group
12-Lead ECG Monitoring
C0430456 (UMLS CUI-1)
Item
Study Time
text
C2348563 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Study Time
Code List
Study Time
CL Item
Screening (Screening)
CL Item
Unsched (Unsched)
CL Item
Unsched (Unsched)
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Time
Item
Actual Time
time
C0040223 (UMLS CUI [1])
Heart Rate
Item
Heart Rate (bpm)
text
C0018810 (UMLS CUI [1])
PR
Item
PR
text
C0429087 (UMLS CUI [1])
QRS
Item
QRS
text
C1880451 (UMLS CUI [1])
QT
Item
QT
text
C1287082 (UMLS CUI [1])
QTc
Item
QTc
text
C0489625 (UMLS CUI [1])
ECG normal
Item
ECG normal
boolean
C0522054 (UMLS CUI [1])
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
Item Group
12-Lead Continous Electrocardiographic Monitoring
C0430456 (UMLS CUI-1)
C4055630 (UMLS CUI-2)
Start Date
Item
Monitoring Start date
date
C0808070 (UMLS CUI [1,1])
C4055630 (UMLS CUI [1,2])
Start time
Item
Monitoring Start Time
time
C1301880 (UMLS CUI [1,1])
C4055630 (UMLS CUI [1,2])
Stop Date
Item
Monitoring Stop Date
date
C0806020 (UMLS CUI [1,1])
C4055630 (UMLS CUI [1,2])
Stop Time
Item
Monitoring Stop Time
time
C1522314 (UMLS CUI [1,1])
C4055630 (UMLS CUI [1,2])
Rhythms of Concern
Item
Rhythms of Concern
boolean
C0420200 (UMLS CUI [1,1])
C0871269 (UMLS CUI [1,2])
C2699424 (UMLS CUI [1,3])
Rhythm of Concern Description
Item
Describe Rhythm
text
C0420200 (UMLS CUI [1,1])
C0871269 (UMLS CUI [1,2])
C2699424 (UMLS CUI [1,3])
C0678257 (UMLS CUI [1,4])
Back to the top of the page