MEDITUEV Occupational health check

Personal data
Beskrivning

Personal data

Name
Beskrivning

Name

Datatyp

text

Alias
UMLS CUI [1]
C0027365
First Name
Beskrivning

First Name

Datatyp

text

Alias
UMLS CUI [1]
C1443235
Date of birth
Beskrivning

Date of birth

Datatyp

date

Alias
UMLS CUI [1]
C0421451
Birth name
Beskrivning

birth name

Datatyp

text

Alias
UMLS CUI [1]
C1549652
Street address (street/number)
Beskrivning

street address

Datatyp

text

Alias
UMLS CUI [1,1]
C1301826
UMLS CUI [1,2]
C0421449
Postal code code/place of residence
Beskrivning

postal code code and place of residence

Datatyp

text

Telephone number
Beskrivning

telephone number

Datatyp

text

Alias
UMLS CUI [1]
C1515258
Sex
Beskrivning

sex

Datatyp

text

Alias
UMLS CUI [1]
C0150831
Date of employment (month/year)
Beskrivning

Date of employment

Datatyp

text

Nationality
Beskrivning

Nationality

Datatyp

text

Alias
UMLS CUI [1]
C0027473
Employer
Beskrivning

Employer

Datatyp

text

Alias
UMLS CUI [1]
C1274022
Health insurance
Beskrivning

Health insurance

Datatyp

text

Alias
UMLS CUI [1]
C0021682
General practitioner
Beskrivning

General practitioner

Datatyp

text

Alias
UMLS CUI [1]
C0017319
Work history
Beskrivning

Work history

1. Profession you were trained in?
Beskrivning

Professional training

Datatyp

text

Alias
UMLS CUI [1]
C2698884
Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Alias
UMLS CUI [1]
C0947611
Former occupations
Beskrivning

Former occupations

2. Please state any former occupations (incl. military service) that you pursued for more than one year.
Beskrivning

Previous occupations

Datatyp

text

Alias
UMLS CUI [1]
C0028811
2. Beginning (year)
Beskrivning

Beginning year

Datatyp

integer

Alias
UMLS CUI [1]
C0439659
2. End (year)
Beskrivning

End year

Datatyp

integer

Alias
UMLS CUI [1]
C0806020
Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C0031831
Current occupation
Beskrivning

Current occupation

3. Which occupation/function are you supposed to take up?
Beskrivning

Current occupation

Datatyp

text

Alias
UMLS CUI [1]
C0421456
3. Since when? (year)
Beskrivning

Beginning year

Datatyp

integer

Alias
UMLS CUI [1]
C0439659
Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Alias
UMLS CUI [1]
C0947611
Working conditions
Beskrivning

Working conditions

4. What is your usual work place (e.g. office, workshop, warehouse, vehicle fleet, forge, foundry)?
Beskrivning

Workplace

Datatyp

text

Alias
UMLS CUI [1]
C0162579
5. Which kind of materials do you work with regularly? (e.g. metal, cement, paint, thinner, gases or other)
Beskrivning

Working material

Datatyp

text

Alias
UMLS CUI [1,1]
C0520510
UMLS CUI [1,2]
C0520510
6. Which work equipment do you use? (e.g. tools, screen, vehicle or other)
Beskrivning

Work equipment

Datatyp

text

Alias
UMLS CUI [1]
C0220824
7. Which means of protection do you use (e.g. protective helmet, ear protection, safety shoes, protective clothing)?
Beskrivning

Protection

Datatyp

text

Alias
UMLS CUI [1]
C0262668
8. Working hours
Beskrivning

Working hours

Datatyp

integer

Alias
UMLS CUI [1]
C2135639
9. Do you do shift work?
Beskrivning

shift work

Datatyp

integer

Alias
UMLS CUI [1]
C1658633
Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Alias
UMLS CUI [1]
C0947611
Working capacity
Beskrivning

Working capacity

10. Have you ever been incapable to work for more than 14 consecutive days within the last 12 months?
Beskrivning

Incapacity to work

Datatyp

boolean

Alias
UMLS CUI [1]
C2984044
11. Do you receive a pension?
Beskrivning

Pension

Datatyp

integer

Alias
UMLS CUI [1]
C0425022
14. Do you have a certificate of disability?
Beskrivning

certificate of disability

Datatyp

integer

Alias
UMLS CUI [1]
C0018576
14. If yes, what is your degree of disability?
Beskrivning

degree of disability

Datatyp

integer

Måttenheter
  • %
Alias
UMLS CUI [1]
C0231170
%
15. Did you change your workplace due to health-related reasons?
Beskrivning

health-related change of workplace

Datatyp

boolean

Alias
UMLS CUI [1]
C0162579
Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Alias
UMLS CUI [1]
C0947611
Medical examinations
Beskrivning

Medical examinations

16. Did you ever undergo an occupational health check?
Beskrivning

Occupational health check

Datatyp

boolean

Alias
UMLS CUI [1]
C2973270
16. If yes, where?
Beskrivning

place of occupational health check

Datatyp

text

Alias
UMLS CUI [1,1]
C2973270
UMLS CUI [1,2]
C2986042
17. Have you been X-rayed in recent years?
Beskrivning

X-ray

Datatyp

boolean

Alias
UMLS CUI [1]
C0043309
17. If yes, which body parts?
Beskrivning

X-ray body part

Datatyp

text

Alias
UMLS CUI [1,1]
C0043309
UMLS CUI [1,2]
C0229962
Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Alias
UMLS CUI [1]
C0947611
18. Which stress factors are/were you exposed to?
Beskrivning

18. Which stress factors are/were you exposed to?

1 Heat
Beskrivning

heat

Datatyp

text

Alias
UMLS CUI [1]
C0018837
2 Cold, wetness, moisture
Beskrivning

cold, wetness, moisture

Datatyp

text

Alias
UMLS CUI [1]
C0009264
UMLS CUI [2]
C1830752
UMLS CUI [3]
C0868994
3 Gas, fumes, dust, smell
Beskrivning

gas, fumes, dust, smell

Datatyp

text

4 Noise [more than 85 dB(A)]
Beskrivning

noise

Datatyp

text

5 Solvent
Beskrivning

solvent

Datatyp

text

6 Cooling lubricant
Beskrivning

cooling lubricant

Datatyp

text

8 Pressure of time
Beskrivning

pressure of time

Datatyp

text

9 Bad posture
Beskrivning

bad posture

Datatyp

text

10 Hard work
Beskrivning

hard work

Datatyp

text

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Work-related sources of irritation
Beskrivning

Work-related sources of irritation

19 Are there factors that irritate you at your workplace?
Beskrivning

source of irritation

Datatyp

text

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Please answer the following questions about your personal living conditions
Beskrivning

Please answer the following questions about your personal living conditions

20. Do you live together with other people?
Beskrivning

living with other people

Datatyp

integer

21. How many children do you have that live with you?
Beskrivning

Number of children

Datatyp

integer

21. Age (years)
Beskrivning

Please state the age of each child.

Datatyp

text

22. Do you smoke?
Beskrivning

Smoking

Datatyp

integer

23. Do you consume alcohol?
Beskrivning

Alcohol consumption

Datatyp

integer

24. Do you do sports?
Beskrivning

sports

Datatyp

integer

25. What do you do to benefit your health?
Beskrivning

actions to benefit health

Datatyp

text

26. Do you go to cancer screenings?
Beskrivning

cancer screening

Datatyp

integer

26. When was the last time?
Beskrivning

year

Datatyp

integer

27.Have you ever undergone a treatment at a health resort?
Beskrivning

Treatment at a health resort

Datatyp

integer

27. When was the last time?
Beskrivning

year

Datatyp

integer

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Are/were there any diseases in your family?
Beskrivning

Are/were there any diseases in your family?

Diabetes
Beskrivning

Diabetes

Datatyp

boolean

Hypertension
Beskrivning

Hypertension

Datatyp

boolean

Stroke
Beskrivning

Stroke

Datatyp

boolean

Alias
UMLS CUI [1]
C0038454
Myocardial infarction
Beskrivning

Myocardial infarction

Datatyp

boolean

Allergies/Hypersensitivity to substances, food, etc.
Beskrivning

Allergies

Datatyp

boolean

Respiratory diseases
Beskrivning

Respiratory diseases

Datatyp

boolean

Gout
Beskrivning

Gout

Datatyp

boolean

Deformities
Beskrivning

Deformities

Datatyp

boolean

Cancer
Beskrivning

cancer

Datatyp

boolean

Other diseases
Beskrivning

Other disease

Datatyp

boolean

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Please answer the following questions about your diseases and health problems
Beskrivning

Please answer the following questions about your diseases and health problems

1 Do you suffer from headaches frequently?
Beskrivning

heachaches

Datatyp

boolean

2 Do you suffer from lack of appetite?
Beskrivning

Lack of appetite

Datatyp

boolean

3 Do you suffer from increased thirst?
Beskrivning

thirst

Datatyp

boolean

4 Do you have sleep disturbances?
Beskrivning

sleep disturbances

Datatyp

boolean

4 If yes, do you have difficulties falling asleep?
Beskrivning

difficulty falling asleep

Datatyp

boolean

4 If yes, do you wake during the night?
Beskrivning

waking during the night

Datatyp

boolean

5 Do you have irregular bowel movements?
Beskrivning

irregular bowel movements

Datatyp

boolean

6 Do you wear glasses/contact lenses?
Beskrivning

glasses/contact lenses

Datatyp

boolean

7 Do you have an eye complaint?
Beskrivning

Eye complaint

Datatyp

boolean

8 Is your hearing impaired?
Beskrivning

impaired hearing

Datatyp

boolean

9 Do you have ear problems?
Beskrivning

Ear problems

Datatyp

boolean

12 Are you prone to diseases of the frontal sinus and the maxillary sinus of the throat?
Beskrivning

diseases of frontal sinus and maxillary sinus, throat

Datatyp

boolean

13 Do/did you have a common cold multiple times a year?
Beskrivning

common cold

Datatyp

boolean

14 Do you cough frequently (regularly every day)?
Beskrivning

Cough

Datatyp

boolean

15 Are you prone to bronchial asthma/bronchitis?
Beskrivning

bronchial asthma/bronchitis

Datatyp

boolean

17 Did you ever have pneumonia/pleurisy/tuberculosis?
Beskrivning

pneumonia, pleurisy, tuberculosis

Datatyp

boolean

18 Have you ever been diagnosed with hypertension?
Beskrivning

Hypertension

Datatyp

boolean

19 Do you suffer from dyspnea?
Beskrivning

dyspnea

Datatyp

boolean

20 Do you feel a tightness in the chest (chest pain) during physical stress?
Beskrivning

Chest tightness

Datatyp

boolean

21 Did you ever have a myocardial infarction?
Beskrivning

myocardial infarction

Datatyp

boolean

22 Do you have other cardiovascular problems?
Beskrivning

other cardiovascular problems

Datatyp

boolean

23 Are you prone to dizziness/disturbed balance?
Beskrivning

dizziness, disturbed balance

Datatyp

boolean

24 Have you been diagnosed with diabetes?
Beskrivning

Diabetes

Datatyp

boolean

25 Were your blood lipid levels ever found to be elevated?
Beskrivning

elevated blood lipid levels

Datatyp

boolean

26 Were your uric acid levels ever found to be elevated (gout)?
Beskrivning

elevated uric acid levels

Datatyp

boolean

27 Have you ever been diagnosed with a thyroid disease?
Beskrivning

thyroid disease

Datatyp

boolean

28 Do you have gastro-intestinal problems/heartburn?
Beskrivning

gastro-intestinal problems, heartburn

Datatyp

boolean

30 Do you have bilious complaints?
Beskrivning

Bilious complaints

Datatyp

boolean

31 Did you ever have jaundice?
Beskrivning

jaundice

Datatyp

boolean

32 Have you been diagnosed with a liver disease?
Beskrivning

liver disease

Datatyp

boolean

33 Are you prone to uropathies (kidney, bladder)?
Beskrivning

uropathy

Datatyp

boolean

34 Do you have problems when urinating?
Beskrivning

problems when urinating

Datatyp

boolean

35 Do you have hemorrhoids?
Beskrivning

hemorrhoids

Datatyp

boolean

36 Dou you have varices?
Beskrivning

varices

Datatyp

boolean

37 Do you have back pain?
Beskrivning

back pain

Datatyp

boolean

37 If yes, where? - 1 cervical spine/neck
Beskrivning

cervical spine or neck pain

Datatyp

text

37 If yes, where? - 2 thoracic spine
Beskrivning

thoracic spine pain

Datatyp

text

37 If yes, where? - 3 lumbar spine/lower back
Beskrivning

lumbar spine or lower back pain

Datatyp

text

38 Do you suffer from lumbago (sciatica)?
Beskrivning

lumbago

Datatyp

boolean

39 Did you have a herniated disk?
Beskrivning

herniated disk

Datatyp

boolean

40 Do you have pain in any joints or limbs?
Beskrivning

joint pain/limb pain

Datatyp

boolean

41 Do you have a seizure disorder?
Beskrivning

seizure disorder

Datatyp

boolean

42 Do you have a neurological/psychiatric disease?
Beskrivning

neurological/psychiatric disease

Datatyp

boolean

43 Are you prone to dermatoses?
Beskrivning

dermatosis

Datatyp

boolean

44 Do you suffer from allergies?
Beskrivning

Allergies

Datatyp

boolean

45 Do you have hay fever?
Beskrivning

hay fever

Datatyp

boolean

46 Did you have any bone fractures?
Beskrivning

bone fractures

Datatyp

boolean

47 Did you have an accident that led to any permanent damage?
Beskrivning

permanent damage due to accident

Datatyp

boolean

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Surgeries
Beskrivning

Surgeries

48. Did you ever undergo surgery?
Beskrivning

Surgery

Datatyp

boolean

1 Heart
Beskrivning

Heart surgery

Datatyp

boolean

2 Kidney
Beskrivning

Kidney surgery

Datatyp

boolean

3 Gallbladder
Beskrivning

Gallbladder surgery

Datatyp

boolean

4 Hernia
Beskrivning

hernia surgery

Datatyp

boolean

5 Stomach
Beskrivning

stomach surgery

Datatyp

boolean

7 Bone
Beskrivning

bone surgery

Datatyp

boolean

8 Other surgery
Beskrivning

other surgery

Datatyp

boolean

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Dental/medical treatment
Beskrivning

Dental/medical treatment

49. Are you currently under dental/medical treatment?
Beskrivning

dental/medical treatment

Datatyp

boolean

49. If yes, why?
Beskrivning

dental/medical treatment reason

Datatyp

text

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Vaccination
Beskrivning

Vaccination

50. Are you vaccinated against tetanus?
Beskrivning

tetanus vaccination

Datatyp

boolean

50. When?
Beskrivning

year

Datatyp

integer

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Current medication
Beskrivning

Current medication

51. Are you taking any medication of at least one of the following types (mutiple selections possible)?
Beskrivning

Current medication

Datatyp

boolean

1 Medication for headache
Beskrivning

medication for headache

Datatyp

boolean

2 Pain medication
Beskrivning

pain medication

Datatyp

boolean

3 Cardiovascular agents
Beskrivning

Cardiovascular agents

Datatyp

boolean

4 Laxatives
Beskrivning

laxatives

Datatyp

boolean

5 Tranquilizer
Beskrivning

Tranquilizer

Datatyp

boolean

6 Sleeping pills
Beskrivning

sleeping pills

Datatyp

boolean

7 Stomachic
Beskrivning

stomachic

Datatyp

boolean

8 Bronchial medication
Beskrivning

Bronchial medication

Datatyp

boolean

9 Other medication
Beskrivning

other medication

Datatyp

boolean

9 Which other medication?
Beskrivning

other medicaton specification

Datatyp

text

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

Miscellaneous
Beskrivning

Miscellaneous

52. Other complaints
Beskrivning

Other complaints

Datatyp

text

53. Are you pregnant?
Beskrivning

Pregnancy

Datatyp

integer

54. Do you undergo gynecological screenings regularly?
Beskrivning

Gynecological screening

Datatyp

integer

Comments of physician
Beskrivning

Comments of physician

Datatyp

text

General comments
Beskrivning

General comments

Datatyp

text

Similar models

MEDITUEV Occupational health check

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Personal data
Name
Item
Name
text
C0027365 (UMLS CUI [1])
First Name
Item
First Name
text
C1443235 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
birth name
Item
Birth name
text
C1549652 (UMLS CUI [1])
street address
Item
Street address (street/number)
text
C1301826 (UMLS CUI [1,1])
C0421449 (UMLS CUI [1,2])
postal code code and place of residence
Item
Postal code code/place of residence
text
telephone number
Item
Telephone number
text
C1515258 (UMLS CUI [1])
Item
Sex
text
C0150831 (UMLS CUI [1])
Code List
Sex
CL Item
female (female)
(Comment:en)
CL Item
male (male)
(Comment:en)
Date of employment
Item
Date of employment (month/year)
text
Nationality
Item
Nationality
text
C0027473 (UMLS CUI [1])
Employer
Item
Employer
text
C1274022 (UMLS CUI [1])
Health insurance
Item
Health insurance
text
C0021682 (UMLS CUI [1])
General practitioner
Item
General practitioner
text
C0017319 (UMLS CUI [1])
Item Group
Work history
Professional training
Item
1. Profession you were trained in?
text
C2698884 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Former occupations
Previous occupations
Item
2. Please state any former occupations (incl. military service) that you pursued for more than one year.
text
C0028811 (UMLS CUI [1])
Beginning year
Item
2. Beginning (year)
integer
C0439659 (UMLS CUI [1])
End year
Item
2. End (year)
integer
C0806020 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Item Group
Current occupation
Current occupation
Item
3. Which occupation/function are you supposed to take up?
text
C0421456 (UMLS CUI [1])
Beginning year
Item
3. Since when? (year)
integer
C0439659 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Working conditions
Workplace
Item
4. What is your usual work place (e.g. office, workshop, warehouse, vehicle fleet, forge, foundry)?
text
C0162579 (UMLS CUI [1])
Working material
Item
5. Which kind of materials do you work with regularly? (e.g. metal, cement, paint, thinner, gases or other)
text
C0520510 (UMLS CUI [1,1])
C0520510 (UMLS CUI [1,2])
Work equipment
Item
6. Which work equipment do you use? (e.g. tools, screen, vehicle or other)
text
C0220824 (UMLS CUI [1])
Protection
Item
7. Which means of protection do you use (e.g. protective helmet, ear protection, safety shoes, protective clothing)?
text
C0262668 (UMLS CUI [1])
Item
8. Working hours
integer
C2135639 (UMLS CUI [1])
Code List
8. Working hours
CL Item
normal (1)
CL Item
part-time (2)
CL Item
often overtime (3)
CL Item
hours per week (4)
Item
9. Do you do shift work?
integer
C1658633 (UMLS CUI [1])
Code List
9. Do you do shift work?
CL Item
no (1)
C1298908 (UMLS CUI-1)
(Comment:de)
CL Item
early shift and late shift (2)
C0425104 (UMLS CUI-1)
(Comment:de)
CL Item
alternate shift incl. night shift (3)
C1660631 (UMLS CUI-1)
(Comment:de)
CL Item
night shift only (4)
C1660631 (UMLS CUI-1)
(Comment:de)
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Working capacity
Incapacity to work
Item
10. Have you ever been incapable to work for more than 14 consecutive days within the last 12 months?
boolean
C2984044 (UMLS CUI [1])
Item
11. Do you receive a pension?
integer
C0425022 (UMLS CUI [1])
Code List
11. Do you receive a pension?
CL Item
no (1)
CL Item
yes (2)
CL Item
requested (3)
Item
14. Do you have a certificate of disability?
integer
C0018576 (UMLS CUI [1])
Code List
14. Do you have a certificate of disability?
CL Item
no (1)
CL Item
yes (2)
CL Item
requested (3)
degree of disability
Item
14. If yes, what is your degree of disability?
integer
C0231170 (UMLS CUI [1])
health-related change of workplace
Item
15. Did you change your workplace due to health-related reasons?
boolean
C0162579 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Medical examinations
Occupational health check
Item
16. Did you ever undergo an occupational health check?
boolean
C2973270 (UMLS CUI [1])
place of occupational health check
Item
16. If yes, where?
text
C2973270 (UMLS CUI [1,1])
C2986042 (UMLS CUI [1,2])
X-ray
Item
17. Have you been X-rayed in recent years?
boolean
C0043309 (UMLS CUI [1])
X-ray body part
Item
17. If yes, which body parts?
text
C0043309 (UMLS CUI [1,1])
C0229962 (UMLS CUI [1,2])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
18. Which stress factors are/were you exposed to?
Item
1 Heat
text
C0018837 (UMLS CUI [1])
Code List
1 Heat
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
2 Cold, wetness, moisture
text
C0009264 (UMLS CUI [1])
C1830752 (UMLS CUI [2])
C0868994 (UMLS CUI [3])
Code List
2 Cold, wetness, moisture
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
3 Gas, fumes, dust, smell
text
Code List
3 Gas, fumes, dust, smell
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
4 Noise [more than 85 dB(A)]
text
Code List
4 Noise [more than 85 dB(A)]
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
5 Solvent
text
Code List
5 Solvent
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
6 Cooling lubricant
text
Code List
6 Cooling lubricant
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
8 Pressure of time
text
Code List
8 Pressure of time
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
9 Bad posture
text
Code List
9 Bad posture
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
10 Hard work
text
Code List
10 Hard work
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Comments of physician
Item
Comments of physician
text
Item Group
Work-related sources of irritation
source of irritation
Item
19 Are there factors that irritate you at your workplace?
text
Comments of physician
Item
text
Item Group
Please answer the following questions about your personal living conditions
Item
20. Do you live together with other people?
integer
Code List
20. Do you live together with other people?
CL Item
living in a familiy/community (1)
CL Item
living alone (2)
CL Item
Answer refused (3)
Number of children
Item
21. How many children do you have that live with you?
integer
Age of children
Item
21. Age (years)
text
Item
22. Do you smoke?
integer
Code List
22. Do you smoke?
CL Item
no (1)
CL Item
yes (2)
CL Item
not anymore (3)
Item
23. Do you consume alcohol?
integer
Code List
23. Do you consume alcohol?
CL Item
no (1)
CL Item
yes (2)
CL Item
sometimes (3)
CL Item
daily (4)
Item
24. Do you do sports?
integer
Code List
24. Do you do sports?
CL Item
no (1)
CL Item
regularly (2)
CL Item
irregularly (3)
actions to benefit health
Item
25. What do you do to benefit your health?
text
Item
26. Do you go to cancer screenings?
integer
Code List
26. Do you go to cancer screenings?
CL Item
no (1)
CL Item
yes (2)
latest cancer screening
Item
26. When was the last time?
integer
Item
27.Have you ever undergone a treatment at a health resort?
integer
Code List
27.Have you ever undergone a treatment at a health resort?
CL Item
no (1)
CL Item
yes (2)
latest treatment at a health resort
Item
27. When was the last time?
integer
Comments of physician
Item
Comments of physician
text
Item Group
Are/were there any diseases in your family?
Diabetes
Item
Diabetes
boolean
Hypertension
Item
Hypertension
boolean
Stroke
Item
Stroke
boolean
C0038454 (UMLS CUI [1])
Myocardial infarction
Item
Myocardial infarction
boolean
Allergies
Item
Allergies/Hypersensitivity to substances, food, etc.
boolean
Respiratory diseases
Item
Respiratory diseases
boolean
Gout
Item
Gout
boolean
Deformities
Item
Deformities
boolean
cancer
Item
Cancer
boolean
Other disease
Item
Other diseases
boolean
Comments of physician
Item
Comments of physician
text
Item Group
Please answer the following questions about your diseases and health problems
heachaches
Item
1 Do you suffer from headaches frequently?
boolean
Lack of appetite
Item
2 Do you suffer from lack of appetite?
boolean
thirst
Item
3 Do you suffer from increased thirst?
boolean
sleep disturbances
Item
4 Do you have sleep disturbances?
boolean
difficulty falling asleep
Item
4 If yes, do you have difficulties falling asleep?
boolean
waking during the night
Item
4 If yes, do you wake during the night?
boolean
irregular bowel movements
Item
5 Do you have irregular bowel movements?
boolean
glasses/contact lenses
Item
6 Do you wear glasses/contact lenses?
boolean
Eye complaint
Item
7 Do you have an eye complaint?
boolean
impaired hearing
Item
8 Is your hearing impaired?
boolean
Ear problems
Item
9 Do you have ear problems?
boolean
diseases of frontal sinus and maxillary sinus, throat
Item
12 Are you prone to diseases of the frontal sinus and the maxillary sinus of the throat?
boolean
common cold
Item
13 Do/did you have a common cold multiple times a year?
boolean
Cough
Item
14 Do you cough frequently (regularly every day)?
boolean
bronchial asthma/bronchitis
Item
15 Are you prone to bronchial asthma/bronchitis?
boolean
pneumonia, pleurisy, tuberculosis
Item
17 Did you ever have pneumonia/pleurisy/tuberculosis?
boolean
Hypertension
Item
18 Have you ever been diagnosed with hypertension?
boolean
dyspnea
Item
19 Do you suffer from dyspnea?
boolean
Chest tightness
Item
20 Do you feel a tightness in the chest (chest pain) during physical stress?
boolean
myocardial infarction
Item
21 Did you ever have a myocardial infarction?
boolean
other cardiovascular problems
Item
22 Do you have other cardiovascular problems?
boolean
dizziness, disturbed balance
Item
23 Are you prone to dizziness/disturbed balance?
boolean
Diabetes
Item
24 Have you been diagnosed with diabetes?
boolean
elevated blood lipid levels
Item
25 Were your blood lipid levels ever found to be elevated?
boolean
elevated uric acid levels
Item
26 Were your uric acid levels ever found to be elevated (gout)?
boolean
thyroid disease
Item
27 Have you ever been diagnosed with a thyroid disease?
boolean
gastro-intestinal problems, heartburn
Item
28 Do you have gastro-intestinal problems/heartburn?
boolean
Bilious complaints
Item
30 Do you have bilious complaints?
boolean
jaundice
Item
31 Did you ever have jaundice?
boolean
liver disease
Item
32 Have you been diagnosed with a liver disease?
boolean
uropathy
Item
33 Are you prone to uropathies (kidney, bladder)?
boolean
problems when urinating
Item
34 Do you have problems when urinating?
boolean
hemorrhoids
Item
35 Do you have hemorrhoids?
boolean
varices
Item
36 Dou you have varices?
boolean
back pain
Item
37 Do you have back pain?
boolean
Item
37 If yes, where? - 1 cervical spine/neck
text
Code List
37 If yes, where? - 1 cervical spine/neck
CL Item
sometimes  (sometimes)
CL Item
frequently  (frequently)
CL Item
daily  (daily)
Item
37 If yes, where? - 2 thoracic spine
text
Code List
37 If yes, where? - 2 thoracic spine
CL Item
sometimes  (sometimes)
CL Item
frequently  (frequently)
CL Item
daily  (daily)
Item
37 If yes, where? - 3 lumbar spine/lower back
text
Code List
37 If yes, where? - 3 lumbar spine/lower back
CL Item
sometimes  (sometimes)
CL Item
frequently  (frequently)
CL Item
daily  (daily)
lumbago
Item
38 Do you suffer from lumbago (sciatica)?
boolean
herniated disk
Item
39 Did you have a herniated disk?
boolean
joint pain/limb pain
Item
40 Do you have pain in any joints or limbs?
boolean
seizure disorder
Item
41 Do you have a seizure disorder?
boolean
neurological/psychiatric disease
Item
42 Do you have a neurological/psychiatric disease?
boolean
dermatosis
Item
43 Are you prone to dermatoses?
boolean
Allergies
Item
44 Do you suffer from allergies?
boolean
hay fever
Item
45 Do you have hay fever?
boolean
bone fractures
Item
46 Did you have any bone fractures?
boolean
permanent damage due to accident
Item
47 Did you have an accident that led to any permanent damage?
boolean
Comments of physician
Item
Comments of physician
text
Item Group
Surgeries
Surgery
Item
48. Did you ever undergo surgery?
boolean
Heart surgery
Item
1 Heart
boolean
Kidney surgery
Item
2 Kidney
boolean
Gallbladder surgery
Item
3 Gallbladder
boolean
hernia surgery
Item
4 Hernia
boolean
stomach surgery
Item
5 Stomach
boolean
bone surgery
Item
7 Bone
boolean
other surgery
Item
8 Other surgery
boolean
Comments of physician
Item
Comments of physician
text
Item Group
Dental/medical treatment
dental/medical treatment
Item
49. Are you currently under dental/medical treatment?
boolean
dental/medical treatment reason
Item
49. If yes, why?
text
Comments of physician
Item
Comments of physician
text
Item Group
Vaccination
tetanus vaccination
Item
50. Are you vaccinated against tetanus?
boolean
time of tetanus vaccination
Item
50. When?
integer
Comments of physician
Item
Comments of physician
text
Item Group
Current medication
Current medication
Item
51. Are you taking any medication of at least one of the following types (mutiple selections possible)?
boolean
medication for headache
Item
1 Medication for headache
boolean
pain medication
Item
2 Pain medication
boolean
Cardiovascular agents
Item
3 Cardiovascular agents
boolean
laxatives
Item
4 Laxatives
boolean
Tranquilizer
Item
5 Tranquilizer
boolean
sleeping pills
Item
6 Sleeping pills
boolean
stomachic
Item
7 Stomachic
boolean
Bronchial medication
Item
8 Bronchial medication
boolean
other medication
Item
9 Other medication
boolean
other medicaton specification
Item
9 Which other medication?
text
Comments of physician
Item
Comments of physician
text
Item Group
Miscellaneous
Other complaints
Item
52. Other complaints
text
Item
53. Are you pregnant?
integer
Code List
53. Are you pregnant?
CL Item
yes (1)
CL Item
no (2)
Item
54. Do you undergo gynecological screenings regularly?
integer
Code List
54. Do you undergo gynecological screenings regularly?
CL Item
yes (1)
CL Item
no (2)
Comments of physician
Item
Comments of physician
text
General comments
Item
General comments
text