ID

27662

Description

The occupational health check provides information about possibly unhealthy or hazardous working conditions. In this way it can aid in the improvement of work places, the reduction of risks as well as in the early detection and prevention of work-related health problems. The aim is to ensure employability and occupational health protection. https://www.medituev.de/de/arbeitsmedizin/vorsorge/ TÜV Nord MEDITUEV. Provided by Dr. med. Rudolf Richter.

Link

https://www.medituev.de/de/arbeitsmedizin/vorsorge/

Keywords

  1. 11/25/17 11/25/17 -
  2. 11/27/17 11/27/17 -
Copyright Holder

TÜV Nord MEDITUEV

Uploaded on

November 25, 2017

DOI

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License

Creative Commons BY-NC 3.0

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MEDITUEV Occupational health check

MEDITUEV Occupational health check

Personal data
Description

Personal data

Name
Description

Name

Data type

text

Alias
UMLS CUI [1]
C0027365
First Name
Description

First Name

Data type

text

Alias
UMLS CUI [1]
C1443235
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Birth name
Description

birth name

Data type

text

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

street address

Data type

text

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

postal code code and place of residence

Data type

text

Telephone number
Description

telephone number

Data type

text

Alias
UMLS CUI [1]
C1515258
Sex
Description

sex

Data type

text

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

Date of employment

Data type

text

Nationality
Description

Nationality

Data type

text

Alias
UMLS CUI [1]
C0027473
Employer
Description

Employer

Data type

text

Alias
UMLS CUI [1]
C1274022
Health insurance
Description

Health insurance

Data type

text

Alias
UMLS CUI [1]
C0021682
General practitioner
Description

General practitioner

Data type

text

Alias
UMLS CUI [1]
C0017319
Work history
Description

Work history

1. Profession you were trained in?
Description

Professional training

Data type

text

Alias
UMLS CUI [1]
C2698884
Comments of physician
Description

Comments of physician

Data type

text

Alias
UMLS CUI [1]
C0947611
Former occupations
Description

Former occupations

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

Previous occupations

Data type

text

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

Beginning year

Data type

integer

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

End year

Data type

integer

Alias
UMLS CUI [1]
C0806020
Comments of physician
Description

Comments of physician

Data type

text

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

Current occupation

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

Current occupation

Data type

text

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

Beginning year

Data type

integer

Alias
UMLS CUI [1]
C0439659
Comments of physician
Description

Comments of physician

Data type

text

Alias
UMLS CUI [1]
C0947611
Working conditions
Description

Working conditions

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

Workplace

Data type

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)
Description

Working material

Data type

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)
Description

Work equipment

Data type

text

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

Protection

Data type

text

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

Working hours

Data type

integer

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

shift work

Data type

integer

Alias
UMLS CUI [1]
C1658633
Comments of physician
Description

Comments of physician

Data type

text

Alias
UMLS CUI [1]
C0947611
Working capacity
Description

Working capacity

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

Incapacity to work

Data type

boolean

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

Pension

Data type

integer

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

certificate of disability

Data type

integer

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

degree of disability

Data type

integer

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

health-related change of workplace

Data type

boolean

Alias
UMLS CUI [1]
C0162579
Comments of physician
Description

Comments of physician

Data type

text

Alias
UMLS CUI [1]
C0947611
Medical examinations
Description

Medical examinations

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

Occupational health check

Data type

boolean

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

place of occupational health check

Data type

text

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

X-ray

Data type

boolean

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

X-ray body part

Data type

text

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

Comments of physician

Data type

text

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

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

1 Heat
Description

heat

Data type

text

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

cold, wetness, moisture

Data type

text

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

gas, fumes, dust, smell

Data type

text

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

noise

Data type

text

5 Solvent
Description

solvent

Data type

text

6 Cooling lubricant
Description

cooling lubricant

Data type

text

8 Pressure of time
Description

pressure of time

Data type

text

9 Bad posture
Description

bad posture

Data type

text

10 Hard work
Description

hard work

Data type

text

Comments of physician
Description

Comments of physician

Data type

text

Work-related sources of irritation
Description

Work-related sources of irritation

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

source of irritation

Data type

text

Comments of physician
Description

Comments of physician

Data type

text

Please answer the following questions about your personal living conditions
Description

Please answer the following questions about your personal living conditions

20. Do you live together with other people?
Description

living with other people

Data type

integer

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

Number of children

Data type

integer

21. Age (years)
Description

Please state the age of each child.

Data type

text

22. Do you smoke?
Description

Smoking

Data type

integer

23. Do you consume alcohol?
Description

Alcohol consumption

Data type

integer

24. Do you do sports?
Description

sports

Data type

integer

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

actions to benefit health

Data type

text

26. Do you go to cancer screenings?
Description

cancer screening

Data type

integer

26. When was the last time?
Description

year

Data type

integer

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

Treatment at a health resort

Data type

integer

27. When was the last time?
Description

year

Data type

integer

Comments of physician
Description

Comments of physician

Data type

text

Are/were there any diseases in your family?
Description

Are/were there any diseases in your family?

Diabetes
Description

Diabetes

Data type

boolean

Hypertension
Description

Hypertension

Data type

boolean

Stroke
Description

Stroke

Data type

boolean

Alias
UMLS CUI [1]
C0038454
Myocardial infarction
Description

Myocardial infarction

Data type

boolean

Allergies/Hypersensitivity to substances, food, etc.
Description

Allergies

Data type

boolean

Respiratory diseases
Description

Respiratory diseases

Data type

boolean

Gout
Description

Gout

Data type

boolean

Deformities
Description

Deformities

Data type

boolean

Cancer
Description

cancer

Data type

boolean

Other diseases
Description

Other disease

Data type

boolean

Comments of physician
Description

Comments of physician

Data type

text

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

Please answer the following questions about your diseases and health problems

1 Do you suffer from headaches frequently?
Description

heachaches

Data type

boolean

2 Do you suffer from lack of appetite?
Description

Lack of appetite

Data type

boolean

3 Do you suffer from increased thirst?
Description

thirst

Data type

boolean

4 Do you have sleep disturbances?
Description

sleep disturbances

Data type

boolean

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

difficulty falling asleep

Data type

boolean

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

waking during the night

Data type

boolean

5 Do you have irregular bowel movements?
Description

irregular bowel movements

Data type

boolean

6 Do you wear glasses/contact lenses?
Description

glasses/contact lenses

Data type

boolean

7 Do you have an eye complaint?
Description

Eye complaint

Data type

boolean

8 Is your hearing impaired?
Description

impaired hearing

Data type

boolean

9 Do you have ear problems?
Description

Ear problems

Data type

boolean

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

diseases of frontal sinus and maxillary sinus, throat

Data type

boolean

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

common cold

Data type

boolean

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

Cough

Data type

boolean

15 Are you prone to bronchial asthma/bronchitis?
Description

bronchial asthma/bronchitis

Data type

boolean

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

pneumonia, pleurisy, tuberculosis

Data type

boolean

18 Have you ever been diagnosed with hypertension?
Description

Hypertension

Data type

boolean

19 Do you suffer from dyspnea?
Description

dyspnea

Data type

boolean

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

Chest tightness

Data type

boolean

21 Did you ever have a myocardial infarction?
Description

myocardial infarction

Data type

boolean

22 Do you have other cardiovascular problems?
Description

other cardiovascular problems

Data type

boolean

23 Are you prone to dizziness/disturbed balance?
Description

dizziness, disturbed balance

Data type

boolean

24 Have you been diagnosed with diabetes?
Description

Diabetes

Data type

boolean

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

elevated blood lipid levels

Data type

boolean

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

elevated uric acid levels

Data type

boolean

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

thyroid disease

Data type

boolean

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

gastro-intestinal problems, heartburn

Data type

boolean

30 Do you have bilious complaints?
Description

Bilious complaints

Data type

boolean

31 Did you ever have jaundice?
Description

jaundice

Data type

boolean

32 Have you been diagnosed with a liver disease?
Description

liver disease

Data type

boolean

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

uropathy

Data type

boolean

34 Do you have problems when urinating?
Description

problems when urinating

Data type

boolean

35 Do you have hemorrhoids?
Description

hemorrhoids

Data type

boolean

36 Dou you have varices?
Description

varices

Data type

boolean

37 Do you have back pain?
Description

back pain

Data type

boolean

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

cervical spine or neck pain

Data type

text

37 If yes, where? - 2 thoracic spine
Description

thoracic spine pain

Data type

text

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

lumbar spine or lower back pain

Data type

text

38 Do you suffer from lumbago (sciatica)?
Description

lumbago

Data type

boolean

39 Did you have a herniated disk?
Description

herniated disk

Data type

boolean

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

joint pain/limb pain

Data type

boolean

41 Do you have a seizure disorder?
Description

seizure disorder

Data type

boolean

42 Do you have a neurological/psychiatric disease?
Description

neurological/psychiatric disease

Data type

boolean

43 Are you prone to dermatoses?
Description

dermatosis

Data type

boolean

44 Do you suffer from allergies?
Description

Allergies

Data type

boolean

45 Do you have hay fever?
Description

hay fever

Data type

boolean

46 Did you have any bone fractures?
Description

bone fractures

Data type

boolean

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

permanent damage due to accident

Data type

boolean

Comments of physician
Description

Comments of physician

Data type

text

Surgeries
Description

Surgeries

48. Did you ever undergo surgery?
Description

Surgery

Data type

boolean

1 Heart
Description

Heart surgery

Data type

boolean

2 Kidney
Description

Kidney surgery

Data type

boolean

3 Gallbladder
Description

Gallbladder surgery

Data type

boolean

4 Hernia
Description

hernia surgery

Data type

boolean

5 Stomach
Description

stomach surgery

Data type

boolean

7 Bone
Description

bone surgery

Data type

boolean

8 Other surgery
Description

other surgery

Data type

boolean

Comments of physician
Description

Comments of physician

Data type

text

Dental/medical treatment
Description

Dental/medical treatment

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

dental/medical treatment

Data type

boolean

49. If yes, why?
Description

dental/medical treatment reason

Data type

text

Comments of physician
Description

Comments of physician

Data type

text

Vaccination
Description

Vaccination

50. Are you vaccinated against tetanus?
Description

tetanus vaccination

Data type

boolean

50. When?
Description

year

Data type

integer

Comments of physician
Description

Comments of physician

Data type

text

Current medication
Description

Current medication

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

Current medication

Data type

boolean

1 Medication for headache
Description

medication for headache

Data type

boolean

2 Pain medication
Description

pain medication

Data type

boolean

3 Cardiovascular agents
Description

Cardiovascular agents

Data type

boolean

4 Laxatives
Description

laxatives

Data type

boolean

5 Tranquilizer
Description

Tranquilizer

Data type

boolean

6 Sleeping pills
Description

sleeping pills

Data type

boolean

7 Stomachic
Description

stomachic

Data type

boolean

8 Bronchial medication
Description

Bronchial medication

Data type

boolean

9 Other medication
Description

other medication

Data type

boolean

9 Which other medication?
Description

other medicaton specification

Data type

text

Comments of physician
Description

Comments of physician

Data type

text

Miscellaneous
Description

Miscellaneous

52. Other complaints
Description

Other complaints

Data type

text

53. Are you pregnant?
Description

Pregnancy

Data type

integer

54. Do you undergo gynecological screenings regularly?
Description

Gynecological screening

Data type

integer

Comments of physician
Description

Comments of physician

Data type

text

General comments
Description

General comments

Data type

text

Similar models

MEDITUEV Occupational health check

Name
Type
Description | Question | Decode (Coded Value)
Data type
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

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