ID

27935

Description

Blood Sample Form Department of Neurology UKM (Begleitschein Blutentnahme für die zelluläre Biobank (Neuroinflammation)) Klinik für Allgemeine Neurologie, Liquor und Labordiagnostik, Neurologische Biobank, Albert-Schweitzer-Campus 1, 48149 Münster. Provided by Dr. Antje Echterhoff

Mots-clés

Versions (1)
  1. 12/6/17 12/6/17 -
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Department of Neurology UKM

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December 6, 2017

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Creative Commons BY-NC 3.0
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Blood Sample Form Neuroinflammatory Biobank Department of Neurology UKM

Allemand Anglais

Blood Sample Form Neuroinflammatory Biobank Department of Neurology UKM

1 Formulaires  
Patient administration
Description

Patient administration

Name
Description

Patient name

Type de données

text

Alias
UMLS CUI [1]
C1299487
First Name
Description

First Name

Type de données

text

Alias
UMLS CUI [1]
C1443235
Date of birth
Description

Date of birth

Type de données

date

Alias
UMLS CUI [1]
C0421451
Gender
Description

Gender

Type de données

text

Alias
UMLS CUI [1]
C0079399
Responsible person
Description

Responsible person

Alias
UMLS CUI-1
C1550483
Name
Description

Name

Type de données

text

Alias
UMLS CUI [1]
C0027365
telephone number
Description

telephone number

Type de données

integer

Alias
UMLS CUI [1]
C1515258
Ward
Description

Ward

Type de données

text

Alias
UMLS CUI [1]
C1305702
Blood sampling
Description

Blood sampling

Alias
UMLS CUI-1
C0005834
blood sample date
Description

blood sample date

Type de données

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0005834
blood sample time
Description

blood sample time

Type de données

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0005834
Diagnosis
Description

Diagnosis

Type de données

integer

Alias
UMLS CUI [1]
C0011900
Other diagnosis
Description

Other diagnosis

Type de données

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0011302
reliable diagnosis
Description

reliable diagnosis

Type de données

boolean

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C3858758
reliable diagnosis date
Description

reliable diagnosis date

Type de données

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0011900
UMLS CUI [1,3]
C3858758
AIE type
Description

AIE type

Type de données

text

Alias
UMLS CUI [1]
C4316639
Current Therapy
Description

Current Therapy

Type de données

integer

Alias
UMLS CUI [1]
C2827774
Other therapy
Description

Other therapy

Type de données

text

Alias
UMLS CUI [1,1]
C2827774
UMLS CUI [1,2]
C0205394
Therapy naive
Description

Therapy naive

Type de données

text

Alias
UMLS CUI [1]
C0919936
Start Date Current Therapy
Description

(Month/Year)

Type de données

date

Alias
UMLS CUI [1,1]
C3173309
UMLS CUI [1,2]
C2827774
Study
Description

Study

Alias
UMLS CUI-1
C0008976
If known, please indicate study name
Description

Study Name

Type de données

text

Alias
UMLS CUI [1]
C2348560
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Similar models

Blood Sample Form Neuroinflammatory Biobank Department of Neurology UKM

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Patient administration
Patient name
Item
Name
text
C1299487 (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])
Gender
Item
Gender
text
C0079399 (UMLS CUI [1])
Item Group
Responsible person
C1550483 (UMLS CUI-1)
Name
Item
Name
text
C0027365 (UMLS CUI [1])
telephone number
Item
telephone number
integer
C1515258 (UMLS CUI [1])
Ward
Item
Ward
text
C1305702 (UMLS CUI [1])
Item Group
Blood sampling
C0005834 (UMLS CUI-1)
blood sample date
Item
blood sample date
date
C0011008 (UMLS CUI [1,1])
C0005834 (UMLS CUI [1,2])
blood sample time
Item
blood sample time
time
C0040223 (UMLS CUI [1,1])
C0005834 (UMLS CUI [1,2])
Item
Diagnosis
integer
C0011900 (UMLS CUI [1])
Diagnosis
Code List
Diagnosis
CL Item
AIE Typ: ________________________ (1)
C4316639 (UMLS CUI-1)
(Comment:de)
CL Item
andere (AOD) (2)
C0434543 (UMLS CUI-1)
(Comment:de)
CL Item
CIS (3)
C2921627 (UMLS CUI-1)
(Comment:de)
CL Item
V. a. entzündliche ZNS Erkrankung (4)
C0683396 (UMLS CUI-1)
(Comment:de)
CL Item
NMO (5)
C0027873 (UMLS CUI-1)
(Comment:de)
CL Item
PML (6)
C0023524 (UMLS CUI-1)
(Comment:de)
CL Item
PPMS (7)
C0751964 (UMLS CUI-1)
(Comment:de)
CL Item
RRMS (8)
C0751967 (UMLS CUI-1)
(Comment:de)
CL Item
Susac (9)
C2717757 (UMLS CUI-1)
(Comment:de)
Other diagnosis
Item
Other diagnosis
text
C0205394 (UMLS CUI [1,1])
C0011302 (UMLS CUI [1,2])
reliable diagnosis
Item
reliable diagnosis
boolean
C0011900 (UMLS CUI [1,1])
C3858758 (UMLS CUI [1,2])
reliable diagnosis date
Item
reliable diagnosis date
date
C0011008 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
C3858758 (UMLS CUI [1,3])
AIE type
Item
AIE type
text
C4316639 (UMLS CUI [1])
Item
Current Therapy
integer
C2827774 (UMLS CUI [1])
Current Therapy
Code List
Current Therapy
CL Item
Alemtuzumab / Lemtrada (1)
C0383429 (UMLS CUI-1)
(Comment:de)
CL Item
BG12 (2)
C0058218 (UMLS CUI-1)
(Comment:de)
CL Item
Daclizumab (3)
C0663182 (UMLS CUI-1)
(Comment:de)
CL Item
FTY (4)
C1699926 (UMLS CUI-1)
(Comment:de)
CL Item
Interferon (GA) (5)
C0907160 (UMLS CUI-2)
(Comment:de)
CL Item
Mitoxantron (6)
C0026259 (UMLS CUI-1)
(Comment:de)
CL Item
Natalizumab (7)
C1172734 (UMLS CUI-1)
(Comment:de)
CL Item
Teriflunomid (8)
C1718383 (UMLS CUI-1)
(Comment:de)
CL Item
Rituximab (9)
C0393022 (UMLS CUI-1)
(Comment:de)
Other therapy
Item
Other therapy
text
C2827774 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Therapy naive
Item
Therapy naive
text
C0919936 (UMLS CUI [1])
Start Date Current Therapy
Item
Start Date Current Therapy
date
C3173309 (UMLS CUI [1,1])
C2827774 (UMLS CUI [1,2])
Item Group
Study
C0008976 (UMLS CUI-1)
Study Name
Item
If known, please indicate study name
text
C2348560 (UMLS CUI [1])
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