ID

27935

Beschrijving

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

Trefwoorden

Versies (1)
  1. 06-12-17 06-12-17 -
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Department of Neurology UKM

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6 december 2017

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

Duits Engels

Blood Sample Form Neuroinflammatory Biobank Department of Neurology UKM

1 Formulieren  
Patientendaten
Beschrijving

Patientendaten

Name
Beschrijving

Patient name

Datatype

text

Alias
UMLS CUI [1]
C1299487
Vorname
Beschrijving

First Name

Datatype

text

Alias
UMLS CUI [1]
C1443235
Geburtsdatum
Beschrijving

Date of birth

Datatype

date

Alias
UMLS CUI [1]
C0421451
Geschlecht
Beschrijving

Gender

Datatype

text

Alias
UMLS CUI [1]
C0079399
Durchführende Person
Beschrijving

Durchführende Person

Alias
UMLS CUI-1
C1550483
Name
Beschrijving

Name

Datatype

text

Alias
UMLS CUI [1]
C0027365
Tel.
Beschrijving

telephone number

Datatype

integer

Alias
UMLS CUI [1]
C1515258
Station
Beschrijving

Ward

Datatype

text

Alias
UMLS CUI [1]
C1305702
Blutabnahme
Beschrijving

Blutabnahme

Alias
UMLS CUI-1
C0005834
Datum
Beschrijving

blood sample date

Datatype

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0005834
Uhrzeit
Beschrijving

blood sample time

Datatype

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0005834
Diagnose
Beschrijving

Diagnosis

Datatype

integer

Alias
UMLS CUI [1]
C0011900
Andere Diagnosen:
Beschrijving

Other diagnosis

Datatype

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0011302
Diagnose gesichert?
Beschrijving

reliable diagnosis

Datatype

boolean

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C3858758
wenn ja, seit
Beschrijving

reliable diagnosis date

Datatype

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0011900
UMLS CUI [1,3]
C3858758
AIE Typ
Beschrijving

AIE type

Datatype

text

Alias
UMLS CUI [1]
C4316639
Aktuelle Therapie
Beschrijving

Current Therapy

Datatype

integer

Alias
UMLS CUI [1]
C2827774
Andere Therapie
Beschrijving

Other therapy

Datatype

text

Alias
UMLS CUI [1,1]
C2827774
UMLS CUI [1,2]
C0205394
Therapie naiv?
Beschrijving

Therapy naive

Datatype

text

Alias
UMLS CUI [1]
C0919936
Beginn der aktuellen Therapie
Beschrijving

(Monat/Jahr)

Datatype

date

Alias
UMLS CUI [1,1]
C3173309
UMLS CUI [1,2]
C2827774
Studie
Beschrijving

Studie

Alias
UMLS CUI-1
C0008976
Falls bekannt, bitte die Studie angeben:
Beschrijving

Study Name

Datatype

text

Alias
UMLS CUI [1]
C2348560
Terug naar het begin van de pagina

Similar models

Blood Sample Form Neuroinflammatory Biobank Department of Neurology UKM

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Patientendaten
Patient name
Item
Name
text
C1299487 (UMLS CUI [1])
First Name
Item
Vorname
text
C1443235 (UMLS CUI [1])
Date of birth
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Gender
Item
Geschlecht
text
C0079399 (UMLS CUI [1])
Item Group
Durchführende Person
C1550483 (UMLS CUI-1)
Name
Item
Name
text
C0027365 (UMLS CUI [1])
telephone number
Item
Tel.
integer
C1515258 (UMLS CUI [1])
Ward
Item
Station
text
C1305702 (UMLS CUI [1])
Item Group
Blutabnahme
C0005834 (UMLS CUI-1)
blood sample date
Item
Datum
date
C0011008 (UMLS CUI [1,1])
C0005834 (UMLS CUI [1,2])
blood sample time
Item
Uhrzeit
time
C0040223 (UMLS CUI [1,1])
C0005834 (UMLS CUI [1,2])
Item
Diagnose
integer
C0011900 (UMLS CUI [1])
Diagnosis
Code List
Diagnose
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
Andere Diagnosen:
text
C0205394 (UMLS CUI [1,1])
C0011302 (UMLS CUI [1,2])
reliable diagnosis
Item
Diagnose gesichert?
boolean
C0011900 (UMLS CUI [1,1])
C3858758 (UMLS CUI [1,2])
reliable diagnosis date
Item
wenn ja, seit
date
C0011008 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
C3858758 (UMLS CUI [1,3])
AIE type
Item
AIE Typ
text
C4316639 (UMLS CUI [1])
Item
Aktuelle Therapie
integer
C2827774 (UMLS CUI [1])
Current Therapy
Code List
Aktuelle Therapie
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
Andere Therapie
text
C2827774 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Therapy naive
Item
Therapie naiv?
text
C0919936 (UMLS CUI [1])
Start Date Current Therapy
Item
Beginn der aktuellen Therapie
date
C3173309 (UMLS CUI [1,1])
C2827774 (UMLS CUI [1,2])
Item Group
Studie
C0008976 (UMLS CUI-1)
Study Name
Item
Falls bekannt, bitte die Studie angeben:
text
C2348560 (UMLS CUI [1])
Terug naar het begin van de pagina 

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