Item
Is the patient suffering from or has he/she ever suffered from any significant medical or surgical condition?
text
C0543467 (UMLS CUI [1])
C0012634 (UMLS CUI [2])
Code List
Is the patient suffering from or has he/she ever suffered from any significant medical or surgical condition?
Diagnosis
Item
Diagnosis
text
C0011900 (UMLS CUI [1])
Year of first diagnosis
Item
Year of first diagnosis (if known)
integer
C0011900 (UMLS CUI [1,1])
C0439234 (UMLS CUI [1,2])
Item
Past or Ongoing
integer
C0549178 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C1444637 (UMLS CUI [2,1])
C0012634 (UMLS CUI [2,2])
Code List
Past or Ongoing
CL Item
Past + Ongoing (3)
Item
Has the patient taken any medication (excluding any pharmacotherapy medication for treatment of RLS) in the 3 months prior to study entry?
text
C2826257 (UMLS CUI [1])
C2347852 (UMLS CUI [2])
Code List
Has the patient taken any medication (excluding any pharmacotherapy medication for treatment of RLS) in the 3 months prior to study entry?
Drug Name
Item
Drug Name (Trade Name Preferred)
text
C0013227 (UMLS CUI [1,1])
C2360065 (UMLS CUI [1,2])
Total Daily Dose
Item
Total Daily Dose (eg 500mg)
integer
C2348070 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Medical Illness/Diagnosis
Item
Medical Illness/Diagnosis (or symptom in absence of diagnosis)
text
C0011900 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C3146298 (UMLS CUI [1,3])
Start Date
Item
Start Date (be as precise as possible)
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
End Date
Item
End Date (or if Continuing mark box)
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Continuing medication
Item
If continuing mark box:
boolean
C0013227 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Item
Has the patient taken any pharmacotherapy medication for treatment of RLS?
text
C0013216 (UMLS CUI [1,1])
C0035258 (UMLS CUI [1,2])
Code List
Has the patient taken any pharmacotherapy medication for treatment of RLS?
Drug Name
Item
Drug Name (Trade Name Preferred)
text
C0013227 (UMLS CUI [1,1])
C2360065 (UMLS CUI [1,2])
Start Date
Item
Start Date (be as precise as possible)
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
End Date
Item
End Date (or if Continuing mark box)
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Continuing medication
Item
If continuing mark box:
boolean
C0013227 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Item
Did the patient respond to the treatment? (mark one)
integer
C0521982 (UMLS CUI [1])
Code List
Did the patient respond to the treatment? (mark one)
Item
Did the patient tolerate the treatment? (mark one)
integer
C0087111 (UMLS CUI [1,1])
C0680282 (UMLS CUI [1,2])
Code List
Did the patient tolerate the treatment? (mark one)