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Targeted Medical History and Baseline Conditions Screening

1 forms  
TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)
Description

TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)

Alias
UMLS CUI-1
C0262926
Subject Number:
Description

Subject Number

Data type

text

Alias
UMLS CUI [1]
C2348585
Subject Initials:
Description

Subject Initials

Data type

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Visit Date:
Description

Visit Date

Data type

date

Alias
UMLS CUI [1]
C1320303
Diagnosis
Description

Diagnosis

Data type

integer

Alias
UMLS CUI [1]
C0011900
Glaucoma
Description

Glaucoma

Data type

text

Alias
UMLS CUI [1]
C0017601
Dry AMD
Description

Dry AMD

Data type

text

Alias
UMLS CUI [1]
C3888461
Wet AMD
Description

Wet AMD

Data type

text

Alias
UMLS CUI [1]
C3888896
No Known History
Description

Medical history

Data type

boolean

Alias
UMLS CUI [1]
C0262926
Condition Currently Active?
Description

Medical condition ongoing

Data type

boolean

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0549178
Onset Date / Procedure Date
Description

Onset Date

Data type

date

Alias
UMLS CUI [1]
C0574845
Date Unknown
Description

Date unknown

Data type

boolean

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0439673
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Similar models

Targeted Medical History and Baseline Conditions Screening

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)
C0262926 (UMLS CUI-1)
Subject Number
Item
Subject Number:
text
C2348585 (UMLS CUI [1])
Subject Initials
Item
Subject Initials:
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Visit Date
Item
Visit Date:
date
C1320303 (UMLS CUI [1])
Item
Diagnosis
integer
C0011900 (UMLS CUI [1])
Organ system code
Code List
Diagnosis
CL Item
Glaucoma (1)
C0017601 (UMLS CUI-1)
(Comment:en)
CL Item
Dry AMD (2)
C3888461 (UMLS CUI-1)
(Comment:en)
CL Item
Wet AMD (3)
C3888896 (UMLS CUI-1)
(Comment:en)
CL Item
Hypertension (4)
C0020538 (UMLS CUI-1)
(Comment:en)
CL Item
Angina (5)
C0002962 (UMLS CUI-1)
(Comment:en)
CL Item
Myocardial Infarction (6)
C0027051 (UMLS CUI-1)
(Comment:en)
CL Item
Congestive Heart Failure (7)
C0018802 (UMLS CUI-1)
(Comment:en)
CL Item
Transient Ischemic Attack (8)
C0007787 (UMLS CUI-1)
(Comment:en)
CL Item
Cerebral Vascular Accident (Stroke)  (9)
C0553692 (UMLS CUI-1)
(Comment:en)
CL Item
Diabetes Mellitus (10)
C0011849 (UMLS CUI-1)
(Comment:en)
CL Item
Prior Non-Ocular Hemorrhage (11)
C0019080 (UMLS CUI-1)
(Comment:en)
CL Item
Deep Venous Thrombosis (12)
C0149871 (UMLS CUI-1)
(Comment:en)
CL Item
Endarterectomy (13)
C0014098 (UMLS CUI-1)
(Comment:en)
CL Item
Renal Failure (14)
C0035078 (UMLS CUI-1)
(Comment:en)
CL Item
Coronary Artery Bypass Surgery (15)
C0010055 (UMLS CUI-1)
(Comment:en)
CL Item
Coronary Stents (16)
C0687568 (UMLS CUI-1)
(Comment:en)
CL Item
Coronary Artery Disease (CAD) (17)
C1956346 (UMLS CUI-1)
(Comment:en)
CL Item
Nose Bleeds (18)
C0014591 (UMLS CUI-1)
(Comment:en)
CL Item
Arrhythmia (19)
C0003811 (UMLS CUI-1)
(Comment:en)
CL Item
Diverticular Disease (20)
C4317009 (UMLS CUI-1)
(Comment:en)
CL Item
Proteinuria (21)
C0033687 (UMLS CUI-1)
(Comment:en)
CL Item
Rheumatoid Arthritis (22)
C0003873 (UMLS CUI-1)
(Comment:en)
CL Item
Dermatitis (23)
C0011603 (UMLS CUI-1)
(Comment:en)
Item
Glaucoma
text
C0017601 (UMLS CUI [1])
Open Angle Glaucoma
Code List
Glaucoma
CL Item
OD (OD)
C0229089 (UMLS CUI-1)
(Comment:en)
CL Item
OS (OS)
C0229090 (UMLS CUI-1)
(Comment:en)
CL Item
OU (OU)
C0229118 (UMLS CUI-1)
(Comment:en)
Item
Dry AMD
text
C3888461 (UMLS CUI [1])
Open Angle Glaucoma
Code List
Dry AMD
CL Item
OD (OD)
C0229089 (UMLS CUI-1)
(Comment:en)
CL Item
OS (OS)
C0229090 (UMLS CUI-1)
(Comment:en)
CL Item
OU (OU)
C0229118 (UMLS CUI-1)
(Comment:en)
Item
Wet AMD
text
C3888896 (UMLS CUI [1])
Open Angle Glaucoma
Code List
Wet AMD
CL Item
OD (OD)
C0229089 (UMLS CUI-1)
(Comment:en)
CL Item
OS (OS)
C0229090 (UMLS CUI-1)
(Comment:en)
CL Item
OU (OU)
C0229118 (UMLS CUI-1)
(Comment:en)
Medical history
Item
No Known History
boolean
C0262926 (UMLS CUI [1])
Medical condition ongoing
Item
Condition Currently Active?
boolean
C0012634 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Onset Date
Item
Onset Date / Procedure Date
date
C0574845 (UMLS CUI [1])
Date unknown
Item
Date Unknown
boolean
C0011008 (UMLS CUI [1,1])
C0439673 (UMLS CUI [1,2])
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