ID

30275

Description

Items used as routine documentation by Eye Clinic of University Clinic Mainz. ODM derived from original form Anamnesebogen 20161116.

Keywords

Versions (4)
  1. 5/27/18 5/27/18 -
  2. 5/30/18 5/30/18 - Sarah Riepenhausen
  3. 6/4/18 6/4/18 - Sarah Riepenhausen
  4. 6/4/18 6/4/18 - Sarah Riepenhausen
Copyright Holder

Eye Clinic of University Clinic Mainz

Uploaded on

May 27, 2018

DOI

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License

Creative Commons BY-NC 3.0
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Medical History Form Center for Ophthalmological Epidemiology and Health Services Research University Clinic Mainz

German

Medical History Form

1 forms  
  1. StudyEvent: ODM
    1. Medical History Form
Anamnese
Description

Anamnese

Alias
UMLS CUI-1
C0262926
Datum:
Description

date

Data type

date

Alias
UMLS CUI [1]
C0011008
Bogen-ID:
Description

Form ID

Data type

text

Alias
UMLS CUI [1,1]
C4255237
UMLS CUI [1,2]
C0600091
Klinik:
Description

clinic

Data type

text

Alias
UMLS CUI [1]
C0442592
Arzt:
Description

physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Geburtsdatum:
Description

date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Geschlecht:
Description

gender

Data type

text

Alias
UMLS CUI [1]
C0079399
Herkunftsland:
Description

Country of origin

Data type

text

Alias
UMLS CUI [1]
C3262211
Ausland:
Description

country

Data type

text

Alias
UMLS CUI [1]
C0454664
Postleitzahl des Wohnortes in Deutschland:
Description

postal code

Data type

integer

Alias
UMLS CUI [1]
C0421454
Datum der Verdachtsdiagnose Glaukom:
Description

date of diagnosis glaucoma

Data type

date

Alias
UMLS CUI [1,1]
C2316983
UMLS CUI [1,2]
C0017601
Von
Description

physician; clinic

Data type

text

Alias
UMLS CUI [1]
C0031831
UMLS CUI [2]
C0442592
Klinik:
Description

clinic

Data type

text

Alias
UMLS CUI [1]
C0442592
Datum Erstvorstellung Augenarzt:
Description

date of visit ophthalmologist

Data type

date

Alias
UMLS CUI [1,1]
C1320303
UMLS CUI [1,2]
C1704292
Augenseite mit Diagnose Glaukom (Elternangabe):
Description

diagnosis eye

Data type

text

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0015392
Therapie seit Erstdiagnose:
Description

therapy

Data type

text

Alias
UMLS CUI [1]
C0087111
Falls Augentropfen: Wirkstoffart und Häufigkeit:
Description

Eye drops active substance dosage

Data type

text

Alias
UMLS CUI [1,1]
C0015399
UMLS CUI [1,2]
C0566267
UMLS CUI [1,3]
C0178602
Augenseite mit Therapie:
Description

therapy eye

Data type

text

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0015392
Falls Operation: wo, wann und welche wurde durchgeführt:
Description

surgery

Data type

text

Alias
UMLS CUI [1]
C0543467
Andere Erkrankungen des Kindes (nicht nur am Auge):
Description

comorbidity

Data type

boolean

Alias
UMLS CUI [1]
C0009488
Falls ja, welche:
Description

comorbidity

Data type

text

Alias
UMLS CUI [1]
C0009488
Einnahme von Medikamenten (außer Augentropfen):
Description

Medication

Data type

boolean

Alias
UMLS CUI [1]
C0013227
Falls ja, welche:
Description

Medication

Data type

text

Alias
UMLS CUI [1]
C0013227
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Similar models

Medical History Form

1 forms
  1. StudyEvent: ODM
    1. Medical History Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Anamnese
C0262926 (UMLS CUI-1)
date
Item
Datum:
date
C0011008 (UMLS CUI [1])
Form ID
Item
Bogen-ID:
text
C4255237 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
clinic
Item
Klinik:
text
C0442592 (UMLS CUI [1])
physician
Item
Arzt:
text
C0031831 (UMLS CUI [1])
date of birth
Item
Geburtsdatum:
date
C0421451 (UMLS CUI [1])
Item
Geschlecht:
text
C0079399 (UMLS CUI [1])
gender
Code List
Geschlecht:
CL Item
weiblich (weiblich)
C0086287 (UMLS CUI-1)
(Comment:de)
CL Item
männlich (männlich)
C0086582 (UMLS CUI-1)
(Comment:de)
Item
Herkunftsland:
text
C3262211 (UMLS CUI [1])
Country of origin
Code List
Herkunftsland:
CL Item
Deutschland (Deutschland)
CL Item
Ausland (Ausland)
country
Item
Ausland:
text
C0454664 (UMLS CUI [1])
postal code
Item
Postleitzahl des Wohnortes in Deutschland:
integer
C0421454 (UMLS CUI [1])
date of diagnosis glaucoma
Item
Datum der Verdachtsdiagnose Glaukom:
date
C2316983 (UMLS CUI [1,1])
C0017601 (UMLS CUI [1,2])
Item
Von
text
C0031831 (UMLS CUI [1])
C0442592 (UMLS CUI [2])
physician; clinic
Code List
Von
CL Item
Augenarzt (Augenarzt)
C1704292 (UMLS CUI-1)
(Comment:de)
CL Item
Kinderarzt (Kinderarzt)
C0237433 (UMLS CUI-1)
(Comment:de)
CL Item
Klinik (Klinik)
C0442592 (UMLS CUI-1)
(Comment:de)
clinic
Item
Klinik:
text
C0442592 (UMLS CUI [1])
date of visit ophthalmologist
Item
Datum Erstvorstellung Augenarzt:
date
C1320303 (UMLS CUI [1,1])
C1704292 (UMLS CUI [1,2])
Item
Augenseite mit Diagnose Glaukom (Elternangabe):
text
C0011900 (UMLS CUI [1,1])
C0015392 (UMLS CUI [1,2])
eye
Code List
Augenseite mit Diagnose Glaukom (Elternangabe):
CL Item
rechtes Auge (rechtes Auge)
C0229089 (UMLS CUI-1)
(Comment:de)
CL Item
linkes Auge (linkes Auge)
C0229090 (UMLS CUI-1)
(Comment:de)
Item
Therapie seit Erstdiagnose:
text
C0087111 (UMLS CUI [1])
therapy
Code List
Therapie seit Erstdiagnose:
CL Item
mit Augentropfen (mit Augentropfen)
C0015399 (UMLS CUI-1)
(Comment:de)
CL Item
keine (keine)
C0746919 (UMLS CUI-1)
(Comment:de)
CL Item
Operation (inkl. Laser) (Operation (inkl. Laser))
C0543467 (UMLS CUI-1)
C0023089 (UMLS CUI-2)
(Comment:de)
Eye drops active substance dosage
Item
Falls Augentropfen: Wirkstoffart und Häufigkeit:
text
C0015399 (UMLS CUI [1,1])
C0566267 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,3])
Item
Augenseite mit Therapie:
text
C0087111 (UMLS CUI [1,1])
C0015392 (UMLS CUI [1,2])
eye
Code List
Augenseite mit Therapie:
CL Item
rechtes Auge (rechtes Auge)
C0229089 (UMLS CUI-1)
(Comment:de)
CL Item
linkes Auge (linkes Auge)
C0229090 (UMLS CUI-1)
(Comment:de)
surgery
Item
Falls Operation: wo, wann und welche wurde durchgeführt:
text
C0543467 (UMLS CUI [1])
comorbidity
Item
Andere Erkrankungen des Kindes (nicht nur am Auge):
boolean
C0009488 (UMLS CUI [1])
comorbidity
Item
Falls ja, welche:
text
C0009488 (UMLS CUI [1])
Medication
Item
Einnahme von Medikamenten (außer Augentropfen):
boolean
C0013227 (UMLS CUI [1])
Medication
Item
Falls ja, welche:
text
C0013227 (UMLS CUI [1])
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