ID

30420

Description

Form used for the documentation of Medical History for the Registry of Children's Glaucoma by the Department of Ophthalmology, University Medical Center Mainz. ODM derived from original form Anamnesebogen20161116, v1.0, supplied by Center for Ophthalmological Epidemiology and Health Services Research, University Medical Center Mainz

Keywords

  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

Department of Ophthalmology, University Medical Center Mainz

Uploaded on

June 4, 2018

DOI

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License

Creative Commons BY-NC 3.0

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Registry of Children's Glaucoma, Department of Ophthalmology, University Medical Center Mainz

Medical History Form

  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: Welches Land?
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 suspected diagnosis glaucoma

Data type

date

Alias
UMLS CUI [1,1]
C2316983
UMLS CUI [1,2]
C0017601
UMLS CUI [1,3]
C0332147
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 first visit to ophthalmologist

Data type

date

Alias
UMLS CUI [1,1]
C4019187
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 and Frequency

Data type

text

Alias
UMLS CUI [1,1]
C0015399
UMLS CUI [1,2]
C0566267
UMLS CUI [2,1]
C3476109
UMLS CUI [2,2]
C0015399
Augenseite mit Therapie:
Description

therapy eye

Data type

text

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0015392
Falls Operation: wo wurde sie durchgeführt?
Description

surgery: Where

Data type

text

Alias
UMLS CUI [1,1]
C0543467
UMLS CUI [1,2]
C0018704
Falls Operation: wann wurde sie durchgeführt?
Description

surgery: When

Data type

datetime

Alias
UMLS CUI [1]
C4255413
Falls Operation: welche wurde durchgeführt?
Description

surgery: What

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

Similar models

Medical History Form

  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])
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])
Code List
Herkunftsland:
CL Item
Deutschland (Deutschland)
C0017480 (UMLS CUI-1)
(Comment:de)
CL Item
Ausland (Ausland)
C0454664 (UMLS CUI-1)
C0205394 (UMLS CUI-2)
(Comment:de)
country
Item
Ausland: Welches Land?
text
C0454664 (UMLS CUI [1])
postal code
Item
Postleitzahl des Wohnortes in Deutschland:
integer
C0421454 (UMLS CUI [1])
date of suspected diagnosis glaucoma
Item
Datum der Verdachtsdiagnose Glaukom:
date
C2316983 (UMLS CUI [1,1])
C0017601 (UMLS CUI [1,2])
C0332147 (UMLS CUI [1,3])
Item
Von
text
C0031831 (UMLS CUI [1])
C0442592 (UMLS CUI [2])
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 first visit to ophthalmologist
Item
Datum Erstvorstellung Augenarzt:
date
C4019187 (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])
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])
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 and Frequency
Item
Falls Augentropfen: Wirkstoffart und Häufigkeit:
text
C0015399 (UMLS CUI [1,1])
C0566267 (UMLS CUI [1,2])
C3476109 (UMLS CUI [2,1])
C0015399 (UMLS CUI [2,2])
Item
Augenseite mit Therapie:
text
C0087111 (UMLS CUI [1,1])
C0015392 (UMLS CUI [1,2])
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: Where
Item
Falls Operation: wo wurde sie durchgeführt?
text
C0543467 (UMLS CUI [1,1])
C0018704 (UMLS CUI [1,2])
surgery: When
Item
Falls Operation: wann wurde sie durchgeführt?
datetime
C4255413 (UMLS CUI [1])
surgery: What
Item
Falls Operation: 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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