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Concomitant Medications Form

1 formularios  
Concomitant Medication Details
Descripción

Concomitant Medication Details

Alias
UMLS CUI-1
C2347852
UMLS CUI-2
C1522508
Sequence Number
Descripción

Sequence Number

Tipo de datos

text

Alias
UMLS CUI [1]
C2348184
Drug Name
Descripción

Trade Name Preferred

Tipo de datos

text

Alias
UMLS CUI [1]
C2360065
Unit Dose
Descripción

Unit Dose

Tipo de datos

integer

Alias
UMLS CUI [1]
C0869039
Units
Descripción

Units

Tipo de datos

text

Alias
UMLS CUI [1]
C1519795
Medication Frequency
Descripción

Frequency

Tipo de datos

text

Alias
UMLS CUI [1]
C3476109
Medication Route
Descripción

Route

Tipo de datos

text

Alias
UMLS CUI [1]
C0013153
Reason for Medication
Descripción

Reason for Medication

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0013227
Generic dispensed?
Descripción

Generic dispensed?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C3242750
UMLS CUI [1,2]
C0947323
Prescription or OTC?
Descripción

Prescription or OTC?

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0033080
UMLS CUI [2]
C0013231
Medication Start Date
Descripción

Start Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0808070
Medication Taken prior to study?
Descripción

Taken prior to study?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2603343
UMLS CUI [1,3]
C0332152
Medication Ongoing?
Descripción

Ongoing?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0549178
If NO, record the End Date
Descripción

If NO, record the End Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Device Used to Administer Medication
Descripción

Device Used to Administer Medication

Tipo de datos

text

Alias
UMLS CUI [1]
C0699733
UMLS CUI [2]
C0013227
Total Daily Dose
Descripción

Total Daily Dose

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2348070
UMLS CUI [1,2]
C0439810
Was drug administered for an exacerbation?
Descripción

Was drug administered for an exacerbation?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0806914
UMLS CUI [1,2]
C0349790
Was drug administered as a rescue medication?
Descripción

Was drug administered as a rescue medication?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0884980
Cumulative Dose Used?
Descripción

Cumulative Dose Used?

Tipo de datos

text

Alias
UMLS CUI [1]
C2986497
Was drug ever used?
Descripción

Was drug ever used?

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0242510
Drug usage Total duration
Descripción

Total duration

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0242510
UMLS CUI [1,2]
C0449238
Duration Unit
Descripción

Duration Unit

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0449238
UMLS CUI [1,2]
C1519795
Medication Type
Descripción

Medication Type

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0332307
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Similar models

Concomitant Medications Form

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Concomitant Medication Details
C2347852 (UMLS CUI-1)
C1522508 (UMLS CUI-2)
Sequence Number
Item
Sequence Number
text
C2348184 (UMLS CUI [1])
Drug Name
Item
Drug Name
text
C2360065 (UMLS CUI [1])
Unit Dose
Item
Unit Dose
integer
C0869039 (UMLS CUI [1])
Units
Item
Units
text
C1519795 (UMLS CUI [1])
Frequency
Item
Medication Frequency
text
C3476109 (UMLS CUI [1])
Route
Item
Medication Route
text
C0013153 (UMLS CUI [1])
Reason for Medication
Item
Reason for Medication
text
C0392360 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Generic dispensed?
Item
Generic dispensed?
boolean
C3242750 (UMLS CUI [1,1])
C0947323 (UMLS CUI [1,2])
Item
Prescription or OTC?
text
C0013227 (UMLS CUI [1,1])
C0033080 (UMLS CUI [1,2])
C0013231 (UMLS CUI [2])
Prescription of OTC?
Code List
Prescription or OTC?
CL Item
Prescription (1)
CL Item
OTC (2)
Start Date
Item
Medication Start Date
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Taken prior to study?
Item
Medication Taken prior to study?
boolean
C0013227 (UMLS CUI [1,1])
C2603343 (UMLS CUI [1,2])
C0332152 (UMLS CUI [1,3])
Ongoing?
Item
Medication Ongoing?
boolean
C0013227 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
If NO, record the End Date
Item
If NO, record the End Date
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Device Used to Administer Medication
Item
Device Used to Administer Medication
text
C0699733 (UMLS CUI [1])
C0013227 (UMLS CUI [2])
Total Daily Dose
Item
Total Daily Dose
text
C2348070 (UMLS CUI [1,1])
C0439810 (UMLS CUI [1,2])
Was drug administered for an exacerbation?
Item
Was drug administered for an exacerbation?
boolean
C0806914 (UMLS CUI [1,1])
C0349790 (UMLS CUI [1,2])
Was drug administered as a rescue medication?
Item
Was drug administered as a rescue medication?
boolean
C0013227 (UMLS CUI [1,1])
C0884980 (UMLS CUI [1,2])
Cumulative Dose Used?
Item
Cumulative Dose Used?
text
C2986497 (UMLS CUI [1])
Was drug ever used?
Item
Was drug ever used?
boolean
C0242510 (UMLS CUI [1])
Total duration
Item
Drug usage Total duration
text
C0242510 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Item
Duration Unit
text
C0449238 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Duration Unit
Code List
Duration Unit
CL Item
Days (1)
CL Item
Months (2)
CL Item
Weeks (3)
CL Item
Years (4)
Item
Medication Type
text
C0013227 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Medication Type
Code List
Medication Type
CL Item
Non-Asthma (1)
CL Item
Asthma (2)
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