ID
34509
Beschrijving
This form is used for routine documentation. It originates from a medical practice for internal medicine in Cologne-Lindenthal (medical practice Astrid Schareina and Dr. Christina Lind-Weiland, Lindenthalgürtel 36, 50935 Cologne). Published with permission by A. Schareina and Dr. C. Lind-Weiland. Explanation for patients: Your symptoms (or those of your child) may be allergic, i.e. they may be due to certain substances in your environment (or that of your child). To find the allergy triggers, please answer the following questions. Ihre Beschwerden (oder die Ihres Kindes) können allergischen Ursprungs sein, d. h. sie können auf bestimmte Stoffe in Ihrer Umgebung (oder der Ihres Kindes) zurückzuführen sein. Um die Allergieauslöser zu finden, beantworten Sie bitte folgende Fragen:
Trefwoorden
Versies (1)
- 18-01-19 18-01-19 -
Houder van rechten
A. Schareina, Dr. C. Lind-Weiland
Geüploaded op
18 januari 2019
DOI
Voor een aanvraag inloggen.
Licentie
Creative Commons BY-NC 3.0
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Allergy Medical History
Allergy Medical History (Allergieanamnese)
- StudyEvent: ODM
Beschrijving
Current complaints
Alias
- UMLS CUI-1
- C0871764
- UMLS CUI-2
- C0521116
Beschrijving
Please select each symptom with each corresponding temporal occurence.
Datatype
integer
Alias
- UMLS CUI [1]
- C1457887
Beschrijving
Please select each symptom with each corresponding temporal occurence.
Datatype
integer
Alias
- UMLS CUI [1,1]
- C2745955
- UMLS CUI [1,2]
- C0040223
Beschrijving
Medical History
Alias
- UMLS CUI-1
- C0262926
Beschrijving
Do the complaints occur in the morning?
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C2745955
- UMLS CUI [1,3]
- C0332170
Beschrijving
Do the complaints occur during daytime?
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C2745955
- UMLS CUI [1,3]
- C0332169
Beschrijving
Do the complaints occur at night?
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C2745955
- UMLS CUI [1,3]
- C0240526
Beschrijving
If YES, specify below.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0442808
- UMLS CUI [1,3]
- C0014406
Beschrijving
Specify, in which places complaints are increasing
Datatype
text
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0442808
- UMLS CUI [1,3]
- C0014406
- UMLS CUI [1,4]
- C1521902
Beschrijving
If YES, specify below.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0332158
- UMLS CUI [1,3]
- C0003062
Beschrijving
Specify: in contact with which animals do complaints occur?
Datatype
text
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0332158
- UMLS CUI [1,3]
- C0003062
- UMLS CUI [1,4]
- C1521902
Beschrijving
If YES, specify below.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0020517
- UMLS CUI [1,2]
- C0016452
Beschrijving
Specify, which food intolerances have been observed or known.
Datatype
text
Alias
- UMLS CUI [1,1]
- C0020517
- UMLS CUI [1,2]
- C0016452
- UMLS CUI [1,3]
- C1521902
Beschrijving
If YES, specify below.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0026606
- UMLS CUI [2]
- C0038039
- UMLS CUI [3]
- C0563970
Beschrijving
Specify, during which activity complaints arise.
Datatype
text
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0026606
- UMLS CUI [1,3]
- C1521902
Beschrijving
If YES, specify below.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0021564
- UMLS CUI [1,2]
- C0038999
- UMLS CUI [2,1]
- C0021564
- UMLS CUI [2,2]
- C0332575
- UMLS CUI [3,1]
- C0021564
- UMLS CUI [3,2]
- C0033774
- UMLS CUI [3,3]
- C0205322
Beschrijving
Specify reaction to insect bites
Datatype
text
Alias
- UMLS CUI [1,1]
- C0021564
- UMLS CUI [1,2]
- C0871764
- UMLS CUI [1,3]
- C1521902
Beschrijving
Regular contact with hay
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C1440666
Beschrijving
Regular contact with flour
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0016260
Beschrijving
Regular contact with dust
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0013330
Beschrijving
Regular contact with cosmetics
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0010164
Beschrijving
Regular contact with drugs
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0013227
Beschrijving
Old-building flat/house or new building flat/house
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0457933
- UMLS CUI [1,2]
- C0580836
- UMLS CUI [2,1]
- C0457933
- UMLS CUI [2,2]
- C0205314
Beschrijving
Hyposensitization
Datatype
boolean
Alias
- UMLS CUI [1]
- C0178702
Beschrijving
Specify the allergy to which the hyposensitization occurred and when it took place
Datatype
text
Alias
- UMLS CUI [1]
- C0178702
- UMLS CUI [2,1]
- C0178702
- UMLS CUI [2,2]
- C0011008
Beschrijving
Drugs, including analgesics
Datatype
text
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0002771
- UMLS CUI [1,3]
- C0205272
Beschrijving
If YES, specify number of cigarettes per day below.
Datatype
boolean
Alias
- UMLS CUI [1]
- C0543414
Beschrijving
Smoking number of cigarettes per day
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0543414
- UMLS CUI [1,2]
- C3694146
Beschrijving
Regularly sports
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0679823
- UMLS CUI [1,2]
- C0038039
- UMLS CUI [1,3]
- C0449581
Beschrijving
Information about findings
Alias
- UMLS CUI-1
- C1880174
Beschrijving
Information about findings per e-mail or SMS
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C1955348
- UMLS CUI [1,2]
- C0243095
- UMLS CUI [1,3]
- C0013849
- UMLS CUI [1,4]
- C3178909
Beschrijving
Date
Datatype
date
Alias
- UMLS CUI [1]
- C0011008
Beschrijving
Town
Datatype
text
Alias
- UMLS CUI [1]
- C1555315
Beschrijving
Signature of patient
Datatype
text
Alias
- UMLS CUI [1]
- C1519316
Similar models
Allergy Medical History (Allergieanamnese)
- StudyEvent: ODM
C0027365 (UMLS CUI [1,2])
C1442065 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,2])
C0332170 (UMLS CUI [1,3])
C2745955 (UMLS CUI [1,2])
C0332169 (UMLS CUI [1,3])
C2745955 (UMLS CUI [1,2])
C0240526 (UMLS CUI [1,3])
C0442808 (UMLS CUI [1,2])
C0014406 (UMLS CUI [1,3])
C0442808 (UMLS CUI [1,2])
C0014406 (UMLS CUI [1,3])
C1521902 (UMLS CUI [1,4])
C0332158 (UMLS CUI [1,2])
C0003062 (UMLS CUI [1,3])
C0332158 (UMLS CUI [1,2])
C0003062 (UMLS CUI [1,3])
C1521902 (UMLS CUI [1,4])
C0016452 (UMLS CUI [1,2])
C0016452 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
C0026606 (UMLS CUI [1,2])
C0038039 (UMLS CUI [2])
C0563970 (UMLS CUI [3])
C0026606 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
C0038999 (UMLS CUI [1,2])
C0021564 (UMLS CUI [2,1])
C0332575 (UMLS CUI [2,2])
C0021564 (UMLS CUI [3,1])
C0033774 (UMLS CUI [3,2])
C0205322 (UMLS CUI [3,3])
C0871764 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
C1440666 (UMLS CUI [1,2])
C0016260 (UMLS CUI [1,2])
C0013330 (UMLS CUI [1,2])
C0010164 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C0580836 (UMLS CUI [1,2])
C0457933 (UMLS CUI [2,1])
C0205314 (UMLS CUI [2,2])
C0178702 (UMLS CUI [2,1])
C0011008 (UMLS CUI [2,2])
C0002771 (UMLS CUI [1,2])
C0205272 (UMLS CUI [1,3])
C3694146 (UMLS CUI [1,2])
C0038039 (UMLS CUI [1,2])
C0449581 (UMLS CUI [1,3])
C0243095 (UMLS CUI [1,2])
C0013849 (UMLS CUI [1,3])
C3178909 (UMLS CUI [1,4])