ID
34509
Beskrivning
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:
Nyckelord
Versioner (1)
- 2019-01-18 2019-01-18 -
Rättsinnehavare
A. Schareina, Dr. C. Lind-Weiland
Uppladdad den
18 januari 2019
DOI
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Licens
Creative Commons BY-NC 3.0
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Allergy Medical History
Allergy Medical History (Allergieanamnese)
- StudyEvent: ODM
Beskrivning
Current complaints
Alias
- UMLS CUI-1
- C0871764
- UMLS CUI-2
- C0521116
Beskrivning
Please select each symptom with each corresponding temporal occurence.
Datatyp
integer
Alias
- UMLS CUI [1]
- C1457887
Beskrivning
Please select each symptom with each corresponding temporal occurence.
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C2745955
- UMLS CUI [1,2]
- C0040223
Beskrivning
Medical History
Alias
- UMLS CUI-1
- C0262926
Beskrivning
Do the complaints occur in the morning?
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C2745955
- UMLS CUI [1,3]
- C0332170
Beskrivning
Do the complaints occur during daytime?
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C2745955
- UMLS CUI [1,3]
- C0332169
Beskrivning
Do the complaints occur at night?
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C2745955
- UMLS CUI [1,3]
- C0240526
Beskrivning
If YES, specify below.
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0442808
- UMLS CUI [1,3]
- C0014406
Beskrivning
Specify, in which places complaints are increasing
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0442808
- UMLS CUI [1,3]
- C0014406
- UMLS CUI [1,4]
- C1521902
Beskrivning
If YES, specify below.
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0332158
- UMLS CUI [1,3]
- C0003062
Beskrivning
Specify: in contact with which animals do complaints occur?
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0332158
- UMLS CUI [1,3]
- C0003062
- UMLS CUI [1,4]
- C1521902
Beskrivning
If YES, specify below.
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0020517
- UMLS CUI [1,2]
- C0016452
Beskrivning
Specify, which food intolerances have been observed or known.
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0020517
- UMLS CUI [1,2]
- C0016452
- UMLS CUI [1,3]
- C1521902
Beskrivning
If YES, specify below.
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0026606
- UMLS CUI [2]
- C0038039
- UMLS CUI [3]
- C0563970
Beskrivning
Specify, during which activity complaints arise.
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0026606
- UMLS CUI [1,3]
- C1521902
Beskrivning
If YES, specify below.
Datatyp
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
Beskrivning
Specify reaction to insect bites
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0021564
- UMLS CUI [1,2]
- C0871764
- UMLS CUI [1,3]
- C1521902
Beskrivning
Regular contact with hay
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C1440666
Beskrivning
Regular contact with flour
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0016260
Beskrivning
Regular contact with dust
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0013330
Beskrivning
Regular contact with cosmetics
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0010164
Beskrivning
Regular contact with drugs
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0013227
Beskrivning
Old-building flat/house or new building flat/house
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0457933
- UMLS CUI [1,2]
- C0580836
- UMLS CUI [2,1]
- C0457933
- UMLS CUI [2,2]
- C0205314
Beskrivning
Hyposensitization
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0178702
Beskrivning
Specify the allergy to which the hyposensitization occurred and when it took place
Datatyp
text
Alias
- UMLS CUI [1]
- C0178702
- UMLS CUI [2,1]
- C0178702
- UMLS CUI [2,2]
- C0011008
Beskrivning
Drugs, including analgesics
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0002771
- UMLS CUI [1,3]
- C0205272
Beskrivning
If YES, specify number of cigarettes per day below.
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0543414
Beskrivning
Smoking number of cigarettes per day
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0543414
- UMLS CUI [1,2]
- C3694146
Beskrivning
Regularly sports
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C0679823
- UMLS CUI [1,2]
- C0038039
- UMLS CUI [1,3]
- C0449581
Beskrivning
Information about findings
Alias
- UMLS CUI-1
- C1880174
Beskrivning
Information about findings per e-mail or SMS
Datatyp
boolean
Alias
- UMLS CUI [1,1]
- C1955348
- UMLS CUI [1,2]
- C0243095
- UMLS CUI [1,3]
- C0013849
- UMLS CUI [1,4]
- C3178909
Beskrivning
Date
Datatyp
date
Alias
- UMLS CUI [1]
- C0011008
Beskrivning
Town
Datatyp
text
Alias
- UMLS CUI [1]
- C1555315
Beskrivning
Signature of patient
Datatyp
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])