ID
34509
Description
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:
Keywords
Versions (1)
- 1/18/19 1/18/19 -
Copyright Holder
A. Schareina, Dr. C. Lind-Weiland
Uploaded on
January 18, 2019
DOI
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License
Creative Commons BY-NC 3.0
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Allergy Medical History
Allergy Medical History (Allergieanamnese)
- StudyEvent: ODM
Description
Current complaints
Alias
- UMLS CUI-1
- C0871764
- UMLS CUI-2
- C0521116
Description
Please select each symptom with each corresponding temporal occurence.
Data type
integer
Alias
- UMLS CUI [1]
- C1457887
Description
Please select each symptom with each corresponding temporal occurence.
Data type
integer
Alias
- UMLS CUI [1,1]
- C2745955
- UMLS CUI [1,2]
- C0040223
Description
Medical History
Alias
- UMLS CUI-1
- C0262926
Description
Do the complaints occur in the morning?
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C2745955
- UMLS CUI [1,3]
- C0332170
Description
Do the complaints occur during daytime?
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C2745955
- UMLS CUI [1,3]
- C0332169
Description
Do the complaints occur at night?
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C2745955
- UMLS CUI [1,3]
- C0240526
Description
If YES, specify below.
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0442808
- UMLS CUI [1,3]
- C0014406
Description
Specify, in which places complaints are increasing
Data type
text
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0442808
- UMLS CUI [1,3]
- C0014406
- UMLS CUI [1,4]
- C1521902
Description
If YES, specify below.
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0332158
- UMLS CUI [1,3]
- C0003062
Description
Specify: in contact with which animals do complaints occur?
Data type
text
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0332158
- UMLS CUI [1,3]
- C0003062
- UMLS CUI [1,4]
- C1521902
Description
If YES, specify below.
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0020517
- UMLS CUI [1,2]
- C0016452
Description
Specify, which food intolerances have been observed or known.
Data type
text
Alias
- UMLS CUI [1,1]
- C0020517
- UMLS CUI [1,2]
- C0016452
- UMLS CUI [1,3]
- C1521902
Description
If YES, specify below.
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0026606
- UMLS CUI [2]
- C0038039
- UMLS CUI [3]
- C0563970
Description
Specify, during which activity complaints arise.
Data type
text
Alias
- UMLS CUI [1,1]
- C0871764
- UMLS CUI [1,2]
- C0026606
- UMLS CUI [1,3]
- C1521902
Description
If YES, specify below.
Data type
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
Description
Specify reaction to insect bites
Data type
text
Alias
- UMLS CUI [1,1]
- C0021564
- UMLS CUI [1,2]
- C0871764
- UMLS CUI [1,3]
- C1521902
Description
Regular contact with hay
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C1440666
Description
Regular contact with flour
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0016260
Description
Regular contact with dust
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0013330
Description
Regular contact with cosmetics
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0010164
Description
Regular contact with drugs
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0332158
- UMLS CUI [1,2]
- C0013227
Description
Old-building flat/house or new building flat/house
Data type
integer
Alias
- UMLS CUI [1,1]
- C0457933
- UMLS CUI [1,2]
- C0580836
- UMLS CUI [2,1]
- C0457933
- UMLS CUI [2,2]
- C0205314
Description
Hyposensitization
Data type
boolean
Alias
- UMLS CUI [1]
- C0178702
Description
Specify the allergy to which the hyposensitization occurred and when it took place
Data type
text
Alias
- UMLS CUI [1]
- C0178702
- UMLS CUI [2,1]
- C0178702
- UMLS CUI [2,2]
- C0011008
Description
Drugs, including analgesics
Data type
text
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0002771
- UMLS CUI [1,3]
- C0205272
Description
If YES, specify number of cigarettes per day below.
Data type
boolean
Alias
- UMLS CUI [1]
- C0543414
Description
Smoking number of cigarettes per day
Data type
integer
Alias
- UMLS CUI [1,1]
- C0543414
- UMLS CUI [1,2]
- C3694146
Description
Regularly sports
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0679823
- UMLS CUI [1,2]
- C0038039
- UMLS CUI [1,3]
- C0449581
Description
Information about findings
Alias
- UMLS CUI-1
- C1880174
Description
Information about findings per e-mail or SMS
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1955348
- UMLS CUI [1,2]
- C0243095
- UMLS CUI [1,3]
- C0013849
- UMLS CUI [1,4]
- C3178909
Description
Date
Data type
date
Alias
- UMLS CUI [1]
- C0011008
Description
Town
Data type
text
Alias
- UMLS CUI [1]
- C1555315
Description
Signature of patient
Data type
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])