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General medical history/ physical examination

1 forms  
Administrative data
Description

Administrative data

Alias
UMLS CUI-1
C1320722
Subject Number
Description

Subject Number

Data type

text

Alias
UMLS CUI [1]
C2348585
Workbook Number
Description

Workbook Number

Data type

integer

Alias
UMLS CUI [1]
C2986015
Visit type
Description

When you fill in "Medical History": It just needs to be collected for Visit 1. "Physical examination" has to be filled in for each Visit.

Data type

integer

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C0332307
General Medical History/ Physical Examination
Description

General Medical History/ Physical Examination

Alias
UMLS CUI-1
C0262926
UMLS CUI-2
C0031809
Are you aware of any pre-existing conditions, signs or symptoms present prior to the start of the study?
Description

If you tick yes, please give diagnosis and tick appropriate Past/Current box(es).

Data type

text

Alias
UMLS CUI [1]
C0012634
UMLS CUI [2]
C0037088
MedDRA SYSTEM ORGAN CLASS
Description

MedDRA SYSTEM ORGAN CLASS

Data type

integer

Alias
UMLS CUI [1]
C2347091
General Medical History/ Physical examination, diagnosis
Description

Please report medication(s) as specified in the protocol and fill in the Medication section.

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0011900
UMLS CUI [2,1]
C0031809
UMLS CUI [2,2]
C0011900
Disease, signs and symptoms
Description

Disease, signs and symptoms

Data type

integer

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0449438
UMLS CUI [2,1]
C0037088
UMLS CUI [2,2]
C0449438
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Similar models

General medical history/ physical examination

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Subject Number
Item
Subject Number
text
C2348585 (UMLS CUI [1])
Item
Workbook Number
integer
C2986015 (UMLS CUI [1])
Workbook Number
Code List
Workbook Number
CL Item
WB 1 (1)
CL Item
WB 2 (2)
Item
Visit type
integer
C0545082 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Visit type
Code List
Visit type
CL Item
Visit 1 (1)
CL Item
Visit 2 (2)
CL Item
Visit 3 (3)
CL Item
Visit 4 (4)
Item Group
General Medical History/ Physical Examination
C0262926 (UMLS CUI-1)
C0031809 (UMLS CUI-2)
Item
Are you aware of any pre-existing conditions, signs or symptoms present prior to the start of the study?
text
C0012634 (UMLS CUI [1])
C0037088 (UMLS CUI [2])
Medical condition, signs and symptoms
Code List
Are you aware of any pre-existing conditions, signs or symptoms present prior to the start of the study?
CL Item
Yes (Y)
CL Item
No (N)
Item
MedDRA SYSTEM ORGAN CLASS
integer
C2347091 (UMLS CUI [1])
Physical examination
Code List
MedDRA SYSTEM ORGAN CLASS
CL Item
Skin and subcutaneous tissue (1)
CL Item
Musculoskeletal and connective tissue (2)
CL Item
Cardiac (3)
CL Item
Vascular (4)
CL Item
Respiratory, thoracic and mediastinal (5)
CL Item
Gastrointestinal (6)
CL Item
Hepatobiliary (7)
CL Item
Renal and urinary (8)
CL Item
Nervous system (9)
CL Item
Eye (10)
CL Item
Ear and labyrinth (11)
CL Item
Endocrine (12)
CL Item
Metabolism and nutrition (13)
CL Item
Blood and lymphatic system (14)
CL Item
Immune system (incl allergies, autoimmune disorders) (15)
CL Item
Infections and infestations (16)
CL Item
Neoplasms benign, malignant and unspecified (incl cysts, polyps) (17)
CL Item
Surgical and medical procedures (18)
CL Item
Other (99)
General Medical History/ Physical examination, diagnosis
Item
General Medical History/ Physical examination, diagnosis
text
C0262926 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
C0031809 (UMLS CUI [2,1])
C0011900 (UMLS CUI [2,2])
Item
Disease, signs and symptoms
integer
C0012634 (UMLS CUI [1,1])
C0449438 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2,1])
C0449438 (UMLS CUI [2,2])
Examination status
Code List
Disease, signs and symptoms
CL Item
Past (1)
CL Item
Current (2)
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