English

Medical History

1 forms  
  1. StudyEvent: ODM
    1. Medical History
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Site #
Description

Study centre number

Data type

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Patient #
Description

patient ID

Data type

integer

Alias
UMLS CUI [1]
C2348585
Visit Date
Description

visit date

Data type

date

Alias
UMLS CUI [1]
C1320303
Investigator Name
Description

Investigator Name

Data type

text

Alias
UMLS CUI [1]
C2826892
Medical / Surgical / Invasive Procedure History
Description

Medical / Surgical / Invasive Procedure History

Alias
UMLS CUI-1
C0262926
UMLS CUI-2
C0455610
None, check box if there are no significant conditions.
Description

No significant medical history

Data type

boolean

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0750502
UMLS CUI [1,3]
C0332197
Ear, nose, and throat
Description

Medical history: Ear, nose, and throat

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0395797
Ear, nose, and throat: If ‘Yes’, specify condition(s)
Description

Medical history: Ear, nose, and throat - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0395797
UMLS CUI [1,3]
C1521902
Eyes
Description

Medical history: Eyes

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0015397
Eyes: If ‘Yes’, specify condition(s)
Description

Medical history: Eyes - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0015397
UMLS CUI [1,3]
C1521902
Respiratory
Description

Medical history: Respiratory

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0035204
Respiratory: If ‘Yes’, specify condition(s)
Description

Medical history: Respiratory - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0035204
UMLS CUI [1,3]
C1521902
Cardiovascular: Congenital Heart Disease
Description

Medical history: Congenital Heart Disease

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0152021
Cardiovascular: Congenital Heart Disease: If ‘Yes’, specify condition(s)
Description

Medical history: Congenital Heart Disease - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0152021
UMLS CUI [1,3]
C1521902
Cardiovascular: Cardial Arrhythmia
Description

Medical history: Cardiac Arrhythmia

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0003811
Cardiovascular: Cardiac Arrhythmia: If ‘Yes’, specify condition(s)
Description

Medical history: Cardiac Arrhythmia

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0003811
UMLS CUI [1,3]
C1521902
Cardiovascular: Hypertension
Description

Medical history: Hypertension

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0020538
Cardiovascular: Hypertension: If ‘Yes’, specify condition(s)
Description

Medical history: Hypertension - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0020538
UMLS CUI [1,3]
C1521902
Cardiovascular: Other
Description

Medical histroy: Other cardiovascular diseases

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0007222
UMLS CUI [1,3]
C0205394
Cardiovascular: Other: If ‘Yes’, specify condition(s)
Description

Medical histroy: Other cardiovascular diseases - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0007222
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C1521902
Cardiovascular: Other
Description

Medical histroy: Other cardiovascular diseases

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0007222
UMLS CUI [1,3]
C0205394
Cardiovascular: Other: If ‘Yes’, specify condition(s)
Description

Medical histroy: Other cardiovascular diseases - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0007222
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C1521902
Gastrointestinal
Description

Medical history: Gastrointestinal

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0017178
Gastrointestinal: If ‘Yes’, specify condition(s)
Description

Medical history: Gastrointestinal - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0017178
UMLS CUI [1,3]
C1521902
Hepatobiliary and pancreas
Description

Medical history: Hepatobiliary and pancreas

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0267792
UMLS CUI [2,1]
C0262926
UMLS CUI [2,2]
C0030286
Hepatobiliary and pancreas: If ‘Yes’, specify condition(s)
Description

Medical history: Hepatobiliary and pancreas - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0267792
UMLS CUI [1,3]
C1521902
UMLS CUI [2,1]
C0262926
UMLS CUI [2,2]
C0030286
UMLS CUI [2,3]
C1521902
Urinary system
Description

Medical history: Urinary system

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0042075
Urinary system: If ‘Yes’, specify condition(s)
Description

Medical history: Urinary system - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0042075
UMLS CUI [1,3]
C1521902
Reproductive system
Description

Medical history: Reproductive system

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0178829
Reproductive system: If ‘Yes’, specify condition(s)
Description

Medical history: Reproductive system - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0178829
UMLS CUI [1,3]
C1521902
Neurologic
Description

Medical history: Neurologic

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0027765
Neurologic: If ‘Yes’, specify condition(s)
Description

Medical history: Neurologic - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0027765
UMLS CUI [1,3]
C1521902
Blood and lymphatic
Description

Medical history: Blood and lymphatic

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0851353
Blood and lymphatic: If ‘Yes’, specify condition(s)
Description

Medical history: Blood and lymphatic - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0851353
UMLS CUI [1,3]
C1521902
Endocrine and metabolic: Diabetes/Glucose Intolerance
Description

Medical history: Diabetes/Glucose Intolerance

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0271650
UMLS CUI [2,1]
C0262926
UMLS CUI [2,2]
C0011849
Endocrine and metabolic: Diabetes/Glucose Intolerance - If ‘Yes’, specify condition(s)
Description

Medical history: Diabetes/Glucose Intolerance - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0271650
UMLS CUI [1,3]
C1521902
UMLS CUI [2,1]
C0262926
UMLS CUI [2,2]
C0011849
UMLS CUI [2,3]
C1521902
Endocrine and metabolic: Other
Description

Medical history: Other endocrine diseases

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0014130
UMLS CUI [1,3]
C0205394
Endocrine and metabolic: Other: If ‘Yes’, specify condition(s)
Description

Medical history: Other endocrine diseases - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0014130
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C1521902
Musculoskeletal
Description

Medical history: Musculoskeletal

Data type

text

Alias
UMLS CUI [1,1]
C0026857
UMLS CUI [1,2]
C0262926
Musculoskeletal: If ‘Yes’, specify condition(s)
Description

Medical history: Musculoskeletal - specify

Data type

text

Alias
UMLS CUI [1,1]
C0026857
UMLS CUI [1,2]
C0262926
UMLS CUI [1,3]
C1521902
Skin
Description

Medical history: Skin

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0037274
Skin: If ‘Yes’, specify condition(s)
Description

Medical history: Skin - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0037274
UMLS CUI [1,3]
C1521902
Psychiatric
Description

Medical history: Psychiatric

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0004936
Psychiatric: If ‘Yes’, specify condition(s)
Description

Medical history: Psychiatric - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0004936
UMLS CUI [1,3]
C1521902
Allergies
Description

Medical history: Allergies

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0020517
Allergies: If ‘Yes’, specify condition(s)
Description

Medical history: Allergies - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0020517
UMLS CUI [1,3]
C1521902
Other
Description

Medical history: Other

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0205394
Other: If ‘Yes’, specify condition(s)
Description

Medical history: Other - specify

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C1521902
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Similar models

Medical History

1 forms
  1. StudyEvent: ODM
    1. Medical History
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Study centre number
Item
Site #
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
patient ID
Item
Patient #
integer
C2348585 (UMLS CUI [1])
visit date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Investigator Name
Item
Investigator Name
text
C2826892 (UMLS CUI [1])
Item Group
Medical / Surgical / Invasive Procedure History
C0262926 (UMLS CUI-1)
C0455610 (UMLS CUI-2)
No significant medical history
Item
None, check box if there are no significant conditions.
boolean
C0262926 (UMLS CUI [1,1])
C0750502 (UMLS CUI [1,2])
C0332197 (UMLS CUI [1,3])
Item
Ear, nose, and throat
text
C0262926 (UMLS CUI [1,1])
C0395797 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Ear, nose, and throat
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Ear, nose, and throat - specify
Item
Ear, nose, and throat: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0395797 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Eyes
text
C0262926 (UMLS CUI [1,1])
C0015397 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Eyes
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Eyes - specify
Item
Eyes: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0015397 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Respiratory
text
C0262926 (UMLS CUI [1,1])
C0035204 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Respiratory
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Respiratory - specify
Item
Respiratory: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0035204 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Cardiovascular: Congenital Heart Disease
text
C0262926 (UMLS CUI [1,1])
C0152021 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Cardiovascular: Congenital Heart Disease
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Congenital Heart Disease - specify
Item
Cardiovascular: Congenital Heart Disease: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0152021 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Cardiovascular: Cardial Arrhythmia
text
C0262926 (UMLS CUI [1,1])
C0003811 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Cardiovascular: Cardial Arrhythmia
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Cardiac Arrhythmia
Item
Cardiovascular: Cardiac Arrhythmia: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0003811 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Cardiovascular: Hypertension
text
C0262926 (UMLS CUI [1,1])
C0020538 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Cardiovascular: Hypertension
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Hypertension - specify
Item
Cardiovascular: Hypertension: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0020538 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Cardiovascular: Other
text
C0262926 (UMLS CUI [1,1])
C0007222 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Medical history: Ear, nose, and throat
Code List
Cardiovascular: Other
CL Item
Yes (Yes)
CL Item
No (No)
Medical histroy: Other cardiovascular diseases - specify
Item
Cardiovascular: Other: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0007222 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C1521902 (UMLS CUI [1,4])
Item
Cardiovascular: Other
text
C0262926 (UMLS CUI [1,1])
C0007222 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Medical history: Ear, nose, and throat
Code List
Cardiovascular: Other
CL Item
Yes (Yes)
CL Item
No (No)
Medical histroy: Other cardiovascular diseases - specify
Item
Cardiovascular: Other: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0007222 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C1521902 (UMLS CUI [1,4])
Item
Gastrointestinal
text
C0262926 (UMLS CUI [1,1])
C0017178 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Gastrointestinal
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Gastrointestinal - specify
Item
Gastrointestinal: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0017178 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Hepatobiliary and pancreas
text
C0262926 (UMLS CUI [1,1])
C0267792 (UMLS CUI [1,2])
C0262926 (UMLS CUI [2,1])
C0030286 (UMLS CUI [2,2])
Medical history: Ear, nose, and throat
Code List
Hepatobiliary and pancreas
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Hepatobiliary and pancreas - specify
Item
Hepatobiliary and pancreas: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0267792 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
C0262926 (UMLS CUI [2,1])
C0030286 (UMLS CUI [2,2])
C1521902 (UMLS CUI [2,3])
Item
Urinary system
text
C0262926 (UMLS CUI [1,1])
C0042075 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Urinary system
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Urinary system - specify
Item
Urinary system: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0042075 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Reproductive system
text
C0262926 (UMLS CUI [1,1])
C0178829 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Reproductive system
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Reproductive system - specify
Item
Reproductive system: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0178829 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Neurologic
text
C0262926 (UMLS CUI [1,1])
C0027765 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Neurologic
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Neurologic - specify
Item
Neurologic: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0027765 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Blood and lymphatic
text
C0262926 (UMLS CUI [1,1])
C0851353 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Blood and lymphatic
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Blood and lymphatic - specify
Item
Blood and lymphatic: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0851353 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Endocrine and metabolic: Diabetes/Glucose Intolerance
text
C0262926 (UMLS CUI [1,1])
C0271650 (UMLS CUI [1,2])
C0262926 (UMLS CUI [2,1])
C0011849 (UMLS CUI [2,2])
Medical history: Ear, nose, and throat
Code List
Endocrine and metabolic: Diabetes/Glucose Intolerance
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Diabetes/Glucose Intolerance - specify
Item
Endocrine and metabolic: Diabetes/Glucose Intolerance - If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0271650 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
C0262926 (UMLS CUI [2,1])
C0011849 (UMLS CUI [2,2])
C1521902 (UMLS CUI [2,3])
Item
Endocrine and metabolic: Other
text
C0262926 (UMLS CUI [1,1])
C0014130 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Medical history: Ear, nose, and throat
Code List
Endocrine and metabolic: Other
CL Item
Yes (Yes)
CL Item
No (No)
Item
Endocrine and metabolic: Other: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0014130 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C1521902 (UMLS CUI [1,4])
Medical history: Ear, nose, and throat
Code List
Endocrine and metabolic: Other: If ‘Yes’, specify condition(s)
Item
Musculoskeletal
text
C0026857 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Musculoskeletal
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Musculoskeletal - specify
Item
Musculoskeletal: If ‘Yes’, specify condition(s)
text
C0026857 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Skin
text
C0262926 (UMLS CUI [1,1])
C0037274 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Skin
CL Item
Yes (Yes)
CL Item
No (No)
Item
Skin: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0037274 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Medical history: Ear, nose, and throat
Code List
Skin: If ‘Yes’, specify condition(s)
Item
Psychiatric
text
C0262926 (UMLS CUI [1,1])
C0004936 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Psychiatric
CL Item
Yes (Yes)
CL Item
No (No)
Item
Psychiatric: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0004936 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Medical history: Ear, nose, and throat
Code List
Psychiatric: If ‘Yes’, specify condition(s)
Item
Allergies
text
C0262926 (UMLS CUI [1,1])
C0020517 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Allergies
CL Item
Yes (Yes)
CL Item
No (No)
Item
Allergies: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0020517 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Medical history: Ear, nose, and throat
Code List
Allergies: If ‘Yes’, specify condition(s)
Item
Other
text
C0262926 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Medical history: Ear, nose, and throat
Code List
Other
CL Item
Yes (Yes)
CL Item
No (No)
Medical history: Other - specify
Item
Other: If ‘Yes’, specify condition(s)
text
C0262926 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
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