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Knochenmark-Diagnostik Tag 15

1 Formulär  
  1. StudyEvent: Akute myeloische Leukämie(AML) AML alle außer FAB M3
    1. Knochenmark-Diagnostik Tag 15
Patient data
Beskrivning

Patient data

Alias
UMLS CUI 2011AB
C2707520
LOINC Version 232
MTHU031990
Pat. No.: -
Beskrivning

Pat. No.

Datatyp

integer

Alias
UMLS CUI 2011AB
C1830427
LOINC Version 232
MTHU021361
Bone marrow examination
Beskrivning

Bone marrow examination

Alias
UMLS CUI 2011AB
C0005957
SNOMEDCT_2012_01_31
167907006
MedDRA 14.1
10005988
Date - Bone marrow examination
Beskrivning

Datum - Knochenmarkuntersuchung

Datatyp

date

Alias
UMLS CUI 2011AB
C0011008
SNOMEDCT_2012_01_31
410671006
LOINC Version 232
MTHU021546
Code-2
Bone marrow examination
UMLS CUI 2011AB
C0005957
SNOMEDCT_2012_01_31
167907006
MedDRA 14.1
10005988
Obligatory materials shipping (bone marrow + blood) for determination of methylation status to:
Beskrivning

Obligater Materialversand

Datatyp

integer

Alias
Code-1
Mandatory
UMLS CUI 2011AB
C1514873
Code-2
Materials
UMLS CUI 2011AB
C0520510
SNOMEDCT_2012_01_31
260769002
LOINC Version 232
MTHU013790
HL7 V3 2006_05
MAT
Code-3
Shipping
UMLS CUI 2011AB
C1524049
Code-4
Bone marrow
UMLS CUI 2011AB
C0005953
SNOMEDCT_2012_01_31
14016003
LOINC Version 232
MTHU016536
Code-5
Blood
UMLS CUI 2011AB
C0005767
SNOMEDCT_2012_01_31
87612001
LOINC Version 232
MTHU029981
HL7 V3 2006_05
Determination
Code-6
C1148554
no shipping because
Beskrivning

kein Versand weil

Datatyp

string

Alias
Code-1
Absent
UMLS CUI 2011AB
C0332197
SNOMEDCT_2012_01_31
2667000
Code-2
Shipping
UMLS CUI 2011AB
C1524049
Code-3
Reason
UMLS CUI 2011AB
C0392360
SNOMEDCT_2012_01_31
410666004
LOINC Version 232
MTHU008862
Code-4
Materials
UMLS CUI 2011AB
C0520510
SNOMEDCT_2012_01_31
260769002
LOINC Version 232
MTHU013790
HL7 V3 2006_05
MAT
Code-5
Shipping
UMLS CUI 2011AB
C1524049
Shipping of an iliac crest biopsy to:
Beskrivning

Versand einer Beckenkammbiopsie

Datatyp

integer

Alias
Code-1
Shipping
UMLS CUI 2011AB
C1524049
Code-2
Iliac crest
UMLS CUI 2011AB
C0223651
SNOMEDCT_2012_01_31
29850006
Code-3
Biopsy
UMLS CUI 2011AB
C0005558
SNOMEDCT_2012_01_31
86273004
MedDRA 14.1
10004720
LOINC Version 232
MTHU028106
no shipping because
Beskrivning

kein Versand weil

Datatyp

string

Alias
Code-1
Absent
UMLS CUI 2011AB
C0332197
SNOMEDCT_2012_01_31
2667000
Code-2
Shipping
UMLS CUI 2011AB
C1524049
Code-3
Reason
UMLS CUI 2011AB
C0392360
SNOMEDCT_2012_01_31
410666004
LOINC Version 232
MTHU008862
Code-4
Iliac crest
UMLS CUI 2011AB
C0223651
SNOMEDCT_2012_01_31
29850006
Code-5
Biopsy
UMLS CUI 2011AB
C0005558
SNOMEDCT_2012_01_31
86273004
MedDRA 14.1
10004720
LOINC Version 232
MTHU028106
Cytology
Beskrivning

Cytology

Alias
UMLS CUI 2011AB
C1305671
MedDRA 14.1
10061804
LOINC Version 232
MTHU000052
Blast percentage
Beskrivning

Blastenanteil

Datatyp

integer

Alias
Code-1
Blasts
UMLS CUI 2011AB
C0368761
SNOMEDCT_2012_01_31
312256009
LOINC Version 232
MTHU005201
Code-2
Percentage
UMLS CUI 2011AB
CL343029
HL7 V3 2006_05
%
If >=5%, please specify [%]
Beskrivning

wenn >=5%, dann bitte angeben [%]

Datatyp

integer

Alias
Code-1
if
UMLS CUI 2011AB
C0750557
Code-2
Not Less Than
UMLS CUI 2011AB
C0439091
SNOMEDCT_2012_01_31
276138003
HL7 V3 2006_05
GE
Code-3
5
UMLS CUI 2011AB
C0205451
SNOMEDCT_2012_01_31
34001005
Code-4
Percent
UMLS CUI 2011AB
C0439165
SNOMEDCT_2012_01_31
118582008
Code-5
Specify
UMLS CUI 2011AB
C1521902
2nd induction therapy planned? [yes (documentation continued on page 13), no (documentation continued on page 17)]
Beskrivning

2nd induction therapy planned?

Datatyp

boolean

Alias
Code-1
2nd
UMLS CUI 2011AB
C0205436
SNOMEDCT_2012_01_31
81170007
Code-2
Induction Chemotherapy
UMLS CUI 2011AB
C3179010
Code-3
Planned
UMLS CUI 2011AB
C1301732
SNOMEDCT_2012_01_31
397943006
Signature
Beskrivning

Signature

Alias
UMLS CUI 2011AB
C1519316
Date:
Beskrivning

Datum

Datatyp

date

Alias
UMLS CUI 2011AB
C0011008
SNOMEDCT_2012_01_31
410671006
LOINC Version 232
MTHU021546
Name/Signature study physician
Beskrivning

Name/Unterschrift Prüfarzt

Datatyp

string

Alias
Code-1
Name
UMLS CUI 2011AB
C0027365
LOINC Version 232
MTHU008539
Code-2
Signature
UMLS CUI 2011AB
C1519316
Code-3
Study
UMLS CUI 2011AB
C0008976
SNOMEDCT_2012_01_31
110465008
Code-4
Physician
UMLS CUI 2011AB
C0031831
SNOMEDCT_2012_01_31
309343006
LOINC Version 232
MTHU010489
HL7 V3 2006_05
PHYS
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Similar models

Knochenmark-Diagnostik Tag 15

1 Formulär
  1. StudyEvent: Akute myeloische Leukämie(AML) AML alle außer FAB M3
    1. Knochenmark-Diagnostik Tag 15
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Patient data
C2707520 (UMLS CUI 2011AB)
MTHU031990 (LOINC Version 232)
Pat. No.
Item
Pat. No.: -
integer
C1830427 (UMLS CUI 2011AB)
MTHU021361 (LOINC Version 232)
Item Group
Bone marrow examination
C0005957 (UMLS CUI 2011AB)
167907006 (SNOMEDCT_2012_01_31)
10005988 (MedDRA 14.1)
Datum - Knochenmarkuntersuchung
Item
Date - Bone marrow examination
date
C0011008 (UMLS CUI 2011AB)
410671006 (SNOMEDCT_2012_01_31)
MTHU021546 (LOINC Version 232)
Bone marrow examination (Code-2)
C0005957 (UMLS CUI 2011AB)
167907006 (SNOMEDCT_2012_01_31)
10005988 (MedDRA 14.1)
Item
Obligatory materials shipping (bone marrow + blood) for determination of methylation status to:
integer
Mandatory (Code-1)
C1514873 (UMLS CUI 2011AB)
Materials (Code-2)
C0520510 (UMLS CUI 2011AB)
260769002 (SNOMEDCT_2012_01_31)
MTHU013790 (LOINC Version 232)
MAT (HL7 V3 2006_05)
Shipping (Code-3)
C1524049 (UMLS CUI 2011AB)
Bone marrow (Code-4)
C0005953 (UMLS CUI 2011AB)
14016003 (SNOMEDCT_2012_01_31)
MTHU016536 (LOINC Version 232)
Blood (Code-5)
C0005767 (UMLS CUI 2011AB)
87612001 (SNOMEDCT_2012_01_31)
MTHU029981 (LOINC Version 232)
Determination (HL7 V3 2006_05)
C1148554 (Code-6)
Obligater Materialversand
Code List
Obligatory materials shipping (bone marrow + blood) for determination of methylation status to:
CL Item
Munster (1)
C0454791 (UMLS CUI 2011AB)
223810004 (SNOMEDCT_2012_01_31)
CL Item
Dresden (2)
no_code (Code-1)
CL Item
Frankfurt (3)
no_code (Code-1)
CL Item
no shipping because (kein Versand weil)
Absent (Code-1)
C0332197 (UMLS CUI 2011AB)
2667000 (SNOMEDCT_2012_01_31)
Shipping (Code-2)
C1524049 (UMLS CUI 2011AB)
Reason (Code-3)
C0392360 (UMLS CUI 2011AB)
410666004 (SNOMEDCT_2012_01_31)
MTHU008862 (LOINC Version 232)
kein Versand weil
Item
no shipping because
string
Absent (Code-1)
C0332197 (UMLS CUI 2011AB)
2667000 (SNOMEDCT_2012_01_31)
Shipping (Code-2)
C1524049 (UMLS CUI 2011AB)
Reason (Code-3)
C0392360 (UMLS CUI 2011AB)
410666004 (SNOMEDCT_2012_01_31)
MTHU008862 (LOINC Version 232)
Materials (Code-4)
C0520510 (UMLS CUI 2011AB)
260769002 (SNOMEDCT_2012_01_31)
MTHU013790 (LOINC Version 232)
MAT (HL7 V3 2006_05)
Shipping (Code-5)
C1524049 (UMLS CUI 2011AB)
Item
Shipping of an iliac crest biopsy to:
integer
Shipping (Code-1)
C1524049 (UMLS CUI 2011AB)
Iliac crest (Code-2)
C0223651 (UMLS CUI 2011AB)
29850006 (SNOMEDCT_2012_01_31)
Biopsy (Code-3)
C0005558 (UMLS CUI 2011AB)
86273004 (SNOMEDCT_2012_01_31)
10004720 (MedDRA 14.1)
MTHU028106 (LOINC Version 232)
Versand einer Beckenkammbiopsie
Code List
Shipping of an iliac crest biopsy to:
CL Item
Munster (1)
C0454791 (UMLS CUI 2011AB)
223810004 (SNOMEDCT_2012_01_31)
CL Item
Dresden (2)
no_code (Code-1)
CL Item
Frankfurt (3)
no_code (Code-1)
CL Item
no shipping because (kein Versand weil)
Absent (Code-1)
C0332197 (UMLS CUI 2011AB)
2667000 (SNOMEDCT_2012_01_31)
Shipping (Code-2)
C1524049 (UMLS CUI 2011AB)
Reason (Code-3)
C0392360 (UMLS CUI 2011AB)
410666004 (SNOMEDCT_2012_01_31)
MTHU008862 (LOINC Version 232)
kein Versand weil
Item
no shipping because
string
Absent (Code-1)
C0332197 (UMLS CUI 2011AB)
2667000 (SNOMEDCT_2012_01_31)
Shipping (Code-2)
C1524049 (UMLS CUI 2011AB)
Reason (Code-3)
C0392360 (UMLS CUI 2011AB)
410666004 (SNOMEDCT_2012_01_31)
MTHU008862 (LOINC Version 232)
Iliac crest (Code-4)
C0223651 (UMLS CUI 2011AB)
29850006 (SNOMEDCT_2012_01_31)
Biopsy (Code-5)
C0005558 (UMLS CUI 2011AB)
86273004 (SNOMEDCT_2012_01_31)
10004720 (MedDRA 14.1)
MTHU028106 (LOINC Version 232)
Item Group
Cytology
C1305671 (UMLS CUI 2011AB)
10061804 (MedDRA 14.1)
MTHU000052 (LOINC Version 232)
Item
Blast percentage
integer
Blasts (Code-1)
C0368761 (UMLS CUI 2011AB)
312256009 (SNOMEDCT_2012_01_31)
MTHU005201 (LOINC Version 232)
Percentage (Code-2)
CL343029 (UMLS CUI 2011AB)
% (HL7 V3 2006_05)
Blastenanteil
Code List
Blast percentage
CL Item
<5% (1)
Less than (Code-1)
C0439092 (UMLS CUI 2011AB)
276139006 (SNOMEDCT_2012_01_31)
LT (HL7 V3 2006_05)
5 (Code-2)
C0205451 (UMLS CUI 2011AB)
34001005 (SNOMEDCT_2012_01_31)
Percent (Code-3)
C0439165 (UMLS CUI 2011AB)
118582008 (SNOMEDCT_2012_01_31)
CL Item
>=5% (2)
Not Less Than (Code-1)
C0439091 (UMLS CUI 2011AB)
276138003 (SNOMEDCT_2012_01_31)
GE (HL7 V3 2006_05)
5 (Code-2)
C0205451 (UMLS CUI 2011AB)
34001005 (SNOMEDCT_2012_01_31)
Percent (Code-3)
C0439165 (UMLS CUI 2011AB)
118582008 (SNOMEDCT_2012_01_31)
CL Item
cannot be assessed (3)
cannot be assessed (Code-1)
C1707258 (UMLS CUI 2011AB)
wenn >=5%, dann bitte angeben [%]
Item
If >=5%, please specify [%]
integer
if (Code-1)
C0750557 (UMLS CUI 2011AB)
Not Less Than (Code-2)
C0439091 (UMLS CUI 2011AB)
276138003 (SNOMEDCT_2012_01_31)
GE (HL7 V3 2006_05)
5 (Code-3)
C0205451 (UMLS CUI 2011AB)
34001005 (SNOMEDCT_2012_01_31)
Percent (Code-4)
C0439165 (UMLS CUI 2011AB)
118582008 (SNOMEDCT_2012_01_31)
Specify (Code-5)
C1521902 (UMLS CUI 2011AB)
2nd induction therapy planned?
Item
2nd induction therapy planned? [yes (documentation continued on page 13), no (documentation continued on page 17)]
boolean
2nd (Code-1)
C0205436 (UMLS CUI 2011AB)
81170007 (SNOMEDCT_2012_01_31)
Induction Chemotherapy (Code-2)
C3179010 (UMLS CUI 2011AB)
Planned (Code-3)
C1301732 (UMLS CUI 2011AB)
397943006 (SNOMEDCT_2012_01_31)
Item Group
Signature
C1519316 (UMLS CUI 2011AB)
Datum
Item
Date:
date
C0011008 (UMLS CUI 2011AB)
410671006 (SNOMEDCT_2012_01_31)
MTHU021546 (LOINC Version 232)
Name/Unterschrift Prüfarzt
Item
Name/Signature study physician
string
Name (Code-1)
C0027365 (UMLS CUI 2011AB)
MTHU008539 (LOINC Version 232)
Signature (Code-2)
C1519316 (UMLS CUI 2011AB)
Study (Code-3)
C0008976 (UMLS CUI 2011AB)
110465008 (SNOMEDCT_2012_01_31)
Physician (Code-4)
C0031831 (UMLS CUI 2011AB)
309343006 (SNOMEDCT_2012_01_31)
MTHU010489 (LOINC Version 232)
PHYS (HL7 V3 2006_05)
Tillbaka till toppen