Sichel-Reg, 1. Meldebogen

1 Formulär

StudyEvent: ODM-Test
1. Sichel-Reg, 1. Meldebogen

Patient data

Beskrivning

Patient data

Alias

UMLS CUI-1: C2707520

Last Name

Beskrivning

Last Name

Datatyp

text

Alias

UMLS CUI-1: C1301584

First Name

Beskrivning

First Name

Datatyp

text

Alias

UMLS CUI-1: C1443235

Birth Date

Beskrivning

Birth Date

Datatyp

date

Alias

UMLS CUI-1: C0421451

Gender

Beskrivning

Gender

Datatyp

integer

Alias

UMLS CUI-1: C0079399

male (1)

female (2)

Reporting date

Beskrivning

Date of report

Datatyp

date

Alias

UMLS CUI-1: C1302584

Registry ID

Beskrivning

Registry ID

Datatyp

text

Alias

UMLS CUI-1: C1549709

Street (patient)

Beskrivning

Street (patient)

Datatyp

text

Alias

UMLS CUI-1: C1301826

UMLS CUI-2: C0421449

ZIP (patient)

Beskrivning

ZIP (patient)

Datatyp

text

Alias

UMLS CUI-1: C0421454

Town (patient)

Beskrivning

Town (patient)

Datatyp

text

Alias

UMLS CUI-1: C1555315

E-mail (patient)

Beskrivning

E-mail (patient)

Datatyp

text

Alias

UMLS CUI-1: C1705961

UMLS CUI-2: C0030705

Telephone (patient)

Beskrivning

Telephone (patient)

Datatyp

text

Alias

UMLS CUI-1: C0421455

Treating Clinic

Beskrivning

Treating Clinic

Alias

UMLS CUI-1: C1522326

UMLS CUI-2: C0442592

Clinic

Beskrivning

Clinic

Datatyp

text

Alias

UMLS CUI-1: C0442592

Contact person

Beskrivning

Contact person

Datatyp

text

Alias

UMLS CUI-1: C0337611

Street (clinic)

Beskrivning

Street (clinic)

Datatyp

text

Alias

UMLS CUI-1: C1301826

UMLS CUI-2: C0442592

ZIP (clinic)

Beskrivning

ZIP (clinic)

Datatyp

text

Alias

UMLS CUI-1: C1521842

UMLS CUI-2: C0442592

Town (Clinic)

Beskrivning

Town (Clinic)

Datatyp

text

Alias

UMLS CUI-1: C1555315

UMLS CUI-2: C0442592

E-mail (clinic)

Beskrivning

E-mail (clinic)

Datatyp

text

Alias

UMLS CUI-1: C1705961

UMLS CUI-2: C0442592

Telephone (clinic)

Beskrivning

Telephone (clinic)

Datatyp

text

Alias

UMLS CUI-1: C0039457

UMLS CUI-2: C0442592

Fax (clinic)

Beskrivning

Fax (clinic)

Datatyp

text

Alias

UMLS CUI-1: C1549619

UMLS CUI-2: C0442592

General practitioner

Beskrivning

General practitioner

Alias

UMLS CUI-1: C0017319

Physicians office

Beskrivning

Physicians office

Datatyp

text

Alias

UMLS CUI-1: C0031834

Contact person

Beskrivning

Contact person

Datatyp

text

Alias

UMLS CUI-1: C0337611

Street (GP)

Beskrivning

Street (GP)

Datatyp

text

Alias

UMLS CUI-1: C1301826

UMLS CUI-2: C0017319

ZIP (GP)

Beskrivning

ZIP (GP)

Datatyp

text

Alias

UMLS CUI-1: C1521842

UMLS CUI-2: C0017319

Town (GP)

Beskrivning

Town (GP)

Datatyp

text

Alias

UMLS CUI-1: C1555315

UMLS CUI-2: C0017319

E-Mail (GP)

Beskrivning

E-Mail (General practitioner)

Datatyp

text

Alias

UMLS CUI-1: C1705961

UMLS CUI-2: C0017319

Telephone (GP)

Beskrivning

Telephone (GP)

Datatyp

text

Alias

UMLS CUI-1: C0039457

UMLS CUI-2: C0017319

Fax (GP)

Beskrivning

Fax (general practitioner)

Datatyp

text

Alias

UMLS CUI-1: C1549619

UMLS CUI-2: C0017319

Patient Characteristics

Beskrivning

Patient Characteristics

Alias

UMLS CUI-1: C0815172

Diagnosis

Beskrivning

Diagnosis (e.g. HbSS, HbSC...)

Datatyp

text

Alias

UMLS CUI-1: C0011900

Country of origin

Beskrivning

Country of origin

Datatyp

text

Alias

UMLS CUI-1: C3262211

Marital status

Beskrivning

Marital status

Datatyp

text

Alias

UMLS CUI-1: C0024819

NEVER MARRIED (1)

MARRIED (2)

DIVORCED (3)

WIDOWED (4)

Professional career

Beskrivning

Professional career

Alias

UMLS CUI-1: C0178534

School type

Beskrivning

Type of school

Datatyp

text

Alias

UMLS CUI-1: C1547791

School graduation

Beskrivning

School graduation

Datatyp

text

Alias

UMLS CUI-1: C0237640

Educational Status

Beskrivning

Educational Status

Datatyp

text

Alias

UMLS CUI-1: C0013658

Current activities

Beskrivning

Current activities

Datatyp

text

Alias

UMLS CUI-1: C0336911

Comments

Beskrivning

Comments

Alias

UMLS CUI-1: C0947611

Comments

Beskrivning

Comments

Datatyp

text

Alias

UMLS CUI-1: C0947611

Signature

Beskrivning

Signature

Alias

UMLS CUI-1: C1519316

Physicians

Beskrivning

Name of physician

Datatyp

text

Alias

UMLS CUI-1: C0031831

UMLS CUI-2: C0027365

Date signed

Beskrivning

Date of signature

Datatyp

text

Alias

UMLS CUI-1: C3262251

Signature

Beskrivning

Signature

Datatyp

text

Alias

UMLS CUI-1: C1519316

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Sichel-Reg, 1. Meldebogen

1 Formulär

StudyEvent: ODM-Test
1. Sichel-Reg, 1. Meldebogen

Name

Typ

Description | Question | Decode (Coded Value)

Datatyp

Alias

Patient data

Item Group

Patient data

C2707520 (UMLS CUI-1)

Last Name

Item

Last Name

text

C1301584 (UMLS CUI-1)

First Name

Item

text

C1443235 (UMLS CUI-1)

Birth Date

Item

date

C0421451 (UMLS CUI-1)

Gender

Item

integer

C0079399 (UMLS CUI-1)

Gender

Code List

Gender

CL Item

male (1)

C0024554 (UMLS CUI-1)

CL Item

female (2)

C0015780 (UMLS CUI-1)

Reporting date

Item

date

C1302584 (UMLS CUI-1)

Registry ID

Item

text

C1549709 (UMLS CUI-1)

Street (patient)

Item

text

C1301826 (UMLS CUI-1)
C0421449 (UMLS CUI-2)

ZIP (patient)

Item

text

C0421454 (UMLS CUI-1)

Town (patient)

Item

text

C1555315 (UMLS CUI-1)

E-mail (patient)

Item

text

C1705961 (UMLS CUI-1)
C0030705 (UMLS CUI-2)

Telephone (patient)

Item

text

C0421455 (UMLS CUI-1)

Treating Clinic

Item Group

Treating Clinic

C1522326 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

Clinic

Item

text

C0442592 (UMLS CUI-1)

Contact person

Item

text

C0337611 (UMLS CUI-1)

Street (clinic)

Item

text

C1301826 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

ZIP (clinic)

Item

text

C1521842 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

Town (Clinic)

Item

text

C1555315 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

E-mail (clinic)

Item

text

C1705961 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

Telephone (clinic)

Item

text

C0039457 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

Fax (clinic)

Item

text

C1549619 (UMLS CUI-1)
C0442592 (UMLS CUI-2)

General practitioner

Item Group

General practitioner

C0017319 (UMLS CUI-1)

Physicians office

Item

text

C0031834 (UMLS CUI-1)

Contact person

Item

text

C0337611 (UMLS CUI-1)

Street (GP)

Item

text

C1301826 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

ZIP (GP)

Item

text

C1521842 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

Town (GP)

Item

text

C1555315 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

E-Mail (GP)

Item

text

C1705961 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

Telephone (GP)

Item

text

C0039457 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

Fax (GP)

Item

text

C1549619 (UMLS CUI-1)
C0017319 (UMLS CUI-2)

Patient Characteristics

Item Group

Patient Characteristics

C0815172 (UMLS CUI-1)

Diagnosis

Item

text

C0011900 (UMLS CUI-1)

Country of origin

Item

text

C3262211 (UMLS CUI-1)

Marital status

Item

text

C0024819 (UMLS CUI-1)

Marital status

Code List

Marital status

CL Item

NEVER MARRIED (1)

CL Item

MARRIED (2)

CL Item

DIVORCED (3)

CL Item

WIDOWED (4)

Professional career

Item Group

Professional career

C0178534 (UMLS CUI-1)

School type

Item

text

C1547791 (UMLS CUI-1)

School graduation

Item

text

C0237640 (UMLS CUI-1)

Educational Status

Item

text

C0013658 (UMLS CUI-1)

Current activities

Item

text

C0336911 (UMLS CUI-1)

Comments

Item Group

Comments

C0947611 (UMLS CUI-1)

Comments

Item

text

C0947611 (UMLS CUI-1)

Signature

Item Group

Signature

C1519316 (UMLS CUI-1)

Physicians

Item

text

C0031831 (UMLS CUI-1)
C0027365 (UMLS CUI-2)

Date signed

Item

text

C3262251 (UMLS CUI-1)

Signature

Item

text

C1519316 (UMLS CUI-1)

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