ID

4834

Beschrijving

Registerzentrale: Dr. Dickerhoff / Dr. Potthoff, Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf

Trefwoorden

Versies (2)
  1. 04-04-14 04-04-14 - Martin Dugas
  2. 17-09-21 17-09-21 -
Geüploaded op

4 april 2014

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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Registry for Sickle Cell Diseases, 1.registration form

Duits Engels

Sichel-Reg, 1. Meldebogen

1 Formulieren  
  1. StudyEvent: ODM-Test
    1. Sichel-Reg, 1. Meldebogen
Patient data
Beschrijving

Patient data

Alias
UMLS CUI-1
C2707520
Last Name
Beschrijving

Last Name

Datatype

text

Alias
UMLS CUI-1
C1301584
First Name
Beschrijving

First Name

Datatype

text

Alias
UMLS CUI-1
C1443235
Birth Date
Beschrijving

Birth Date

Datatype

date

Alias
UMLS CUI-1
C0421451
Gender
Beschrijving

Gender

Datatype

integer

Alias
UMLS CUI-1
C0079399
Reporting date
Beschrijving

Date of report

Datatype

date

Alias
UMLS CUI-1
C1302584
Registry ID
Beschrijving

Registry ID

Datatype

text

Alias
UMLS CUI-1
C1549709
Street (patient)
Beschrijving

Street (patient)

Datatype

text

Alias
UMLS CUI-1
C1301826
UMLS CUI-2
C0421449
ZIP (patient)
Beschrijving

ZIP (patient)

Datatype

text

Alias
UMLS CUI-1
C0421454
Town (patient)
Beschrijving

Town (patient)

Datatype

text

Alias
UMLS CUI-1
C1555315
E-mail (patient)
Beschrijving

E-mail (patient)

Datatype

text

Alias
UMLS CUI-1
C1705961
UMLS CUI-2
C0030705
Telephone (patient)
Beschrijving

Telephone (patient)

Datatype

text

Alias
UMLS CUI-1
C0421455
Treating Clinic
Beschrijving

Treating Clinic

Alias
UMLS CUI-1
C1522326
UMLS CUI-2
C0442592
Clinic
Beschrijving

Clinic

Datatype

text

Alias
UMLS CUI-1
C0442592
Contact person
Beschrijving

Contact person

Datatype

text

Alias
UMLS CUI-1
C0337611
Street (clinic)
Beschrijving

Street (clinic)

Datatype

text

Alias
UMLS CUI-1
C1301826
UMLS CUI-2
C0442592
ZIP (clinic)
Beschrijving

ZIP (clinic)

Datatype

text

Alias
UMLS CUI-1
C1521842
UMLS CUI-2
C0442592
Town (Clinic)
Beschrijving

Town (Clinic)

Datatype

text

Alias
UMLS CUI-1
C1555315
UMLS CUI-2
C0442592
E-mail (clinic)
Beschrijving

E-mail (clinic)

Datatype

text

Alias
UMLS CUI-1
C1705961
UMLS CUI-2
C0442592
Telephone (clinic)
Beschrijving

Telephone (clinic)

Datatype

text

Alias
UMLS CUI-1
C0039457
UMLS CUI-2
C0442592
Fax (clinic)
Beschrijving

Fax (clinic)

Datatype

text

Alias
UMLS CUI-1
C1549619
UMLS CUI-2
C0442592
General practitioner
Beschrijving

General practitioner

Alias
UMLS CUI-1
C0017319
Physicians office
Beschrijving

Physicians office

Datatype

text

Alias
UMLS CUI-1
C0031834
Contact person
Beschrijving

Contact person

Datatype

text

Alias
UMLS CUI-1
C0337611
Street (GP)
Beschrijving

Street (GP)

Datatype

text

Alias
UMLS CUI-1
C1301826
UMLS CUI-2
C0017319
ZIP (GP)
Beschrijving

ZIP (GP)

Datatype

text

Alias
UMLS CUI-1
C1521842
UMLS CUI-2
C0017319
Town (GP)
Beschrijving

Town (GP)

Datatype

text

Alias
UMLS CUI-1
C1555315
UMLS CUI-2
C0017319
E-Mail (GP)
Beschrijving

E-Mail (General practitioner)

Datatype

text

Alias
UMLS CUI-1
C1705961
UMLS CUI-2
C0017319
Telephone (GP)
Beschrijving

Telephone (GP)

Datatype

text

Alias
UMLS CUI-1
C0039457
UMLS CUI-2
C0017319
Fax (GP)
Beschrijving

Fax (general practitioner)

Datatype

text

Alias
UMLS CUI-1
C1549619
UMLS CUI-2
C0017319
Patient Characteristics
Beschrijving

Patient Characteristics

Alias
UMLS CUI-1
C0815172
Diagnosis
Beschrijving

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

Datatype

text

Alias
UMLS CUI-1
C0011900
Country of origin
Beschrijving

Country of origin

Datatype

text

Alias
UMLS CUI-1
C3262211
Marital status
Beschrijving

Marital status

Datatype

text

Alias
UMLS CUI-1
C0024819
Professional career
Beschrijving

Professional career

Alias
UMLS CUI-1
C0178534
School type
Beschrijving

Type of school

Datatype

text

Alias
UMLS CUI-1
C1547791
School graduation
Beschrijving

School graduation

Datatype

text

Alias
UMLS CUI-1
C0237640
Educational Status
Beschrijving

Educational Status

Datatype

text

Alias
UMLS CUI-1
C0013658
Current activities
Beschrijving

Current activities

Datatype

text

Alias
UMLS CUI-1
C0336911
Comments
Beschrijving

Comments

Alias
UMLS CUI-1
C0947611
Comments
Beschrijving

Comments

Datatype

text

Alias
UMLS CUI-1
C0947611
Signature
Beschrijving

Signature

Alias
UMLS CUI-1
C1519316
Physicians
Beschrijving

Name of physician

Datatype

text

Alias
UMLS CUI-1
C0031831
UMLS CUI-2
C0027365
Date signed
Beschrijving

Date of signature

Datatype

text

Alias
UMLS CUI-1
C3262251
Signature
Beschrijving

Signature

Datatype

text

Alias
UMLS CUI-1
C1519316
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Similar models

Sichel-Reg, 1. Meldebogen

1 Formulieren
  1. StudyEvent: ODM-Test
    1. Sichel-Reg, 1. Meldebogen
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
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)
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)
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)
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)
Item Group
Patient Characteristics
C0815172 (UMLS CUI-1)
Diagnosis
Item
text
C0011900 (UMLS CUI-1)
Country of origin
Item
text
C3262211 (UMLS CUI-1)
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)
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)
Item Group
Comments
C0947611 (UMLS CUI-1)
Comments
Item
text
C0947611 (UMLS CUI-1)
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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