ID

4834

Beskrivning

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

Nyckelord

Versioner (2)
  1. 2014-04-04 2014-04-04 - Martin Dugas
  2. 2021-09-17 2021-09-17 -
Uppladdad den

4 april 2014

DOI

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Licens

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

Tysk Engelsk

Sichel-Reg, 1. Meldebogen

1 Formulär  
  1. 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
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
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
Tillbaka till toppen

Similar models

Sichel-Reg, 1. Meldebogen

1 Formulär
  1. StudyEvent: ODM-Test
    1. Sichel-Reg, 1. Meldebogen
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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)
Tillbaka till toppen 

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