Description:

Form from HIS OpenVistA

Keywords:
Versions (4) ▾
  1. 2/18/12
  2. 8/7/14
  3. 8/9/14
  4. 6/26/15
Uploaded on:

August 9, 2014

DOI:
No DOI assigned. To request one pleaselog in.
License:
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

HIS HEALTH HISTORY I_ANESTHESIA MULTIDISCIPLINARY

HIS

  1. StudyEvent: HIS
    1. HIS
Overview
Anesthesia Specific
Are you allergic to adhesive tape?
Are you allergic to rubber products?
General anaesthesia (GA)
Spinal Anaesthesia
epidural anesthesia
Regional Anesthesia Procedure
Local anaesthesia (LA)
anesthetic: Moderate sedation
anesthetic: Axillary block
Health History - Endocrine
Diabetes mellitus
Hyperthyroidism
Hypothyroidism
Health History - Neurologic
Health History - Cardiovascular
Health History - Respiratory
Health History - Genitourinary
Haemodialysis
Peritoneal Dialysis (PD)
Health History - Gastrointestinal
Health History - Other
DO YOU HAVE DENTURES
DO YOU HAVE BRIDGEWORK
DO YOU HAVE CAPPED TEETH
DO YOU HAVE LOOSE TEETH
Health History - Women's health
pregnant
Health History - Substance abuse and Smoking
Smoker
Have you ever smoked /used tobacco products?
Pediatric Smoking: Does anyone in your household currently use tobacco products?
Has anyone in the house hold quit using tobacco products in the last 12 months?
Tobacco/Smoking Cessation information/advice given to Patient
Tobacco/Smoking Cessation information/advice given to Other
Immunizations
SPECIALTY CLINIC specific
Nutrition
Have you experienced any unexplained weight loss or gain in the past 6 months?
Assistance / Mobility
Do you live alone?
Needs assistance at home