ID

5582

Beskrivning

Form from HIS OpenVistA

Nyckelord

  1. 2012-02-18 2012-02-18 -
  2. 2014-08-07 2014-08-07 - Martin Dugas
  3. 2014-08-09 2014-08-09 - Martin Dugas
  4. 2015-06-26 2015-06-26 - Martin Dugas
Uppladdad den

9 augusti 2014

DOI

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Creative Commons BY-NC 3.0 Legacy

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HIS HEALTH HISTORY I_ANESTHESIA MULTIDISCIPLINARY

  1. StudyEvent: HIS
    1. HIS
Overview
Beskrivning

Overview

Alter
Beskrivning

Age

Datatyp

string

Alias
UMLS CUI 2011AA
C0001779
SNOMED CT 2011_0131
397669002
Größe
Beskrivning

Height

Datatyp

string

Alias
UMLS CUI-1
C0005890
LOINC Version 232
MTHU005354
Gewicht
Beskrivning

Weight

Datatyp

string

Alias
UMLS
C0005910
SNOMED CT 2011_0131
107647005
MedDRA 14.1
10047890
LOINC Version 232
LP18015-5
Temperatur
Beskrivning

Temperature

Datatyp

string

Alias
UMLS CUI 2011AA
C0039476
SNOMED CT 2011_0131
246508008
LOINC Version 232
MTHU009008
Pulsfrequenz
Beskrivning

Pulse Rate

Datatyp

string

Alias
UMLS CUI 2011AA
C0232117
SNOMED CT 2011_0131
78564009
MedDRA 14.1
10037485
Atemfrequenz
Beskrivning

Respiratory rate

Datatyp

string

Alias
UMLS CUI 2011AA
C0231832
SNOMED CT 2011_0131
86290005
MedDRA 14.1
10038709
LOINC Version 232
MTHU008344
Blutdruck
Beskrivning

Blood Pressure

Datatyp

string

Alias
UMLS CUI 2011AA
C0005823
SNOMED CT 2011_0131
75367002
LOINC Version 232
MTHU008342
PT'S RESIDENCE
Beskrivning

PT'S RESIDENCE

Datatyp

string

LANGUAGE/COMMUNICATION BARRIER
Beskrivning

LANGUAGE/COMMUNICATION BARRIER

Datatyp

string

PRIMARY LANGUAGE
Beskrivning

PRIMARY LANGUAGE

Datatyp

string

Hauptbeschwerden
Beskrivning

CHIEF COMPLAINT

Datatyp

string

Alias
UMLS CUI 2011AA
C0277786
SNOMED CT 2011_0131
33962009
LOINC Version 232
MTHU001077
Hausarzt
Beskrivning

Primary Care Physician (PCP)

Datatyp

string

Alias
UMLS CUI 2011AA
C0033131, C0017319
SNOMED CT 2011_0131
446050000, 59058001
HL7 V3 2006_05
PCP
Anesthesia Specific
Beskrivning

Anesthesia Specific

Allergien
Beskrivning

Allergies

Datatyp

string

Alias
UMLS CUI 2011AA
C0020517
SNOMED CT 2011_0131
257550005
ICD-10-CM Version 2010
T78.40
Are you allergic to adhesive tape?
Beskrivning

Are you allergic to adhesive tape?

Datatyp

boolean

Are you allergic to rubber products?
Beskrivning

Are you allergic to rubber products?

Datatyp

boolean

Previous Surgeries?
Beskrivning

Previous Surgeries?

Datatyp

string

Surgery involving an anesthetic?
Beskrivning

Surgery involving an anesthetic?

Datatyp

string

Allgemeinanästhesie
Beskrivning

General Anesthesia

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0002915
SNOMED CT 2011_0131
50697003
MedDRA 14.1
10018060
Spinalanästhesie
Beskrivning

Spinal Anesthesia

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0002928
SNOMED CT 2011_0131
231249005
MedDRA 14.1
10041536
Epiduralanästhesie
Beskrivning

Epidural anaesthesia

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0002913
SNOMED CT 2011_0131
18946005
MedDRA 14.1
10015011
Regionalanästhesie
Beskrivning

Regional anesthesia

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0002911
SNOMED CT 2011_0131
27372005
Lokalanästhesie
Beskrivning

Local anesthesia

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0002921
SNOMED CT 2011_0131
386761002
MedDRA 14.1
10024758
anesthetic: Moderate sedation
Beskrivning

anesthetic: Moderate sedation

Datatyp

boolean

anesthetic: Axillary block
Beskrivning

anesthetic: Axillary block

Datatyp

boolean

Have you or a family member ever had a problem with an anesthesic? If Yes, describe:
Beskrivning

Have you or a family member ever had a problem with an anesthesic? If Yes, describe:

Datatyp

string

Health History - Endocrine
Beskrivning

Health History - Endocrine

Diabetes mellitus
Beskrivning

Diabetes

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0011849
SNOMED CT 2011_0131
191044006
If Diabetes, last time med taken
Beskrivning

If Diabetes, last time med taken

Datatyp

string

Hyperthyreose
Beskrivning

Hyperthyroidism

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0020550
SNOMED CT 2011_0131
34486009
MedDRA 14.1
10020850
LOINC Version 232
MTHU020782
ICD-10-CM Version 2010
E05.9
ICD-9-CM Version 2011
242.9
CTCAE 1105E
E10322
Hypothyreose
Beskrivning

Hypothyroidism

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0020676
SNOMED CT 2011_0131
40930008
MedDRA 14.1
10021114
LOINC Version 232
MTHU020783
ICD-10-CM Version 2010
E03.9
ICD-9-CM Version 2011
244.9
CTCAE 1105E
E10334
Health History - Neurologic
Beskrivning

Health History - Neurologic

Schlaganfall
Beskrivning

CVA/Stroke/TIA

Datatyp

string

Alias
UMLS CUI 2011AA
C0038454
SNOMED CT 2011_0131
230690007
MedDRA 14.1
10042244
ICD-10-CM Version 2010
I63.9
CTCAE 1105E
E12826
Krampfanfall
Beskrivning

Seizures

Datatyp

string

Alias
UMLS CUI 2011AA
C0036572
SNOMED CT 2011_0131
91175000
MedDRA 14.1
10039910
ICD-9-CM Version 2011
780.39
Taubheitsgefühl
Beskrivning

Numbness/Tingling to Arms/Legs

Datatyp

string

Alias
UMLS CUI 2011AA
C0028643
SNOMED CT 2011_0131
44077006
MedDRA 14.1
10029829
ICD-9-CM Version 2011
782.0
Migraines and/or Headaches
Beskrivning

Migraines and/or Headaches

Datatyp

string

Alias
UMLS CUI 2011AA
C0149931, C0018681
SNOMED CT 2011_0131
37796009, 25064002
MedDRA 14.1
10027599,1
LOINC Version 232
MTHU020860
ICD-10-CM Version 2010
G43, R51
ICD-9-CM Version 2011
346, 784.0
CTCAE 1105E
E12678
Blackout or Fainting Spells
Beskrivning

Blackout or Fainting Spells

Datatyp

string

Alias
UMLS CUI 2011AA
C0312422
SNOMED CT 2011_0131
418648005
MedDRA 14.1
10004982
ICD-10-CM Version 2010
R55
ICD-9-CM Version 2011
780.2
Health History - Cardiovascular
Beskrivning

Health History - Cardiovascular

Heart Attack/MI
Beskrivning

Heart Attack/MI

Datatyp

string

Alias
UMLS CUI 2011AA
C0027051
SNOMED CT 2011_0131
22298006
MedDRA 14.1
10028596
LOINC Version 232
MTHU035551
ICD-10-CM Version 2010
I21-I22
ICD-9-CM Version 2011
410
CTCAE 1105E
E10152
Hypertonie
Beskrivning

High Blood Pressure

Datatyp

string

Alias
UMLS CUI 2011AA
C0020538
SNOMED CT 2011_0131
38341003
MedDRA 14.1
10020772
LOINC Version 232
MTHU020789
ICD-10-CM Version 2010
I10
ICD-9-CM Version 2011
997.91
CTCAE 1105E
E13785
Tachykardie
Beskrivning

Rapid Heart Rate

Datatyp

string

Alias
UMLS CUI 2011AA
C0039231
SNOMED CT 2011_0131
3424008
MedDRA 14.1
10019303
ICD-10-CM Version 2010
R00.0
ICD-9-CM Version 2011
785.0
Herzrhythmusstörung
Beskrivning

Irregular Heart Beat

Datatyp

string

Alias
UMLS CUI 2011AA
C0003811
SNOMED CT 2011_0131
44808001
MedDRA 14.1
10003119
ICD-9-CM Version 2011
427.9
Kardiovaskuläre Erkrankung
Beskrivning

Cardiovascular Disease, Stents, Angioplasty, Heart Catherization

Datatyp

string

Alias
UMLS CUI 2011AA
C0007222
SNOMED CT 2011_0131
105980002
MedDRA 14.1
10007649
ICD-9-CM Version 2011
429.2
Angina Pectoris
Beskrivning

Chest Pain/Angina

Datatyp

string

Alias
UMLS CUI 2011AA
C0002962
SNOMED CT 2011_0131
194828000
MedDRA 14.1
10002383
ICD-10-CM Version 2010
I20
ICD-9-CM Version 2011
413
Health History - Respiratory
Beskrivning

Health History - Respiratory

Lungenerkrankung
Beskrivning

Lung Disease

Datatyp

string

Alias
UMLS CUI 2011AA
C0024115
SNOMED CT 2011_0131
19829001
MedDRA 14.1
10025082
ICD-10-CM Version 2010
J98.4
Herzinsuffizienz
Beskrivning

Congestive Heart Failure

Datatyp

string

Alias
UMLS CUI 2011AA
C0264722
SNOMED CT 2011_0131
42343007
MedDRA 14.1
10007559
LOINC Version 232
MTHU020787
ICD-10-CM Version 2010
I50
ICD-9-CM Version 2011
428
Chronischer Husten
Beskrivning

Chronic Cough

Datatyp

string

Alias
UMLS CUI 2011AA
C0010201
SNOMED CT 2011_0131
68154008
MedDRA 14.1
10066656
Asthma
Beskrivning

Asthma/Wheezing

Datatyp

string

Alias
UMLS CUI 2011AA
C0004096
SNOMED CT 2011_0131
195967001
MedDRA 14.1
10003553
LOINC Version 232
MTHU020815
ICD-10-CM Version 2010
J45
ICD-9-CM Version 2011
493
COPD, Bronchitis, Lungenemphysem
Beskrivning

COPD/Bronchitis/Emphysema

Datatyp

string

Alias
UMLS CUI 2011AA
C0024117, C0006277, C0034067
SNOMED CT 2011_0131
13645005, 32398004, 87433001
MedDRA 14.1
10009033, 10006451, 10014561
ICD-10-CM Version 2010
J44.9, J40, J43
ICD-9-CM Version 2011
496, 490, 492
CTCAE 1105E
E11323
Pneumonie
Beskrivning

Pneumonia

Datatyp

string

Alias
UMLS CUI 2011AA
C0032285
SNOMED CT 2011_0131
233604007
MedDRA 14.1
10035664
LOINC Version 232
MTHU020831
ICD-10-CM Version 2010
J18.9
CTCAE 1105E
E13502
Health History - Genitourinary
Beskrivning

Health History - Genitourinary

Abnormal Kidney function
Beskrivning

Abnormal Kidney function

Datatyp

string

Alias
UMLS CUI 2011AA
C1565489
MedDRA 14.1
10038474
Hämodialyse
Beskrivning

On Hemodialysis

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0019004
SNOMED CT 2011_0131
302497006
MedDRA 14.1
10018875
ICD-10-CM Version 2010
E71.43
ICD-9-CM Version 2011
39.95
Peritonealdialyse
Beskrivning

On Peritoneal Dialysis

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0031139
SNOMED CT 2011_0131
71192002
MedDRA 14.1
10034660
ICD-9-CM Version 2011
54.98
Health History - Gastrointestinal
Beskrivning

Health History - Gastrointestinal

Ikterus
Beskrivning

Yellow Jaundice

Datatyp

string

Alias
UMLS CUI 2011AA
C0022346
SNOMED CT 2011_0131
18165001
MedDRA 14.1
10023126
ICD-10-CM Version 2010
R17
Hepatitis
Beskrivning

Hepatitis/Liver Disease

Datatyp

string

Alias
UMLS CUI 2011AA
C0019158
SNOMED CT 2011_0131
29001004
MedDRA 14.1
10019717
Gastroösophagealer Reflux
Beskrivning

Freq. Indigestion/Reflux Disease

Datatyp

string

Alias
UMLS CUI 2011AA
C0558176
SNOMED CT 2011_0131
225587003
Gastroduodenales Ulkus
Beskrivning

Gastric Ulcers

Datatyp

string

Alias
UMLS CUI 2011AA
C0030920
SNOMED CT 2011_0131
13200003
MedDRA 14.1
10034341
ICD-10-CM Version 2010
K27
ICD-9-CM Version 2011
533
Health History - Other
Beskrivning

Health History - Other

Blutungsneigung
Beskrivning

Bleed or Bruise Easily

Datatyp

string

Alias
UMLS CUI 2011AA
C1458140
SNOMED CT 2011_0131
248250000
MedDRA 14.1
10005134
Transfusion
Beskrivning

Blood Transfusions

Datatyp

string

Alias
UMLS CUI 2011AA
C1879316
SNOMED CT 2011_0131
5447007
MedDRA 14.1
10066152
Krebs
Beskrivning

Cancer

Datatyp

string

Alias
UMLS CUI 2011AA
C0006826
SNOMED CT 2011_0131
363346000
MedDRA 14.1
10028997
LOINC Version 232
MTHU010328
ICD-10-CM Version 2010
C00-C96
Bleeding Disorders
Beskrivning

Bleeding Disorders

Datatyp

string

SAS - Sleep apnea syndrome
Beskrivning

Obstructive Sleep Apnea

Datatyp

string

Alias
UMLS CUI 2011AA
C0037315
SNOMED CT 2011_0131
73430006
MedDRA 14.1
10040979
ICD-10-CM Version 2010
G47.30
ICD-9-CM Version 2011
780.57
CTCAE 1105E
E13566
HAVE YOU HAD ANY MAJOR ILLNESS
Beskrivning

HAVE YOU HAD ANY MAJOR ILLNESS

Datatyp

string

DO YOU HAVE DENTURES
Beskrivning

DO YOU HAVE DENTURES

Datatyp

boolean

DO YOU HAVE BRIDGEWORK
Beskrivning

DO YOU HAVE BRIDGEWORK

Datatyp

boolean

DO YOU HAVE CAPPED TEETH
Beskrivning

DO YOU HAVE CAPPED TEETH

Datatyp

boolean

DO YOU HAVE LOOSE TEETH
Beskrivning

DO YOU HAVE LOOSE TEETH

Datatyp

boolean

Medikation
Beskrivning

Are you taking any medications NOW?

Datatyp

string

Alias
UMLS CUI 2011AA
C0013227
Steroide
Beskrivning

Have you taken steroids in the last 6 months?

Datatyp

string

Alias
UMLS CUI 2011AA
C0038317
SNOMED CT 2011_0131
116566001
Health History - Women's health
Beskrivning

Health History - Women's health

DATE OF LAST PERIOD
Beskrivning

DATE OF LAST PERIOD

Datatyp

date

schwanger
Beskrivning

Are pregnant?

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0549206
MedDRA 14.1
10036586
Weeks Gestation
Beskrivning

Weeks Gestation

Datatyp

integer

Estimated date of confinement (delivery date)
Beskrivning

EDC

Datatyp

date

Health History - Substance abuse and Smoking
Beskrivning

Health History - Substance abuse and Smoking

Drogenmissbrauch
Beskrivning

Substance abuse

Datatyp

string

Alias
UMLS CUI 2011AA
C0740858
SNOMED CT 2011_0131
66214007
MedDRA 14.1
10066169
LOINC Version 232
MTHU019364
Raucher
Beskrivning

Do you currently smoke/use tobacco products?

Datatyp

boolean

Alias
UMLS CUI 2011AA
CL025861
What type of tobacco products?
Beskrivning

What type of tobacco products?

Datatyp

string

How much?
Beskrivning

How much?

Datatyp

string

Have you ever smoked /used tobacco products?
Beskrivning

Have you ever smoked /used tobacco products?

Datatyp

boolean

When did you quit?(If has used products in the past 12 months,MUST give smoking cessation advice/information)
Beskrivning

When did you quit?(If has used products in the past 12 months,MUST give smoking cessation advice/information)

Datatyp

date

What type of tobacco products?
Beskrivning

What type of tobacco products?

Datatyp

string

How much?
Beskrivning

How much?

Datatyp

string

Pediatric Smoking: Does anyone in your household currently use tobacco products?
Beskrivning

Pediatric Smoking: Does anyone in your household currently use tobacco products?

Datatyp

boolean

What type of tobacco products?
Beskrivning

What type of tobacco products?

Datatyp

string

How much?
Beskrivning

How much?

Datatyp

string

Has anyone in the house hold quit using tobacco products in the last 12 months?
Beskrivning

Has anyone in the house hold quit using tobacco products in the last 12 months?

Datatyp

boolean

When did the person in your house hold quit?(If has used products in the past 12 months, MUST give smoking cessation advice/information)
Beskrivning

When did the person in your house hold quit?(If has used products in the past 12 months, MUST give smoking cessation advice/information)

Datatyp

date

What type of tobacco products?
Beskrivning

What type of tobacco products?

Datatyp

string

How much?
Beskrivning

How much?

Datatyp

string

Tobacco/Smoking Cessation information/advice given to Patient
Beskrivning

Tobacco/Smoking Cessation information/advice given to Patient

Datatyp

boolean

Tobacco/Smoking Cessation information/advice given to Other
Beskrivning

Tobacco/Smoking Cessation information/advice given to Other

Datatyp

boolean

In what format was the smoking cessation given (Verbal, Handwritten, Pre-printed)?
Beskrivning

In what format was the smoking cessation given (Verbal, Handwritten, Pre-printed)?

Datatyp

integer

How much alcohol?
Beskrivning

How much alcohol?

Datatyp

string

How often alcohol?
Beskrivning

How often alcohol?

Datatyp

string

RECREATIONAL DRUGS
Beskrivning

RECREATIONAL DRUGS

Datatyp

string

Immunizations
Beskrivning

Immunizations

Impfung
Beskrivning

Immunizations

Datatyp

string

Alias
UMLS CUI 2011AA
C0020971
SNOMED CT 2011_0131
127785005
MedDRA 14.1
10021431
HL7 V3 2006_05
IMMUNIZ
SPECIALTY CLINIC specific
Beskrivning

SPECIALTY CLINIC specific

SPECIALTY CLINIC specific
Beskrivning

SPECIALTY CLINIC specific

Datatyp

string

Nutrition
Beskrivning

Nutrition

Current Weight
Beskrivning

Current Weight

Datatyp

integer

Have you experienced any unexplained weight loss or gain in the past 6 months?
Beskrivning

Have you experienced any unexplained weight loss or gain in the past 6 months?

Datatyp

boolean

As compared to normal, would you rate your food intake during the past month as either: CHANGED- MORE- LESS
Beskrivning

As compared to normal, would you rate your food intake during the past month as either: CHANGED- MORE- LESS

Datatyp

integer

Assistance / Mobility
Beskrivning

Assistance / Mobility

Do you live alone?
Beskrivning

Do you live alone?

Datatyp

boolean

Benötigt Unterstützung zuhause
Beskrivning

Does anyone assist you at home?

Datatyp

boolean

Alias
UMLS CUI 2011AA
C0578564
SNOMED CT 2011_0131
301887005
If yes, Name and phone number of person and/or facility that assists
Beskrivning

If yes, Name and phone number of person and/or facility that assists

Datatyp

string

Equipment needed for WOUND(S)
Beskrivning

Equipment needed for WOUND(S)

Datatyp

string

Wunde
Beskrivning

Where is your wound(s) located?

Datatyp

string

Alias
UMLS CUI 2011AA
C0043250
SNOMED CT 2011_0131
13924000
MedDRA 14.1
10052428
LOINC Version 232
MTHU001326
How long have you had the wound(s)?
Beskrivning

How long have you had the wound(s)?

Datatyp

date

How did the wounds start?
Beskrivning

How did the wounds start?

Datatyp

string

How have you been treating the wound(s)?
Beskrivning

How have you been treating the wound(s)?

Datatyp

string

Similar models

  1. StudyEvent: HIS
    1. HIS
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Age
Item
Alter
string
C0001779 (UMLS CUI 2011AA)
397669002 (SNOMED CT 2011_0131)
Height
Item
Größe
string
C0005890 (UMLS CUI-1)
MTHU005354 (LOINC Version 232)
Weight
Item
Gewicht
string
C0005910 (UMLS)
107647005 (SNOMED CT 2011_0131)
10047890 (MedDRA 14.1)
LP18015-5 (LOINC Version 232)
Temperature
Item
Temperatur
string
C0039476 (UMLS CUI 2011AA)
246508008 (SNOMED CT 2011_0131)
MTHU009008 (LOINC Version 232)
Pulse Rate
Item
Pulsfrequenz
string
C0232117 (UMLS CUI 2011AA)
78564009 (SNOMED CT 2011_0131)
10037485 (MedDRA 14.1)
Respiratory rate
Item
Atemfrequenz
string
C0231832 (UMLS CUI 2011AA)
86290005 (SNOMED CT 2011_0131)
10038709 (MedDRA 14.1)
MTHU008344 (LOINC Version 232)
Blood Pressure
Item
Blutdruck
string
C0005823 (UMLS CUI 2011AA)
75367002 (SNOMED CT 2011_0131)
MTHU008342 (LOINC Version 232)
PT'S RESIDENCE
Item
PT'S RESIDENCE
string
LANGUAGE/COMMUNICATION BARRIER
Item
LANGUAGE/COMMUNICATION BARRIER
string
PRIMARY LANGUAGE
Item
PRIMARY LANGUAGE
string
CHIEF COMPLAINT
Item
Hauptbeschwerden
string
C0277786 (UMLS CUI 2011AA)
33962009 (SNOMED CT 2011_0131)
MTHU001077 (LOINC Version 232)
Primary Care Physician (PCP)
Item
Hausarzt
string
C0033131, C0017319 (UMLS CUI 2011AA)
446050000, 59058001 (SNOMED CT 2011_0131)
PCP (HL7 V3 2006_05)
Allergies
Item
Allergien
string
C0020517 (UMLS CUI 2011AA)
257550005 (SNOMED CT 2011_0131)
T78.40 (ICD-10-CM Version 2010)
Are you allergic to adhesive tape?
Item
Are you allergic to adhesive tape?
boolean
Are you allergic to rubber products?
Item
Are you allergic to rubber products?
boolean
Previous Surgeries?
Item
Previous Surgeries?
string
Surgery involving an anesthetic?
Item
Surgery involving an anesthetic?
string
General Anesthesia
Item
Allgemeinanästhesie
boolean
C0002915 (UMLS CUI 2011AA)
50697003 (SNOMED CT 2011_0131)
10018060 (MedDRA 14.1)
Spinal Anesthesia
Item
Spinalanästhesie
boolean
C0002928 (UMLS CUI 2011AA)
231249005 (SNOMED CT 2011_0131)
10041536 (MedDRA 14.1)
Epidural anaesthesia
Item
Epiduralanästhesie
boolean
C0002913 (UMLS CUI 2011AA)
18946005 (SNOMED CT 2011_0131)
10015011 (MedDRA 14.1)
Regional anesthesia
Item
Regionalanästhesie
boolean
C0002911 (UMLS CUI 2011AA)
27372005 (SNOMED CT 2011_0131)
Local anesthesia
Item
Lokalanästhesie
boolean
C0002921 (UMLS CUI 2011AA)
386761002 (SNOMED CT 2011_0131)
10024758 (MedDRA 14.1)
anesthetic: Moderate sedation
Item
anesthetic: Moderate sedation
boolean
anesthetic: Axillary block
Item
anesthetic: Axillary block
boolean
Have you or a family member ever had a problem with an anesthesic? If Yes, describe:
Item
Have you or a family member ever had a problem with an anesthesic? If Yes, describe:
string
Diabetes
Item
Diabetes mellitus
boolean
C0011849 (UMLS CUI 2011AA)
191044006 (SNOMED CT 2011_0131)
If Diabetes, last time med taken
Item
If Diabetes, last time med taken
string
Hyperthyroidism
Item
Hyperthyreose
boolean
C0020550 (UMLS CUI 2011AA)
34486009 (SNOMED CT 2011_0131)
10020850 (MedDRA 14.1)
MTHU020782 (LOINC Version 232)
E05.9 (ICD-10-CM Version 2010)
242.9 (ICD-9-CM Version 2011)
E10322 (CTCAE 1105E)
Hypothyroidism
Item
Hypothyreose
boolean
C0020676 (UMLS CUI 2011AA)
40930008 (SNOMED CT 2011_0131)
10021114 (MedDRA 14.1)
MTHU020783 (LOINC Version 232)
E03.9 (ICD-10-CM Version 2010)
244.9 (ICD-9-CM Version 2011)
E10334 (CTCAE 1105E)
CVA/Stroke/TIA
Item
Schlaganfall
string
C0038454 (UMLS CUI 2011AA)
230690007 (SNOMED CT 2011_0131)
10042244 (MedDRA 14.1)
I63.9 (ICD-10-CM Version 2010)
E12826 (CTCAE 1105E)
Seizures
Item
Krampfanfall
string
C0036572 (UMLS CUI 2011AA)
91175000 (SNOMED CT 2011_0131)
10039910 (MedDRA 14.1)
780.39 (ICD-9-CM Version 2011)
Numbness/Tingling to Arms/Legs
Item
Taubheitsgefühl
string
C0028643 (UMLS CUI 2011AA)
44077006 (SNOMED CT 2011_0131)
10029829 (MedDRA 14.1)
782.0 (ICD-9-CM Version 2011)
Migraines and/or Headaches
Item
Migraines and/or Headaches
string
C0149931, C0018681 (UMLS CUI 2011AA)
37796009, 25064002 (SNOMED CT 2011_0131)
10027599,1 (MedDRA 14.1)
MTHU020860 (LOINC Version 232)
G43, R51 (ICD-10-CM Version 2010)
346, 784.0 (ICD-9-CM Version 2011)
E12678 (CTCAE 1105E)
Blackout or Fainting Spells
Item
Blackout or Fainting Spells
string
C0312422 (UMLS CUI 2011AA)
418648005 (SNOMED CT 2011_0131)
10004982 (MedDRA 14.1)
R55 (ICD-10-CM Version 2010)
780.2 (ICD-9-CM Version 2011)
Heart Attack/MI
Item
Heart Attack/MI
string
C0027051 (UMLS CUI 2011AA)
22298006 (SNOMED CT 2011_0131)
10028596 (MedDRA 14.1)
MTHU035551 (LOINC Version 232)
I21-I22 (ICD-10-CM Version 2010)
410 (ICD-9-CM Version 2011)
E10152 (CTCAE 1105E)
High Blood Pressure
Item
Hypertonie
string
C0020538 (UMLS CUI 2011AA)
38341003 (SNOMED CT 2011_0131)
10020772 (MedDRA 14.1)
MTHU020789 (LOINC Version 232)
I10 (ICD-10-CM Version 2010)
997.91 (ICD-9-CM Version 2011)
E13785 (CTCAE 1105E)
Rapid Heart Rate
Item
Tachykardie
string
C0039231 (UMLS CUI 2011AA)
3424008 (SNOMED CT 2011_0131)
10019303 (MedDRA 14.1)
R00.0 (ICD-10-CM Version 2010)
785.0 (ICD-9-CM Version 2011)
Irregular Heart Beat
Item
Herzrhythmusstörung
string
C0003811 (UMLS CUI 2011AA)
44808001 (SNOMED CT 2011_0131)
10003119 (MedDRA 14.1)
427.9 (ICD-9-CM Version 2011)
Cardiovascular Disease, Stents, Angioplasty, Heart Catherization
Item
Kardiovaskuläre Erkrankung
string
C0007222 (UMLS CUI 2011AA)
105980002 (SNOMED CT 2011_0131)
10007649 (MedDRA 14.1)
429.2 (ICD-9-CM Version 2011)
Chest Pain/Angina
Item
Angina Pectoris
string
C0002962 (UMLS CUI 2011AA)
194828000 (SNOMED CT 2011_0131)
10002383 (MedDRA 14.1)
I20 (ICD-10-CM Version 2010)
413 (ICD-9-CM Version 2011)
Lung Disease
Item
Lungenerkrankung
string
C0024115 (UMLS CUI 2011AA)
19829001 (SNOMED CT 2011_0131)
10025082 (MedDRA 14.1)
J98.4 (ICD-10-CM Version 2010)
Congestive Heart Failure
Item
Herzinsuffizienz
string
C0264722 (UMLS CUI 2011AA)
42343007 (SNOMED CT 2011_0131)
10007559 (MedDRA 14.1)
MTHU020787 (LOINC Version 232)
I50 (ICD-10-CM Version 2010)
428 (ICD-9-CM Version 2011)
Chronic Cough
Item
Chronischer Husten
string
C0010201 (UMLS CUI 2011AA)
68154008 (SNOMED CT 2011_0131)
10066656 (MedDRA 14.1)
Asthma/Wheezing
Item
Asthma
string
C0004096 (UMLS CUI 2011AA)
195967001 (SNOMED CT 2011_0131)
10003553 (MedDRA 14.1)
MTHU020815 (LOINC Version 232)
J45 (ICD-10-CM Version 2010)
493 (ICD-9-CM Version 2011)
COPD/Bronchitis/Emphysema
Item
COPD, Bronchitis, Lungenemphysem
string
C0024117, C0006277, C0034067 (UMLS CUI 2011AA)
13645005, 32398004, 87433001 (SNOMED CT 2011_0131)
10009033, 10006451, 10014561 (MedDRA 14.1)
J44.9, J40, J43 (ICD-10-CM Version 2010)
496, 490, 492 (ICD-9-CM Version 2011)
E11323 (CTCAE 1105E)
Pneumonia
Item
Pneumonie
string
C0032285 (UMLS CUI 2011AA)
233604007 (SNOMED CT 2011_0131)
10035664 (MedDRA 14.1)
MTHU020831 (LOINC Version 232)
J18.9 (ICD-10-CM Version 2010)
E13502 (CTCAE 1105E)
Abnormal Kidney function
Item
Abnormal Kidney function
string
C1565489 (UMLS CUI 2011AA)
10038474 (MedDRA 14.1)
On Hemodialysis
Item
Hämodialyse
boolean
C0019004 (UMLS CUI 2011AA)
302497006 (SNOMED CT 2011_0131)
10018875 (MedDRA 14.1)
E71.43 (ICD-10-CM Version 2010)
39.95 (ICD-9-CM Version 2011)
On Peritoneal Dialysis
Item
Peritonealdialyse
boolean
C0031139 (UMLS CUI 2011AA)
71192002 (SNOMED CT 2011_0131)
10034660 (MedDRA 14.1)
54.98 (ICD-9-CM Version 2011)
Yellow Jaundice
Item
Ikterus
string
C0022346 (UMLS CUI 2011AA)
18165001 (SNOMED CT 2011_0131)
10023126 (MedDRA 14.1)
R17 (ICD-10-CM Version 2010)
Hepatitis/Liver Disease
Item
Hepatitis
string
C0019158 (UMLS CUI 2011AA)
29001004 (SNOMED CT 2011_0131)
10019717 (MedDRA 14.1)
Freq. Indigestion/Reflux Disease
Item
Gastroösophagealer Reflux
string
C0558176 (UMLS CUI 2011AA)
225587003 (SNOMED CT 2011_0131)
Gastric Ulcers
Item
Gastroduodenales Ulkus
string
C0030920 (UMLS CUI 2011AA)
13200003 (SNOMED CT 2011_0131)
10034341 (MedDRA 14.1)
K27 (ICD-10-CM Version 2010)
533 (ICD-9-CM Version 2011)
Bleed or Bruise Easily
Item
Blutungsneigung
string
C1458140 (UMLS CUI 2011AA)
248250000 (SNOMED CT 2011_0131)
10005134 (MedDRA 14.1)
Blood Transfusions
Item
Transfusion
string
C1879316 (UMLS CUI 2011AA)
5447007 (SNOMED CT 2011_0131)
10066152 (MedDRA 14.1)
Cancer
Item
Krebs
string
C0006826 (UMLS CUI 2011AA)
363346000 (SNOMED CT 2011_0131)
10028997 (MedDRA 14.1)
MTHU010328 (LOINC Version 232)
C00-C96 (ICD-10-CM Version 2010)
Bleeding Disorders
Item
Bleeding Disorders
string
Obstructive Sleep Apnea
Item
SAS - Sleep apnea syndrome
string
C0037315 (UMLS CUI 2011AA)
73430006 (SNOMED CT 2011_0131)
10040979 (MedDRA 14.1)
G47.30 (ICD-10-CM Version 2010)
780.57 (ICD-9-CM Version 2011)
E13566 (CTCAE 1105E)
HAVE YOU HAD ANY MAJOR ILLNESS
Item
HAVE YOU HAD ANY MAJOR ILLNESS
string
DO YOU HAVE DENTURES
Item
DO YOU HAVE DENTURES
boolean
DO YOU HAVE BRIDGEWORK
Item
DO YOU HAVE BRIDGEWORK
boolean
DO YOU HAVE CAPPED TEETH
Item
DO YOU HAVE CAPPED TEETH
boolean
DO YOU HAVE LOOSE TEETH
Item
DO YOU HAVE LOOSE TEETH
boolean
Are you taking any medications NOW?
Item
Medikation
string
C0013227 (UMLS CUI 2011AA)
Have you taken steroids in the last 6 months?
Item
Steroide
string
C0038317 (UMLS CUI 2011AA)
116566001 (SNOMED CT 2011_0131)
DATE OF LAST PERIOD
Item
DATE OF LAST PERIOD
date
Are pregnant?
Item
schwanger
boolean
C0549206 (UMLS CUI 2011AA)
10036586 (MedDRA 14.1)
Weeks Gestation
Item
Weeks Gestation
integer
EDC
Item
Estimated date of confinement (delivery date)
date
Substance abuse
Item
Drogenmissbrauch
string
C0740858 (UMLS CUI 2011AA)
66214007 (SNOMED CT 2011_0131)
10066169 (MedDRA 14.1)
MTHU019364 (LOINC Version 232)
Do you currently smoke/use tobacco products?
Item
Raucher
boolean
CL025861 (UMLS CUI 2011AA)
What type of tobacco products?
Item
What type of tobacco products?
string
How much?
Item
How much?
string
Have you ever smoked /used tobacco products?
Item
Have you ever smoked /used tobacco products?
boolean
When did you quit?(If has used products in the past 12 months,MUST give smoking cessation advice/information)
Item
When did you quit?(If has used products in the past 12 months,MUST give smoking cessation advice/information)
date
What type of tobacco products?
Item
What type of tobacco products?
string
How much?
Item
How much?
string
Pediatric Smoking: Does anyone in your household currently use tobacco products?
Item
Pediatric Smoking: Does anyone in your household currently use tobacco products?
boolean
What type of tobacco products?
Item
What type of tobacco products?
string
How much?
Item
How much?
string
Has anyone in the house hold quit using tobacco products in the last 12 months?
Item
Has anyone in the house hold quit using tobacco products in the last 12 months?
boolean
When did the person in your house hold quit?(If has used products in the past 12 months, MUST give smoking cessation advice/information)
Item
When did the person in your house hold quit?(If has used products in the past 12 months, MUST give smoking cessation advice/information)
date
What type of tobacco products?
Item
What type of tobacco products?
string
How much?
Item
How much?
string
Tobacco/Smoking Cessation information/advice given to Patient
Item
Tobacco/Smoking Cessation information/advice given to Patient
boolean
Tobacco/Smoking Cessation information/advice given to Other
Item
Tobacco/Smoking Cessation information/advice given to Other
boolean
In what format was the smoking cessation given (Verbal, Handwritten, Pre-printed)?
Item
In what format was the smoking cessation given (Verbal, Handwritten, Pre-printed)?
integer
How much alcohol?
Item
How much alcohol?
string
How often alcohol?
Item
How often alcohol?
string
RECREATIONAL DRUGS
Item
RECREATIONAL DRUGS
string
Item Group
Immunizations
Item
Impfung
string
C0020971 (UMLS CUI 2011AA)
127785005 (SNOMED CT 2011_0131)
10021431 (MedDRA 14.1)
IMMUNIZ (HL7 V3 2006_05)
SPECIALTY CLINIC specific
Item
SPECIALTY CLINIC specific
string
Item Group
Current Weight
Item
Current Weight
integer
Have you experienced any unexplained weight loss or gain in the past 6 months?
Item
Have you experienced any unexplained weight loss or gain in the past 6 months?
boolean
As compared to normal, would you rate your food intake during the past month as either: CHANGED- MORE- LESS
Item
As compared to normal, would you rate your food intake during the past month as either: CHANGED- MORE- LESS
integer
Do you live alone?
Item
Do you live alone?
boolean
Does anyone assist you at home?
Item
Benötigt Unterstützung zuhause
boolean
C0578564 (UMLS CUI 2011AA)
301887005 (SNOMED CT 2011_0131)
If yes, Name and phone number of person and/or facility that assists
Item
If yes, Name and phone number of person and/or facility that assists
string
Equipment needed for WOUND(S)
Item
Equipment needed for WOUND(S)
string
Where is your wound(s) located?
Item
Wunde
string
C0043250 (UMLS CUI 2011AA)
13924000 (SNOMED CT 2011_0131)
10052428 (MedDRA 14.1)
MTHU001326 (LOINC Version 232)
How long have you had the wound(s)?
Item
How long have you had the wound(s)?
date
How did the wounds start?
Item
How did the wounds start?
string
How have you been treating the wound(s)?
Item
How have you been treating the wound(s)?
string

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