ID
11251
Beschreibung
Form from HIS OpenVistA
Stichworte
Versionen (4)
- 18.02.12 18.02.12 -
- 07.08.14 07.08.14 - Martin Dugas
- 09.08.14 09.08.14 - Martin Dugas
- 26.06.15 26.06.15 - Martin Dugas
Hochgeladen am
26. Juni 2015
DOI
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HEALTH HISTORY I_ANESTHESIA MULTIDISCIPLINARY
HIS
- StudyEvent: HIS
Beschreibung
Anesthesia Specific
Beschreibung
Allergies
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0020517
- SNOMED CT 2011_0131
- 257550005
- ICD-10-CM Version 2010
- T78.40
Beschreibung
Are you allergic to adhesive tape?
Datentyp
boolean
Beschreibung
Are you allergic to rubber products?
Datentyp
boolean
Beschreibung
Previous Surgeries?
Datentyp
string
Beschreibung
Surgery involving an anesthetic?
Datentyp
string
Beschreibung
General Anesthesia
Datentyp
boolean
Alias
- UMLS CUI 2011AA
- C0002915
- SNOMED CT 2011_0131
- 50697003
- MedDRA 14.1
- 10018060
Beschreibung
Spinal Anesthesia
Datentyp
boolean
Alias
- UMLS CUI 2011AA
- C0002928
- SNOMED CT 2011_0131
- 231249005
- MedDRA 14.1
- 10041536
Beschreibung
Epidural anaesthesia
Datentyp
boolean
Alias
- UMLS CUI 2011AA
- C0002913
- SNOMED CT 2011_0131
- 18946005
- MedDRA 14.1
- 10015011
Beschreibung
Regional anesthesia
Datentyp
boolean
Alias
- UMLS CUI 2011AA
- C0002911
- SNOMED CT 2011_0131
- 27372005
Beschreibung
Local anesthesia
Datentyp
boolean
Alias
- UMLS CUI 2011AA
- C0002921
- SNOMED CT 2011_0131
- 386761002
- MedDRA 14.1
- 10024758
Beschreibung
anesthetic: Moderate sedation
Datentyp
boolean
Beschreibung
anesthetic: Axillary block
Datentyp
boolean
Beschreibung
Have you or a family member ever had a problem with an anesthesic? If Yes, describe:
Datentyp
string
Beschreibung
Health History - Endocrine
Beschreibung
Diabetes
Datentyp
boolean
Alias
- UMLS CUI 2011AA
- C0011849
- SNOMED CT 2011_0131
- 191044006
Beschreibung
If Diabetes, last time med taken
Datentyp
string
Beschreibung
Hyperthyroidism
Datentyp
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
Beschreibung
Hypothyroidism
Datentyp
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
Beschreibung
Health History - Neurologic
Beschreibung
CVA/Stroke/TIA
Datentyp
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
Beschreibung
Seizures
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0036572
- SNOMED CT 2011_0131
- 91175000
- MedDRA 14.1
- 10039910
- ICD-9-CM Version 2011
- 780.39
Beschreibung
Numbness/Tingling to Arms/Legs
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0028643
- SNOMED CT 2011_0131
- 44077006
- MedDRA 14.1
- 10029829
- ICD-9-CM Version 2011
- 782.0
Beschreibung
Migraines and/or Headaches
Datentyp
text
Alias
- 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
- UMLS CUI-1
- C0149931
- UMLS CUI-2
- C0018681
Beschreibung
Blackout or Fainting Spells
Datentyp
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
Beschreibung
Health History - Cardiovascular
Beschreibung
Heart Attack/MI
Datentyp
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
Beschreibung
High Blood Pressure
Datentyp
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
Beschreibung
Rapid Heart Rate
Datentyp
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
Beschreibung
Irregular Heart Beat
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0003811
- SNOMED CT 2011_0131
- 44808001
- MedDRA 14.1
- 10003119
- ICD-9-CM Version 2011
- 427.9
Beschreibung
Cardiovascular Disease, Stents, Angioplasty, Heart Catherization
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0007222
- SNOMED CT 2011_0131
- 105980002
- MedDRA 14.1
- 10007649
- ICD-9-CM Version 2011
- 429.2
Beschreibung
Chest Pain/Angina
Datentyp
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
Beschreibung
Health History - Respiratory
Beschreibung
Lung Disease
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0024115
- SNOMED CT 2011_0131
- 19829001
- MedDRA 14.1
- 10025082
- ICD-10-CM Version 2010
- J98.4
Beschreibung
Congestive Heart Failure
Datentyp
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
Beschreibung
Chronic Cough
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0010201
- SNOMED CT 2011_0131
- 68154008
- MedDRA 14.1
- 10066656
Beschreibung
Asthma/Wheezing
Datentyp
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
Beschreibung
COPD/Bronchitis/Emphysema
Datentyp
text
Alias
- 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
- UMLS CUI-1
- C0024117
- UMLS CUI-2
- C0006277
- UMLS CUI-3
- C0034067
Beschreibung
Pneumonia
Datentyp
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
Beschreibung
Health History - Genitourinary
Beschreibung
Abnormal Kidney function
Datentyp
string
Alias
- UMLS CUI 2011AA
- C1565489
- MedDRA 14.1
- 10038474
Beschreibung
On Hemodialysis
Datentyp
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
Beschreibung
On Peritoneal Dialysis
Datentyp
boolean
Alias
- UMLS CUI 2011AA
- C0031139
- SNOMED CT 2011_0131
- 71192002
- MedDRA 14.1
- 10034660
- ICD-9-CM Version 2011
- 54.98
Beschreibung
Health History - Gastrointestinal
Beschreibung
Yellow Jaundice
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0022346
- SNOMED CT 2011_0131
- 18165001
- MedDRA 14.1
- 10023126
- ICD-10-CM Version 2010
- R17
Beschreibung
Hepatitis/Liver Disease
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0019158
- SNOMED CT 2011_0131
- 29001004
- MedDRA 14.1
- 10019717
Beschreibung
Freq. Indigestion/Reflux Disease
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0558176
- SNOMED CT 2011_0131
- 225587003
Beschreibung
Gastric Ulcers
Datentyp
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
Beschreibung
Health History - Other
Beschreibung
Bleed or Bruise Easily
Datentyp
string
Alias
- UMLS CUI 2011AA
- C1458140
- SNOMED CT 2011_0131
- 248250000
- MedDRA 14.1
- 10005134
Beschreibung
Blood Transfusions
Datentyp
string
Alias
- UMLS CUI 2011AA
- C1879316
- SNOMED CT 2011_0131
- 5447007
- MedDRA 14.1
- 10066152
Beschreibung
Cancer
Datentyp
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
Beschreibung
Bleeding Disorders
Datentyp
string
Beschreibung
Obstructive Sleep Apnea
Datentyp
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
Beschreibung
HAVE YOU HAD ANY MAJOR ILLNESS
Datentyp
string
Beschreibung
DO YOU HAVE DENTURES
Datentyp
boolean
Beschreibung
DO YOU HAVE BRIDGEWORK
Datentyp
boolean
Beschreibung
DO YOU HAVE CAPPED TEETH
Datentyp
boolean
Beschreibung
DO YOU HAVE LOOSE TEETH
Datentyp
boolean
Beschreibung
Are you taking any medications NOW?
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0013227
Beschreibung
Have you taken steroids in the last 6 months?
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0038317
- SNOMED CT 2011_0131
- 116566001
Beschreibung
Health History - Women's health
Beschreibung
DATE OF LAST PERIOD
Datentyp
date
Beschreibung
Are pregnant?
Datentyp
boolean
Alias
- UMLS CUI 2011AA
- C0549206
- MedDRA 14.1
- 10036586
Beschreibung
Weeks Gestation
Datentyp
integer
Beschreibung
EDC
Datentyp
date
Beschreibung
Health History - Substance abuse and Smoking
Beschreibung
Substance abuse
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0740858
- SNOMED CT 2011_0131
- 66214007
- MedDRA 14.1
- 10066169
- LOINC Version 232
- MTHU019364
Beschreibung
Smoker
Datentyp
boolean
Alias
- UMLS CUI-1
- C0543414
Beschreibung
What type of tobacco products?
Datentyp
string
Beschreibung
How much?
Datentyp
string
Beschreibung
Have you ever smoked /used tobacco products?
Datentyp
boolean
Beschreibung
When did you quit?(If has used products in the past 12 months,MUST give smoking cessation advice/information)
Datentyp
date
Beschreibung
What type of tobacco products?
Datentyp
string
Beschreibung
How much?
Datentyp
string
Beschreibung
Pediatric Smoking: Does anyone in your household currently use tobacco products?
Datentyp
boolean
Beschreibung
What type of tobacco products?
Datentyp
string
Beschreibung
How much?
Datentyp
string
Beschreibung
Has anyone in the house hold quit using tobacco products in the last 12 months?
Datentyp
boolean
Beschreibung
When did the person in your house hold quit?(If has used products in the past 12 months, MUST give smoking cessation advice/information)
Datentyp
date
Beschreibung
What type of tobacco products?
Datentyp
string
Beschreibung
How much?
Datentyp
string
Beschreibung
Tobacco/Smoking Cessation information/advice given to Patient
Datentyp
boolean
Beschreibung
Tobacco/Smoking Cessation information/advice given to Other
Datentyp
boolean
Beschreibung
In what format was the smoking cessation given (Verbal, Handwritten, Pre-printed)?
Datentyp
integer
Beschreibung
How much alcohol?
Datentyp
string
Beschreibung
How often alcohol?
Datentyp
string
Beschreibung
RECREATIONAL DRUGS
Datentyp
string
Beschreibung
Immunizations
Alias
- UMLS CUI-1
- C0020971
Beschreibung
SPECIALTY CLINIC specific
Beschreibung
Nutrition
Beschreibung
Current weight
Datentyp
float
Maßeinheiten
- kg
Alias
- UMLS CUI-1
- C0005910
Beschreibung
Have you experienced any unexplained weight loss or gain in the past 6 months?
Datentyp
boolean
Beschreibung
As compared to normal, would you rate your food intake during the past month as either: CHANGED- MORE- LESS
Datentyp
integer
Beschreibung
Assistance / Mobility
Beschreibung
Do you live alone?
Datentyp
boolean
Beschreibung
Does anyone assist you at home?
Datentyp
boolean
Alias
- UMLS CUI 2011AA
- C0578564
- SNOMED CT 2011_0131
- 301887005
Beschreibung
If yes, Name and phone number of person and/or facility that assists
Datentyp
string
Beschreibung
Equipment needed for WOUND(S)
Datentyp
string
Beschreibung
Where is your wound(s) located?
Datentyp
string
Alias
- UMLS CUI 2011AA
- C0043250
- SNOMED CT 2011_0131
- 13924000
- MedDRA 14.1
- 10052428
- LOINC Version 232
- MTHU001326
Beschreibung
How long have you had the wound(s)?
Datentyp
date
Beschreibung
How did the wounds start?
Datentyp
string
Beschreibung
How have you been treating the wound(s)?
Datentyp
string
Ähnliche Modelle
HIS
- StudyEvent: HIS
C0001779 (UMLS CUI-1)
10047890 (MedDRA 14.1)
LP18015-5 (LOINC Version 232)
C0005910 (UMLS CUI-1)
10037485 (MedDRA 14.1)
C0232117 (UMLS CUI-1)
10038709 (MedDRA 14.1)
MTHU008344 (LOINC Version 232)
C0231832 (UMLS CUI-1)
PCP (HL7 V3 2006_05)
C0033131 (UMLS CUI-1)
C0017319 (UMLS CUI-2)
257550005 (SNOMED CT 2011_0131)
T78.40 (ICD-10-CM Version 2010)
50697003 (SNOMED CT 2011_0131)
10018060 (MedDRA 14.1)
231249005 (SNOMED CT 2011_0131)
10041536 (MedDRA 14.1)
18946005 (SNOMED CT 2011_0131)
10015011 (MedDRA 14.1)
27372005 (SNOMED CT 2011_0131)
386761002 (SNOMED CT 2011_0131)
10024758 (MedDRA 14.1)
191044006 (SNOMED CT 2011_0131)
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)
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)
230690007 (SNOMED CT 2011_0131)
10042244 (MedDRA 14.1)
I63.9 (ICD-10-CM Version 2010)
E12826 (CTCAE 1105E)
91175000 (SNOMED CT 2011_0131)
10039910 (MedDRA 14.1)
780.39 (ICD-9-CM Version 2011)
44077006 (SNOMED CT 2011_0131)
10029829 (MedDRA 14.1)
782.0 (ICD-9-CM Version 2011)
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)
C0149931 (UMLS CUI-1)
C0018681 (UMLS CUI-2)
418648005 (SNOMED CT 2011_0131)
10004982 (MedDRA 14.1)
R55 (ICD-10-CM Version 2010)
780.2 (ICD-9-CM Version 2011)
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)
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)
3424008 (SNOMED CT 2011_0131)
10019303 (MedDRA 14.1)
R00.0 (ICD-10-CM Version 2010)
785.0 (ICD-9-CM Version 2011)
44808001 (SNOMED CT 2011_0131)
10003119 (MedDRA 14.1)
427.9 (ICD-9-CM Version 2011)
105980002 (SNOMED CT 2011_0131)
10007649 (MedDRA 14.1)
429.2 (ICD-9-CM Version 2011)
194828000 (SNOMED CT 2011_0131)
10002383 (MedDRA 14.1)
I20 (ICD-10-CM Version 2010)
413 (ICD-9-CM Version 2011)
19829001 (SNOMED CT 2011_0131)
10025082 (MedDRA 14.1)
J98.4 (ICD-10-CM Version 2010)
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)
68154008 (SNOMED CT 2011_0131)
10066656 (MedDRA 14.1)
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)
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)
C0024117 (UMLS CUI-1)
C0006277 (UMLS CUI-2)
C0034067 (UMLS CUI-3)
233604007 (SNOMED CT 2011_0131)
10035664 (MedDRA 14.1)
MTHU020831 (LOINC Version 232)
J18.9 (ICD-10-CM Version 2010)
E13502 (CTCAE 1105E)
10038474 (MedDRA 14.1)
302497006 (SNOMED CT 2011_0131)
10018875 (MedDRA 14.1)
E71.43 (ICD-10-CM Version 2010)
39.95 (ICD-9-CM Version 2011)
71192002 (SNOMED CT 2011_0131)
10034660 (MedDRA 14.1)
54.98 (ICD-9-CM Version 2011)
18165001 (SNOMED CT 2011_0131)
10023126 (MedDRA 14.1)
R17 (ICD-10-CM Version 2010)
29001004 (SNOMED CT 2011_0131)
10019717 (MedDRA 14.1)
225587003 (SNOMED CT 2011_0131)
13200003 (SNOMED CT 2011_0131)
10034341 (MedDRA 14.1)
K27 (ICD-10-CM Version 2010)
533 (ICD-9-CM Version 2011)
248250000 (SNOMED CT 2011_0131)
10005134 (MedDRA 14.1)
5447007 (SNOMED CT 2011_0131)
10066152 (MedDRA 14.1)
363346000 (SNOMED CT 2011_0131)
10028997 (MedDRA 14.1)
MTHU010328 (LOINC Version 232)
C00-C96 (ICD-10-CM Version 2010)
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)
116566001 (SNOMED CT 2011_0131)
10036586 (MedDRA 14.1)
66214007 (SNOMED CT 2011_0131)
10066169 (MedDRA 14.1)
MTHU019364 (LOINC Version 232)
127785005 (SNOMED CT 2011_0131)
10021431 (MedDRA 14.1)
IMMUNIZ (HL7 V3 2006_05)
301887005 (SNOMED CT 2011_0131)
13924000 (SNOMED CT 2011_0131)
10052428 (MedDRA 14.1)
MTHU001326 (LOINC Version 232)