ID
11251
Descripción
Form from HIS OpenVistA
Palabras clave
Versiones (4)
- 18/2/12 18/2/12 -
- 7/8/14 7/8/14 - Martin Dugas
- 9/8/14 9/8/14 - Martin Dugas
- 26/6/15 26/6/15 - Martin Dugas
Subido en
26 de junio de 2015
DOI
Para solicitar uno, por favor iniciar sesión.
Licencia
Creative Commons BY-NC 3.0 Legacy
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HEALTH HISTORY I_ANESTHESIA MULTIDISCIPLINARY
HIS
- StudyEvent: HIS
Descripción
Anesthesia Specific
Descripción
Allergies
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0020517
- SNOMED CT 2011_0131
- 257550005
- ICD-10-CM Version 2010
- T78.40
Descripción
Are you allergic to adhesive tape?
Tipo de datos
boolean
Descripción
Are you allergic to rubber products?
Tipo de datos
boolean
Descripción
Previous Surgeries?
Tipo de datos
string
Descripción
Surgery involving an anesthetic?
Tipo de datos
string
Descripción
General Anesthesia
Tipo de datos
boolean
Alias
- UMLS CUI 2011AA
- C0002915
- SNOMED CT 2011_0131
- 50697003
- MedDRA 14.1
- 10018060
Descripción
Spinal Anesthesia
Tipo de datos
boolean
Alias
- UMLS CUI 2011AA
- C0002928
- SNOMED CT 2011_0131
- 231249005
- MedDRA 14.1
- 10041536
Descripción
Epidural anaesthesia
Tipo de datos
boolean
Alias
- UMLS CUI 2011AA
- C0002913
- SNOMED CT 2011_0131
- 18946005
- MedDRA 14.1
- 10015011
Descripción
Regional anesthesia
Tipo de datos
boolean
Alias
- UMLS CUI 2011AA
- C0002911
- SNOMED CT 2011_0131
- 27372005
Descripción
Local anesthesia
Tipo de datos
boolean
Alias
- UMLS CUI 2011AA
- C0002921
- SNOMED CT 2011_0131
- 386761002
- MedDRA 14.1
- 10024758
Descripción
anesthetic: Moderate sedation
Tipo de datos
boolean
Descripción
anesthetic: Axillary block
Tipo de datos
boolean
Descripción
Have you or a family member ever had a problem with an anesthesic? If Yes, describe:
Tipo de datos
string
Descripción
Health History - Endocrine
Descripción
Diabetes
Tipo de datos
boolean
Alias
- UMLS CUI 2011AA
- C0011849
- SNOMED CT 2011_0131
- 191044006
Descripción
If Diabetes, last time med taken
Tipo de datos
string
Descripción
Hyperthyroidism
Tipo de datos
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
Descripción
Hypothyroidism
Tipo de datos
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
Descripción
Health History - Neurologic
Descripción
CVA/Stroke/TIA
Tipo de datos
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
Descripción
Seizures
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0036572
- SNOMED CT 2011_0131
- 91175000
- MedDRA 14.1
- 10039910
- ICD-9-CM Version 2011
- 780.39
Descripción
Numbness/Tingling to Arms/Legs
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0028643
- SNOMED CT 2011_0131
- 44077006
- MedDRA 14.1
- 10029829
- ICD-9-CM Version 2011
- 782.0
Descripción
Migraines and/or Headaches
Tipo de datos
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
Descripción
Blackout or Fainting Spells
Tipo de datos
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
Descripción
Health History - Cardiovascular
Descripción
Heart Attack/MI
Tipo de datos
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
Descripción
High Blood Pressure
Tipo de datos
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
Descripción
Rapid Heart Rate
Tipo de datos
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
Descripción
Irregular Heart Beat
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0003811
- SNOMED CT 2011_0131
- 44808001
- MedDRA 14.1
- 10003119
- ICD-9-CM Version 2011
- 427.9
Descripción
Cardiovascular Disease, Stents, Angioplasty, Heart Catherization
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0007222
- SNOMED CT 2011_0131
- 105980002
- MedDRA 14.1
- 10007649
- ICD-9-CM Version 2011
- 429.2
Descripción
Chest Pain/Angina
Tipo de datos
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
Descripción
Health History - Respiratory
Descripción
Lung Disease
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0024115
- SNOMED CT 2011_0131
- 19829001
- MedDRA 14.1
- 10025082
- ICD-10-CM Version 2010
- J98.4
Descripción
Congestive Heart Failure
Tipo de datos
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
Descripción
Chronic Cough
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0010201
- SNOMED CT 2011_0131
- 68154008
- MedDRA 14.1
- 10066656
Descripción
Asthma/Wheezing
Tipo de datos
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
Descripción
Chronic Obstructive Pulmonary Disease, Bronchial infection, Pulmonary Emphysema
Tipo de datos
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
Descripción
Pneumonia
Tipo de datos
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
Descripción
Health History - Genitourinary
Descripción
Abnormal Kidney function
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C1565489
- MedDRA 14.1
- 10038474
Descripción
On Hemodialysis
Tipo de datos
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
Descripción
On Peritoneal Dialysis
Tipo de datos
boolean
Alias
- UMLS CUI 2011AA
- C0031139
- SNOMED CT 2011_0131
- 71192002
- MedDRA 14.1
- 10034660
- ICD-9-CM Version 2011
- 54.98
Descripción
Health History - Gastrointestinal
Descripción
Yellow Jaundice
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0022346
- SNOMED CT 2011_0131
- 18165001
- MedDRA 14.1
- 10023126
- ICD-10-CM Version 2010
- R17
Descripción
Hepatitis/Liver Disease
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0019158
- SNOMED CT 2011_0131
- 29001004
- MedDRA 14.1
- 10019717
Descripción
Freq. Indigestion/Reflux Disease
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0558176
- SNOMED CT 2011_0131
- 225587003
Descripción
Gastric Ulcers
Tipo de datos
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
Descripción
Health History - Other
Descripción
Bleed or Bruise Easily
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C1458140
- SNOMED CT 2011_0131
- 248250000
- MedDRA 14.1
- 10005134
Descripción
Blood Transfusions
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C1879316
- SNOMED CT 2011_0131
- 5447007
- MedDRA 14.1
- 10066152
Descripción
Cancer
Tipo de datos
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
Descripción
Bleeding Disorders
Tipo de datos
string
Descripción
Obstructive Sleep Apnea
Tipo de datos
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
Descripción
HAVE YOU HAD ANY MAJOR ILLNESS
Tipo de datos
string
Descripción
DO YOU HAVE DENTURES
Tipo de datos
boolean
Descripción
DO YOU HAVE BRIDGEWORK
Tipo de datos
boolean
Descripción
DO YOU HAVE CAPPED TEETH
Tipo de datos
boolean
Descripción
DO YOU HAVE LOOSE TEETH
Tipo de datos
boolean
Descripción
Are you taking any medications NOW?
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0013227
Descripción
Have you taken steroids in the last 6 months?
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0038317
- SNOMED CT 2011_0131
- 116566001
Descripción
Health History - Women's health
Descripción
DATE OF LAST PERIOD
Tipo de datos
date
Descripción
Are pregnant?
Tipo de datos
boolean
Alias
- UMLS CUI 2011AA
- C0549206
- MedDRA 14.1
- 10036586
Descripción
Weeks Gestation
Tipo de datos
integer
Descripción
EDC
Tipo de datos
date
Descripción
Health History - Substance abuse and Smoking
Descripción
Substance abuse
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0740858
- SNOMED CT 2011_0131
- 66214007
- MedDRA 14.1
- 10066169
- LOINC Version 232
- MTHU019364
Descripción
Do you currently smoke/use tobacco products?
Tipo de datos
boolean
Alias
- UMLS CUI-1
- C0543414
Descripción
What type of tobacco products?
Tipo de datos
string
Descripción
How much?
Tipo de datos
string
Descripción
Have you ever smoked /used tobacco products?
Tipo de datos
boolean
Descripción
When did you quit?(If has used products in the past 12 months,MUST give smoking cessation advice/information)
Tipo de datos
date
Descripción
What type of tobacco products?
Tipo de datos
string
Descripción
How much?
Tipo de datos
string
Descripción
Pediatric Smoking: Does anyone in your household currently use tobacco products?
Tipo de datos
boolean
Descripción
What type of tobacco products?
Tipo de datos
string
Descripción
How much?
Tipo de datos
string
Descripción
Has anyone in the house hold quit using tobacco products in the last 12 months?
Tipo de datos
boolean
Descripción
When did the person in your house hold quit?(If has used products in the past 12 months, MUST give smoking cessation advice/information)
Tipo de datos
date
Descripción
What type of tobacco products?
Tipo de datos
string
Descripción
How much?
Tipo de datos
string
Descripción
Tobacco/Smoking Cessation information/advice given to Patient
Tipo de datos
boolean
Descripción
Tobacco/Smoking Cessation information/advice given to Other
Tipo de datos
boolean
Descripción
In what format was the smoking cessation given (Verbal, Handwritten, Pre-printed)?
Tipo de datos
integer
Descripción
How much alcohol?
Tipo de datos
string
Descripción
How often alcohol?
Tipo de datos
string
Descripción
RECREATIONAL DRUGS
Tipo de datos
string
Descripción
Immunizations
Alias
- UMLS CUI-1
- C0020971
Descripción
SPECIALTY CLINIC specific
Descripción
Nutrition
Descripción
Current body weight
Tipo de datos
float
Unidades de medida
- kg
Alias
- UMLS CUI-1
- C0005910
Descripción
Have you experienced any unexplained weight loss or gain in the past 6 months?
Tipo de datos
boolean
Descripción
As compared to normal, would you rate your food intake during the past month as either: CHANGED- MORE- LESS
Tipo de datos
integer
Descripción
Assistance / Mobility
Descripción
Do you live alone?
Tipo de datos
boolean
Descripción
Does anyone assist you at home?
Tipo de datos
boolean
Alias
- UMLS CUI 2011AA
- C0578564
- SNOMED CT 2011_0131
- 301887005
Descripción
If yes, Name and phone number of person and/or facility that assists
Tipo de datos
string
Descripción
Equipment needed for WOUND(S)
Tipo de datos
string
Descripción
Where is your wound(s) located?
Tipo de datos
string
Alias
- UMLS CUI 2011AA
- C0043250
- SNOMED CT 2011_0131
- 13924000
- MedDRA 14.1
- 10052428
- LOINC Version 232
- MTHU001326
Descripción
How long have you had the wound(s)?
Tipo de datos
date
Descripción
How did the wounds start?
Tipo de datos
string
Descripción
How have you been treating the wound(s)?
Tipo de datos
string
Similar models
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)