ID

11976

Beschrijving

Form from HIS OpenVistA

Trefwoorden

  1. 10-02-12 10-02-12 -
  2. 09-07-15 09-07-15 - Martin Dugas
  3. 28-08-15 28-08-15 - Martin Dugas
Geüploaded op

28 augustus 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy

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CARDIAC REHAB CONSULT RESULTS INTERDISCIPLINARY NOTE

  1. StudyEvent: HIS
    1. HIS
Date, Diagnosis, BMI
Beschrijving

Date, Diagnosis, BMI

DATE REFERRAL RECEIVED
Beschrijving

DATE REFERRAL RECEIVED

Datatype

date

ADMISSION DATE TO CARDIAC REHABILITATION
Beschrijving

ADMISSION DATE TO CARDIAC REHABILITATION

Datatype

date

Diagnose
Beschrijving

Diagnosis

Datatype

string

Alias
UMLS CUI
C0011900
SNOMED CT 2010_0731
439401001
LOINC Version 232
MTHU008876
Gewicht
Beschrijving

Current Weight

Datatype

text

Maateenheden
  • kg
Alias
SNOMED CT 2010_0731
107647005
MedDRA 13.1
10047890
LOINC Version 232
LP18015-5
UMLS CUI [1]
C0005910
kg
Größe
Beschrijving

Current Height

Datatype

float

Maateenheden
  • cm
Alias
LOINC Version 232
MTHU005354
UMLS CUI [1]
C0489786
cm
BMI
Beschrijving

BMI

Datatype

float

Maateenheden
  • kg/m2
Alias
SNOMED CT 2010_0731
140075008
MedDRA 13.1
10005894
LOINC Version 232
LP35925-4
UMLS CUI [1]
C1305855
kg/m2
SYMPTOMS
Beschrijving

SYMPTOMS

Alias
UMLS CUI-1
C1457887
Symptome bei Aufnahme
Beschrijving

SYMPTOMS ON ADMISSION

Datatype

text

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0457453
PAST CARDIAC HISTORY
Beschrijving

PAST CARDIAC HISTORY

Alias
UMLS CUI-1
C0559157
Kardiale Anamnese
Beschrijving

PAST CARDIAC HISTORY

Datatype

text

Alias
UMLS CUI [1]
C0559157
PAST Medical HISTORY
Beschrijving

PAST Medical HISTORY

Alias
UMLS CUI-1
C0262926
Akutes Nierenversagen/Dialyse
Beschrijving

ARF/Dialysis

Datatype

string

Arthritis
Beschrijving

Arthritis

Datatype

string

Alias
UMLS CUI
C0003864
SNOMED CT 2010_0731
3723001
MedDRA 13.1
10003246
LOINC Version 232
MTHU020793
ICD-10-CM Version 2010
M19.90
ICD-9-CM Version 2011
716.9
CTCAE Version 4.03
E12378
Asthma
Beschrijving

Asthma

Datatype

string

Alias
UMLS CUI
C0004096
SNOMED CT 2010_0731
195967001
MedDRA 13.1
10003553
LOINC Version 232
MTHU020815
ICD-10-CM Version 2010
J45
ICD-9-CM Version 2011
493
Krebs
Beschrijving

Cancer

Datatype

string

Alias
UMLS CUI
C0006826
SNOMED CT 2010_0731
363346000
MedDRA 13.1
10028997
LOINC Version 232
MTHU010328
ICD-10-CM Version 2010
C00-C96
COPD
Beschrijving

COPD

Datatype

string

Alias
UMLS CUI
C0024117
SNOMED CT 2010_0731
13645005
MedDRA 13.1
10009033
ICD-10-CM Version 2010
J44.9
ICD-9-CM Version 2011
496
Depression
Beschrijving

Depression

Datatype

string

Alias
UMLS CUI
C0011581
SNOMED CT 2010_0731
35489007
MedDRA 13.1
10012401
ICD-10-CM Version 2010
F32.9
Orthopedic Limitation
Beschrijving

Orthopedic Limitation

Datatype

string

Schilddrüsenerkrankung
Beschrijving

Thyroid Disorder

Datatype

string

Alias
UMLS CUI
C0040128
SNOMED CT 2010_0731
14304000
MedDRA 13.1
10043709
ICD-10-CM Version 2010
E00-E07
ICD-9-CM Version 2011
240-246.99
Other
Beschrijving

Other

Datatype

string

Hoher Blutdruck in der Anamnese
Beschrijving

History of Hypertension

Datatype

text

Alias
UMLS CUI [1]
C0455527
History of Diabetes
Beschrijving

History of Diabetes

Datatype

string

Cholesterol History
Beschrijving

Cholesterol History

Datatype

string

LIPID VALUES THIS ADMISSION
Beschrijving

LIPID VALUES THIS ADMISSION

Datatype

string

Körperliche Aktivität
Beschrijving

Physical Activity

Datatype

string

Alias
UMLS CUI
C0026606
SNOMED CT 2010_0731
68130003
LOINC Version 232
MTHU017278
PERTINENT SOCIAL HISTORY
Beschrijving

PERTINENT SOCIAL HISTORY

Family Status
Beschrijving

Family Status

Datatype

text

Alias
UMLS CUI-1
C0682315
PATIENT LIVES
Beschrijving

PATIENT LIVES

Datatype

string

Beschäftigungsstatus
Beschrijving

Employment Status

Datatype

string

Alias
UMLS CUI
C0242271
SNOMED CT 2010_0731
224362002
Familienanamnese
Beschrijving

Family History

Datatype

string

Alias
UMLS CUI
C0241889
SNOMED CT 2010_0731
57177007
Stress
Beschrijving

Stress/ Psychological Concerns

Datatype

string

Alias
UMLS CUI
C0038435
SNOMED CT 2010_0731
262188008
MedDRA 13.1
10042209
PATIENT APPEARS (Behavior)
Beschrijving

PATIENT APPEARS (Behavior)

Datatype

string

Smoking History
Beschrijving

Smoking History

Alias
UMLS CUI-1
C1519384
Raucher
Beschrijving

Uses tobacco products

Datatype

text

Alias
UMLS CUI-1
C0543414
HOW MUCH Smoking
Beschrijving

HOW MUCH Smoking

Datatype

text

Alias
UMLS CUI-1
C1822491
Quit at time of hospitalization
Beschrijving

Quit at time of hospitalization

Datatype

string

Former smoker(not smoked more than 6 months)
Beschrijving

Former smoker(not smoked more than 6 months)

Datatype

string

Quit smoking in
Beschrijving

Quit smoking in

Datatype

date

Never Smoked
Beschrijving

Never Smoked

Datatype

string

NARRATIVE
Beschrijving

NARRATIVE

Datatype

string

Procedure Date and Results
Beschrijving

Procedure Date and Results

Herzkatheter
Beschrijving

CARDIAC CATHETERIZATION

Datatype

string

Alias
UMLS CUI
C0018795
SNOMED CT 2010_0731
41976001
MedDRA 13.1
10007815
ICD-9-CM Version 2011
37.21
CARDIAC CATHETERIZATION DATE
Beschrijving

CARDIAC CATHETERIZATION DATE

Datatype

string

Ejektionsfraktion (EF)
Beschrijving

Ejection Fraction

Datatype

string

Alias
UMLS CUI
C0232174
SNOMED CT 2010_0731
70822001
LV FUNCTION
Beschrijving

LV FUNCTION

Datatype

string

MARK WITH % OCCLUSIONS
Beschrijving

MARK WITH % OCCLUSIONS

Datatype

string

LM
Beschrijving

LM

Datatype

string

LAD
Beschrijving

LAD

Datatype

string

DIAGONAL
Beschrijving

DIAGONAL

Datatype

string

CX
Beschrijving

CX

Datatype

string

ADDITIONAL COMMENTS
Beschrijving

ADDITIONAL COMMENTS

Datatype

string

PTCI / STENT
Beschrijving

PTCI / STENT

Datatype

string

PTCI DATE
Beschrijving

PTCI DATE

Datatype

string

PTCA
Beschrijving

PTCA

Datatype

text

Alias
UMLS CUI-1
C2936173
STENT
Beschrijving

STENT

Datatype

text

Alias
UMLS CUI-1
C0038257
ATHERECTOMY
Beschrijving

ATHERECTOMY

Datatype

string

IIB/IIA INHIBITOR
Beschrijving

IIB/IIA INHIBITOR

Datatype

string

MARK WITH APPROPRIATE LETTER: PTCA-(P), STENT-(S), ATHERECTOMY-(A)
Beschrijving

MARK WITH APPROPRIATE LETTER: PTCA-(P), STENT-(S), ATHERECTOMY-(A)

Datatype

string

LM
Beschrijving

LM

Datatype

string

LAD
Beschrijving

LAD

Datatype

text

Alias
UMLS CUI-1
C0226032
DIAGONAL
Beschrijving

DIAGONAL

Datatype

string

CX
Beschrijving

CX

Datatype

string

ADDITIONAL COMMENTS
Beschrijving

ADDITIONAL COMMENTS

Datatype

string

SURGERY
Beschrijving

SURGERY

Datatype

string

Koronare Bypassoperation
Beschrijving

CABG

Datatype

string

Alias
UMLS CUI
C0010055
SNOMED CT 2010_0731
232717009
MedDRA 13.1
10011077
ICD-9-CM Version 2011
36.10
DATE CABG
Beschrijving

DATE CABG

Datatype

date

MIDCAB
Beschrijving

MIDCAB

Datatype

string

AVR
Beschrijving

AVR

Datatype

string

MVR
Beschrijving

MVR

Datatype

string

OTHER PROCEDURES
Beschrijving

OTHER PROCEDURES

Datatype

string

CARDIOVASCULAR RISK FACTOR
Beschrijving

CARDIOVASCULAR RISK FACTOR

Datatype

string

CORRELATE A NUMBER WITH GRAFT ORIGIN SITE
Beschrijving

CORRELATE A NUMBER WITH GRAFT ORIGIN SITE

Datatype

string

DONOR AREA TO
Beschrijving

DONOR AREA TO

Datatype

string

LIMA
Beschrijving

LIMA

Datatype

string

RIMA
Beschrijving

RIMA

Datatype

string

RADIAL
Beschrijving

RADIAL

Datatype

string

SVG
Beschrijving

SVG

Datatype

string

RPD
Beschrijving

RPD

Datatype

string

PATIENT/FAMILY EDUCATION
Beschrijving

PATIENT/FAMILY EDUCATION

BOOKLET(S) GIVEN
Beschrijving

BOOKLET(S) GIVEN

Datatype

string

DATE BOOKLET(S) given
Beschrijving

DATE BOOKLET(S) given

Datatype

date

BOOKLET VERSIONS
Beschrijving

BOOKLET VERSIONS

Datatype

string

VIDEO(S) SHOWN
Beschrijving

VIDEO(S) SHOWN

Datatype

string

DATE VIDEO(S) shown
Beschrijving

DATE VIDEO(S) shown

Datatype

string

VIDEO VERSION
Beschrijving

VIDEO VERSION

Datatype

string

LEARNER
Beschrijving

LEARNER

Datatype

string

PATIENT'S PHYSICAL READINESS TO LEARN
Beschrijving

PATIENT'S PHYSICAL READINESS TO LEARN

Datatype

string

PSYCHOLOGICALLY WILLING TO LEARN
Beschrijving

PSYCHOLOGICALLY WILLING TO LEARN

Datatype

string

EDUCATIONAL TOPICS: 1.Description of Cardiac Catheterization and site care, 2.Heart structure and function, 3.Myocardial Infarction symptoms and interventions, 4.Unstable Angina symptoms and interventons, 5.Congestive Heart Failure and importance of daily weights, 6.PTCI (Angioplasty,Stent), 7.Open Heart Surgery
Beschrijving

EDUCATIONAL TOPICS Heart Disease

Datatype

string

EDUCATIONAL TOPICS CORONARY RISK AND MODIFICATION: 1.Tobacco Cessation, 2.Exercise guidelines, aerobic exercise for minimum of 30 minutes, 3.Dietary Modifications, 4.Stress Management, 5.Cholesterol and Triglycerides, 6.Diabetes Management, 7.Obesity, 8.Medication, 9.Hypertension
Beschrijving

EDUCATIONAL TOPICS CORONARY RISK AND MODIFICATION

Datatype

string

DISCHARGE SPECIFIC INSTRUCTIONS: 1.Activity, 2.Site / Incision care, 3.Daily Weight, 4.Returning to work, 5.Driving, 6.Recurrent Chest Pain, 7.Psychosocial, 8.Coumadin, 9.Sex
Beschrijving

DISCHARGE SPECIFIC INSTRUCTIONS

Datatype

string

CARDIAC REHAB NARRATIVE
Beschrijving

CARDIAC REHAB NARRATIVE

Datatype

string

Similar models

  1. StudyEvent: HIS
    1. HIS
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
DATE REFERRAL RECEIVED
Item
DATE REFERRAL RECEIVED
date
ADMISSION DATE TO CARDIAC REHABILITATION
Item
ADMISSION DATE TO CARDIAC REHABILITATION
date
Diagnosis
Item
Diagnose
string
C0011900 (UMLS CUI)
439401001 (SNOMED CT 2010_0731)
MTHU008876 (LOINC Version 232)
Current Weight
Item
Gewicht
text
107647005 (SNOMED CT 2010_0731)
10047890 (MedDRA 13.1)
LP18015-5 (LOINC Version 232)
C0005910 (UMLS CUI [1])
Current Height
Item
Größe
float
MTHU005354 (LOINC Version 232)
C0489786 (UMLS CUI [1])
BMI
Item
BMI
float
140075008 (SNOMED CT 2010_0731)
10005894 (MedDRA 13.1)
LP35925-4 (LOINC Version 232)
C1305855 (UMLS CUI [1])
Item Group
C1457887 (UMLS CUI-1)
SYMPTOMS ON ADMISSION
Item
Symptome bei Aufnahme
text
C1457887 (UMLS CUI [1,1])
C0457453 (UMLS CUI [1,2])
Item Group
C0559157 (UMLS CUI-1)
PAST CARDIAC HISTORY
Item
Kardiale Anamnese
text
C0559157 (UMLS CUI [1])
Item Group
C0262926 (UMLS CUI-1)
ARF/Dialysis
Item
Akutes Nierenversagen/Dialyse
string
Arthritis
Item
Arthritis
string
C0003864 (UMLS CUI)
3723001 (SNOMED CT 2010_0731)
10003246 (MedDRA 13.1)
MTHU020793 (LOINC Version 232)
M19.90 (ICD-10-CM Version 2010)
716.9 (ICD-9-CM Version 2011)
E12378 (CTCAE Version 4.03)
Asthma
Item
Asthma
string
C0004096 (UMLS CUI)
195967001 (SNOMED CT 2010_0731)
10003553 (MedDRA 13.1)
MTHU020815 (LOINC Version 232)
J45 (ICD-10-CM Version 2010)
493 (ICD-9-CM Version 2011)
Cancer
Item
Krebs
string
C0006826 (UMLS CUI)
363346000 (SNOMED CT 2010_0731)
10028997 (MedDRA 13.1)
MTHU010328 (LOINC Version 232)
C00-C96 (ICD-10-CM Version 2010)
COPD
Item
COPD
string
C0024117 (UMLS CUI)
13645005 (SNOMED CT 2010_0731)
10009033 (MedDRA 13.1)
J44.9 (ICD-10-CM Version 2010)
496 (ICD-9-CM Version 2011)
Depression
Item
Depression
string
C0011581 (UMLS CUI)
35489007 (SNOMED CT 2010_0731)
10012401 (MedDRA 13.1)
F32.9 (ICD-10-CM Version 2010)
Orthopedic Limitation
Item
Orthopedic Limitation
string
Thyroid Disorder
Item
Schilddrüsenerkrankung
string
C0040128 (UMLS CUI)
14304000 (SNOMED CT 2010_0731)
10043709 (MedDRA 13.1)
E00-E07 (ICD-10-CM Version 2010)
240-246.99 (ICD-9-CM Version 2011)
Other
Item
Other
string
History of Hypertension
Item
Hoher Blutdruck in der Anamnese
text
C0455527 (UMLS CUI [1])
History of Diabetes
Item
History of Diabetes
string
Cholesterol History
Item
Cholesterol History
string
LIPID VALUES THIS ADMISSION
Item
LIPID VALUES THIS ADMISSION
string
Physical Activity
Item
Körperliche Aktivität
string
C0026606 (UMLS CUI)
68130003 (SNOMED CT 2010_0731)
MTHU017278 (LOINC Version 232)
Family Status
Item
Family Status
text
C0682315 (UMLS CUI-1)
PATIENT LIVES
Item
PATIENT LIVES
string
Employment Status
Item
Beschäftigungsstatus
string
C0242271 (UMLS CUI)
224362002 (SNOMED CT 2010_0731)
Family History
Item
Familienanamnese
string
C0241889 (UMLS CUI)
57177007 (SNOMED CT 2010_0731)
Stress/ Psychological Concerns
Item
Stress
string
C0038435 (UMLS CUI)
262188008 (SNOMED CT 2010_0731)
10042209 (MedDRA 13.1)
PATIENT APPEARS (Behavior)
Item
PATIENT APPEARS (Behavior)
string
Item Group
C1519384 (UMLS CUI-1)
Uses tobacco products
Item
Raucher
text
C0543414 (UMLS CUI-1)
HOW MUCH Smoking
Item
HOW MUCH Smoking
text
C1822491 (UMLS CUI-1)
Quit at time of hospitalization
Item
Quit at time of hospitalization
string
Former smoker(not smoked more than 6 months)
Item
Former smoker(not smoked more than 6 months)
string
Quit smoking in
Item
Quit smoking in
date
Never Smoked
Item
Never Smoked
string
NARRATIVE
Item
NARRATIVE
string
CARDIAC CATHETERIZATION
Item
Herzkatheter
string
C0018795 (UMLS CUI)
41976001 (SNOMED CT 2010_0731)
10007815 (MedDRA 13.1)
37.21 (ICD-9-CM Version 2011)
CARDIAC CATHETERIZATION DATE
Item
CARDIAC CATHETERIZATION DATE
string
Ejection Fraction
Item
Ejektionsfraktion (EF)
string
C0232174 (UMLS CUI)
70822001 (SNOMED CT 2010_0731)
LV FUNCTION
Item
LV FUNCTION
string
MARK WITH % OCCLUSIONS
Item
MARK WITH % OCCLUSIONS
string
LM
Item
LM
string
LAD
Item
LAD
string
DIAGONAL
Item
DIAGONAL
string
CX
Item
CX
string
ADDITIONAL COMMENTS
Item
ADDITIONAL COMMENTS
string
PTCI / STENT
Item
PTCI / STENT
string
PTCI DATE
Item
PTCI DATE
string
PTCA
Item
PTCA
text
C2936173 (UMLS CUI-1)
STENT
Item
STENT
text
C0038257 (UMLS CUI-1)
ATHERECTOMY
Item
ATHERECTOMY
string
IIB/IIA INHIBITOR
Item
IIB/IIA INHIBITOR
string
MARK WITH APPROPRIATE LETTER: PTCA-(P), STENT-(S), ATHERECTOMY-(A)
Item
MARK WITH APPROPRIATE LETTER: PTCA-(P), STENT-(S), ATHERECTOMY-(A)
string
LM
Item
LM
string
LAD
Item
LAD
text
C0226032 (UMLS CUI-1)
DIAGONAL
Item
DIAGONAL
string
CX
Item
CX
string
ADDITIONAL COMMENTS
Item
ADDITIONAL COMMENTS
string
SURGERY
Item
SURGERY
string
CABG
Item
Koronare Bypassoperation
string
C0010055 (UMLS CUI)
232717009 (SNOMED CT 2010_0731)
10011077 (MedDRA 13.1)
36.10 (ICD-9-CM Version 2011)
DATE CABG
Item
DATE CABG
date
MIDCAB
Item
MIDCAB
string
AVR
Item
AVR
string
MVR
Item
MVR
string
OTHER PROCEDURES
Item
OTHER PROCEDURES
string
CARDIOVASCULAR RISK FACTOR
Item
CARDIOVASCULAR RISK FACTOR
string
CORRELATE A NUMBER WITH GRAFT ORIGIN SITE
Item
CORRELATE A NUMBER WITH GRAFT ORIGIN SITE
string
DONOR AREA TO
Item
DONOR AREA TO
string
LIMA
Item
LIMA
string
RIMA
Item
RIMA
string
RADIAL
Item
RADIAL
string
SVG
Item
SVG
string
RPD
Item
RPD
string
BOOKLET(S) GIVEN
Item
BOOKLET(S) GIVEN
string
DATE BOOKLET(S) given
Item
DATE BOOKLET(S) given
date
BOOKLET VERSIONS
Item
BOOKLET VERSIONS
string
VIDEO(S) SHOWN
Item
VIDEO(S) SHOWN
string
DATE VIDEO(S) shown
Item
DATE VIDEO(S) shown
string
VIDEO VERSION
Item
VIDEO VERSION
string
LEARNER
Item
LEARNER
string
PATIENT'S PHYSICAL READINESS TO LEARN
Item
PATIENT'S PHYSICAL READINESS TO LEARN
string
PSYCHOLOGICALLY WILLING TO LEARN
Item
PSYCHOLOGICALLY WILLING TO LEARN
string
EDUCATIONAL TOPICS Heart Disease
Item
EDUCATIONAL TOPICS: 1.Description of Cardiac Catheterization and site care, 2.Heart structure and function, 3.Myocardial Infarction symptoms and interventions, 4.Unstable Angina symptoms and interventons, 5.Congestive Heart Failure and importance of daily weights, 6.PTCI (Angioplasty,Stent), 7.Open Heart Surgery
string
EDUCATIONAL TOPICS CORONARY RISK AND MODIFICATION
Item
EDUCATIONAL TOPICS CORONARY RISK AND MODIFICATION: 1.Tobacco Cessation, 2.Exercise guidelines, aerobic exercise for minimum of 30 minutes, 3.Dietary Modifications, 4.Stress Management, 5.Cholesterol and Triglycerides, 6.Diabetes Management, 7.Obesity, 8.Medication, 9.Hypertension
string
DISCHARGE SPECIFIC INSTRUCTIONS
Item
DISCHARGE SPECIFIC INSTRUCTIONS: 1.Activity, 2.Site / Incision care, 3.Daily Weight, 4.Returning to work, 5.Driving, 6.Recurrent Chest Pain, 7.Psychosocial, 8.Coumadin, 9.Sex
string
CARDIAC REHAB NARRATIVE
Item
CARDIAC REHAB NARRATIVE
string

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