ID
187
Beschrijving
Form from HIS OpenVistA
Trefwoorden
Versies (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
Geüploaded op
18 februari 2012
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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HIS HEALTH HISTORY I_ANESTHESIA MULTIDISCIPLINARY
HIS
- StudyEvent: HIS
Beschrijving
Anesthesia Specific
Beschrijving
Allergies
Datatype
string
Alias
- UMLS CUI 2011AA
- C0020517
- SNOMED CT 2011_0131
- 257550005
- ICD-10-CM Version 2010
- T78.40
Beschrijving
Are you allergic to adhesive tape?
Datatype
boolean
Beschrijving
Are you allergic to rubber products?
Datatype
boolean
Beschrijving
Previous Surgeries?
Datatype
string
Beschrijving
Surgery involving an anesthetic?
Datatype
string
Beschrijving
General Anesthesia
Datatype
boolean
Alias
- UMLS CUI 2011AA
- C0002915
- SNOMED CT 2011_0131
- 50697003
- MedDRA 14.1
- 10018060
Beschrijving
Spinal Anesthesia
Datatype
boolean
Alias
- UMLS CUI 2011AA
- C0002928
- SNOMED CT 2011_0131
- 231249005
- MedDRA 14.1
- 10041536
Beschrijving
Epidural anaesthesia
Datatype
boolean
Alias
- UMLS CUI 2011AA
- C0002913
- SNOMED CT 2011_0131
- 18946005
- MedDRA 14.1
- 10015011
Beschrijving
Regional anesthesia
Datatype
boolean
Alias
- UMLS CUI 2011AA
- C0002911
- SNOMED CT 2011_0131
- 27372005
Beschrijving
Local anesthesia
Datatype
boolean
Alias
- UMLS CUI 2011AA
- C0002921
- SNOMED CT 2011_0131
- 386761002
- MedDRA 14.1
- 10024758
Beschrijving
anesthetic: Moderate sedation
Datatype
boolean
Beschrijving
anesthetic: Axillary block
Datatype
boolean
Beschrijving
Have you or a family member ever had a problem with an anesthesic? If Yes, describe:
Datatype
string
Beschrijving
Health History - Endocrine
Beschrijving
Diabetes
Datatype
boolean
Alias
- UMLS CUI 2011AA
- C0011849
- SNOMED CT 2011_0131
- 191044006
Beschrijving
If Diabetes, last time med taken
Datatype
string
Beschrijving
Hyperthyroidism
Datatype
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
Beschrijving
Hypothyroidism
Datatype
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
Beschrijving
Health History - Neurologic
Beschrijving
CVA/Stroke/TIA
Datatype
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
Beschrijving
Seizures
Datatype
string
Alias
- UMLS CUI 2011AA
- C0036572
- SNOMED CT 2011_0131
- 91175000
- MedDRA 14.1
- 10039910
- ICD-9-CM Version 2011
- 780.39
Beschrijving
Numbness/Tingling to Arms/Legs
Datatype
string
Alias
- UMLS CUI 2011AA
- C0028643
- SNOMED CT 2011_0131
- 44077006
- MedDRA 14.1
- 10029829
- ICD-9-CM Version 2011
- 782.0
Beschrijving
Migraines and/or Headaches
Datatype
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
Beschrijving
Blackout or Fainting Spells
Datatype
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
Beschrijving
Health History - Cardiovascular
Beschrijving
Heart Attack/MI
Datatype
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
Beschrijving
High Blood Pressure
Datatype
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
Beschrijving
Rapid Heart Rate
Datatype
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
Beschrijving
Irregular Heart Beat
Datatype
string
Alias
- UMLS CUI 2011AA
- C0003811
- SNOMED CT 2011_0131
- 44808001
- MedDRA 14.1
- 10003119
- ICD-9-CM Version 2011
- 427.9
Beschrijving
Cardiovascular Disease, Stents, Angioplasty, Heart Catherization
Datatype
string
Alias
- UMLS CUI 2011AA
- C0007222
- SNOMED CT 2011_0131
- 105980002
- MedDRA 14.1
- 10007649
- ICD-9-CM Version 2011
- 429.2
Beschrijving
Chest Pain/Angina
Datatype
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
Beschrijving
Health History - Respiratory
Beschrijving
Lung Disease
Datatype
string
Alias
- UMLS CUI 2011AA
- C0024115
- SNOMED CT 2011_0131
- 19829001
- MedDRA 14.1
- 10025082
- ICD-10-CM Version 2010
- J98.4
Beschrijving
Congestive Heart Failure
Datatype
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
Beschrijving
Chronic Cough
Datatype
string
Alias
- UMLS CUI 2011AA
- C0010201
- SNOMED CT 2011_0131
- 68154008
- MedDRA 14.1
- 10066656
Beschrijving
Asthma/Wheezing
Datatype
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
Beschrijving
COPD/Bronchitis/Emphysema
Datatype
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
Beschrijving
Pneumonia
Datatype
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
Beschrijving
Health History - Genitourinary
Beschrijving
Abnormal Kidney function
Datatype
string
Alias
- UMLS CUI 2011AA
- C1565489
- MedDRA 14.1
- 10038474
Beschrijving
On Hemodialysis
Datatype
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
Beschrijving
On Peritoneal Dialysis
Datatype
boolean
Alias
- UMLS CUI 2011AA
- C0031139
- SNOMED CT 2011_0131
- 71192002
- MedDRA 14.1
- 10034660
- ICD-9-CM Version 2011
- 54.98
Beschrijving
Health History - Gastrointestinal
Beschrijving
Yellow Jaundice
Datatype
string
Alias
- UMLS CUI 2011AA
- C0022346
- SNOMED CT 2011_0131
- 18165001
- MedDRA 14.1
- 10023126
- ICD-10-CM Version 2010
- R17
Beschrijving
Hepatitis/Liver Disease
Datatype
string
Alias
- UMLS CUI 2011AA
- C0019158
- SNOMED CT 2011_0131
- 29001004
- MedDRA 14.1
- 10019717
Beschrijving
Freq. Indigestion/Reflux Disease
Datatype
string
Alias
- UMLS CUI 2011AA
- C0558176
- SNOMED CT 2011_0131
- 225587003
Beschrijving
Gastric Ulcers
Datatype
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
Beschrijving
Health History - Other
Beschrijving
Bleed or Bruise Easily
Datatype
string
Alias
- UMLS CUI 2011AA
- C1458140
- SNOMED CT 2011_0131
- 248250000
- MedDRA 14.1
- 10005134
Beschrijving
Blood Transfusions
Datatype
string
Alias
- UMLS CUI 2011AA
- C1879316
- SNOMED CT 2011_0131
- 5447007
- MedDRA 14.1
- 10066152
Beschrijving
Cancer
Datatype
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
Beschrijving
Bleeding Disorders
Datatype
string
Beschrijving
Obstructive Sleep Apnea
Datatype
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
Beschrijving
HAVE YOU HAD ANY MAJOR ILLNESS
Datatype
string
Beschrijving
DO YOU HAVE DENTURES
Datatype
boolean
Beschrijving
DO YOU HAVE BRIDGEWORK
Datatype
boolean
Beschrijving
DO YOU HAVE CAPPED TEETH
Datatype
boolean
Beschrijving
DO YOU HAVE LOOSE TEETH
Datatype
boolean
Beschrijving
Are you taking any medications NOW?
Datatype
string
Alias
- UMLS CUI 2011AA
- C0013227
Beschrijving
Have you taken steroids in the last 6 months?
Datatype
string
Alias
- UMLS CUI 2011AA
- C0038317
- SNOMED CT 2011_0131
- 116566001
Beschrijving
Health History - Women's health
Beschrijving
DATE OF LAST PERIOD
Datatype
date
Beschrijving
Are pregnant?
Datatype
boolean
Alias
- UMLS CUI 2011AA
- C0549206
- MedDRA 14.1
- 10036586
Beschrijving
Weeks Gestation
Datatype
integer
Beschrijving
EDC
Datatype
date
Beschrijving
Health History - Substance abuse and Smoking
Beschrijving
Substance abuse
Datatype
string
Alias
- UMLS CUI 2011AA
- C0740858
- SNOMED CT 2011_0131
- 66214007
- MedDRA 14.1
- 10066169
- LOINC Version 232
- MTHU019364
Beschrijving
Do you currently smoke/use tobacco products?
Datatype
boolean
Alias
- UMLS CUI 2011AA
- CL025861
Beschrijving
What type of tobacco products?
Datatype
string
Beschrijving
How much?
Datatype
string
Beschrijving
Have you ever smoked /used tobacco products?
Datatype
boolean
Beschrijving
When did you quit?(If has used products in the past 12 months,MUST give smoking cessation advice/information)
Datatype
date
Beschrijving
What type of tobacco products?
Datatype
string
Beschrijving
How much?
Datatype
string
Beschrijving
Pediatric Smoking: Does anyone in your household currently use tobacco products?
Datatype
boolean
Beschrijving
What type of tobacco products?
Datatype
string
Beschrijving
How much?
Datatype
string
Beschrijving
Has anyone in the house hold quit using tobacco products in the last 12 months?
Datatype
boolean
Beschrijving
When did the person in your house hold quit?(If has used products in the past 12 months, MUST give smoking cessation advice/information)
Datatype
date
Beschrijving
What type of tobacco products?
Datatype
string
Beschrijving
How much?
Datatype
string
Beschrijving
Tobacco/Smoking Cessation information/advice given to Patient
Datatype
boolean
Beschrijving
Tobacco/Smoking Cessation information/advice given to Other
Datatype
boolean
Beschrijving
In what format was the smoking cessation given (Verbal, Handwritten, Pre-printed)?
Datatype
integer
Beschrijving
How much alcohol?
Datatype
string
Beschrijving
How often alcohol?
Datatype
string
Beschrijving
RECREATIONAL DRUGS
Datatype
string
Beschrijving
Immunizations
Beschrijving
SPECIALTY CLINIC specific
Beschrijving
Nutrition
Beschrijving
Current Weight
Datatype
integer
Beschrijving
Have you experienced any unexplained weight loss or gain in the past 6 months?
Datatype
boolean
Beschrijving
As compared to normal, would you rate your food intake during the past month as either: CHANGED- MORE- LESS
Datatype
integer
Beschrijving
Assistance / Mobility
Beschrijving
Do you live alone?
Datatype
boolean
Beschrijving
Does anyone assist you at home?
Datatype
boolean
Alias
- UMLS CUI 2011AA
- C0578564
- SNOMED CT 2011_0131
- 301887005
Beschrijving
If yes, Name and phone number of person and/or facility that assists
Datatype
string
Beschrijving
Equipment needed for WOUND(S)
Datatype
string
Beschrijving
Where is your wound(s) located?
Datatype
string
Alias
- UMLS CUI 2011AA
- C0043250
- SNOMED CT 2011_0131
- 13924000
- MedDRA 14.1
- 10052428
- LOINC Version 232
- MTHU001326
Beschrijving
How long have you had the wound(s)?
Datatype
date
Beschrijving
How did the wounds start?
Datatype
string
Beschrijving
How have you been treating the wound(s)?
Datatype
string
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