ID
187
Beskrivning
Form from HIS OpenVistA
Nyckelord
Versioner (4)
- 2012-02-18 2012-02-18 -
- 2014-08-07 2014-08-07 - Martin Dugas
- 2014-08-09 2014-08-09 - Martin Dugas
- 2015-06-26 2015-06-26 - Martin Dugas
Uppladdad den
18 februari 2012
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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HIS HEALTH HISTORY I_ANESTHESIA MULTIDISCIPLINARY
HIS
- StudyEvent: HIS
Beskrivning
Anesthesia Specific
Beskrivning
Allergies
Datatyp
string
Alias
- UMLS CUI 2011AA
- C0020517
- SNOMED CT 2011_0131
- 257550005
- ICD-10-CM Version 2010
- T78.40
Beskrivning
Are you allergic to adhesive tape?
Datatyp
boolean
Beskrivning
Are you allergic to rubber products?
Datatyp
boolean
Beskrivning
Previous Surgeries?
Datatyp
string
Beskrivning
Surgery involving an anesthetic?
Datatyp
string
Beskrivning
General Anesthesia
Datatyp
boolean
Alias
- UMLS CUI 2011AA
- C0002915
- SNOMED CT 2011_0131
- 50697003
- MedDRA 14.1
- 10018060
Beskrivning
Spinal Anesthesia
Datatyp
boolean
Alias
- UMLS CUI 2011AA
- C0002928
- SNOMED CT 2011_0131
- 231249005
- MedDRA 14.1
- 10041536
Beskrivning
Epidural anaesthesia
Datatyp
boolean
Alias
- UMLS CUI 2011AA
- C0002913
- SNOMED CT 2011_0131
- 18946005
- MedDRA 14.1
- 10015011
Beskrivning
Regional anesthesia
Datatyp
boolean
Alias
- UMLS CUI 2011AA
- C0002911
- SNOMED CT 2011_0131
- 27372005
Beskrivning
Local anesthesia
Datatyp
boolean
Alias
- UMLS CUI 2011AA
- C0002921
- SNOMED CT 2011_0131
- 386761002
- MedDRA 14.1
- 10024758
Beskrivning
anesthetic: Moderate sedation
Datatyp
boolean
Beskrivning
anesthetic: Axillary block
Datatyp
boolean
Beskrivning
Have you or a family member ever had a problem with an anesthesic? If Yes, describe:
Datatyp
string
Beskrivning
Health History - Endocrine
Beskrivning
Diabetes
Datatyp
boolean
Alias
- UMLS CUI 2011AA
- C0011849
- SNOMED CT 2011_0131
- 191044006
Beskrivning
If Diabetes, last time med taken
Datatyp
string
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
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
Beskrivning
Health History - Neurologic
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
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
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
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
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
Beskrivning
Health History - Cardiovascular
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
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
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
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
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
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
Beskrivning
Health History - Respiratory
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
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
Beskrivning
Chronic Cough
Datatyp
string
Alias
- UMLS CUI 2011AA
- C0010201
- SNOMED CT 2011_0131
- 68154008
- MedDRA 14.1
- 10066656
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
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
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
Beskrivning
Health History - Genitourinary
Beskrivning
Abnormal Kidney function
Datatyp
string
Alias
- UMLS CUI 2011AA
- C1565489
- MedDRA 14.1
- 10038474
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
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
Beskrivning
Health History - Gastrointestinal
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
Beskrivning
Hepatitis/Liver Disease
Datatyp
string
Alias
- UMLS CUI 2011AA
- C0019158
- SNOMED CT 2011_0131
- 29001004
- MedDRA 14.1
- 10019717
Beskrivning
Freq. Indigestion/Reflux Disease
Datatyp
string
Alias
- UMLS CUI 2011AA
- C0558176
- SNOMED CT 2011_0131
- 225587003
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
Beskrivning
Health History - Other
Beskrivning
Bleed or Bruise Easily
Datatyp
string
Alias
- UMLS CUI 2011AA
- C1458140
- SNOMED CT 2011_0131
- 248250000
- MedDRA 14.1
- 10005134
Beskrivning
Blood Transfusions
Datatyp
string
Alias
- UMLS CUI 2011AA
- C1879316
- SNOMED CT 2011_0131
- 5447007
- MedDRA 14.1
- 10066152
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
Beskrivning
Bleeding Disorders
Datatyp
string
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
Beskrivning
HAVE YOU HAD ANY MAJOR ILLNESS
Datatyp
string
Beskrivning
DO YOU HAVE DENTURES
Datatyp
boolean
Beskrivning
DO YOU HAVE BRIDGEWORK
Datatyp
boolean
Beskrivning
DO YOU HAVE CAPPED TEETH
Datatyp
boolean
Beskrivning
DO YOU HAVE LOOSE TEETH
Datatyp
boolean
Beskrivning
Are you taking any medications NOW?
Datatyp
string
Alias
- UMLS CUI 2011AA
- C0013227
Beskrivning
Have you taken steroids in the last 6 months?
Datatyp
string
Alias
- UMLS CUI 2011AA
- C0038317
- SNOMED CT 2011_0131
- 116566001
Beskrivning
Health History - Women's health
Beskrivning
DATE OF LAST PERIOD
Datatyp
date
Beskrivning
Are pregnant?
Datatyp
boolean
Alias
- UMLS CUI 2011AA
- C0549206
- MedDRA 14.1
- 10036586
Beskrivning
Weeks Gestation
Datatyp
integer
Beskrivning
EDC
Datatyp
date
Beskrivning
Health History - Substance abuse and Smoking
Beskrivning
Substance abuse
Datatyp
string
Alias
- UMLS CUI 2011AA
- C0740858
- SNOMED CT 2011_0131
- 66214007
- MedDRA 14.1
- 10066169
- LOINC Version 232
- MTHU019364
Beskrivning
Do you currently smoke/use tobacco products?
Datatyp
boolean
Alias
- UMLS CUI 2011AA
- CL025861
Beskrivning
What type of tobacco products?
Datatyp
string
Beskrivning
How much?
Datatyp
string
Beskrivning
Have you ever smoked /used tobacco products?
Datatyp
boolean
Beskrivning
When did you quit?(If has used products in the past 12 months,MUST give smoking cessation advice/information)
Datatyp
date
Beskrivning
What type of tobacco products?
Datatyp
string
Beskrivning
How much?
Datatyp
string
Beskrivning
Pediatric Smoking: Does anyone in your household currently use tobacco products?
Datatyp
boolean
Beskrivning
What type of tobacco products?
Datatyp
string
Beskrivning
How much?
Datatyp
string
Beskrivning
Has anyone in the house hold quit using tobacco products in the last 12 months?
Datatyp
boolean
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
Beskrivning
What type of tobacco products?
Datatyp
string
Beskrivning
How much?
Datatyp
string
Beskrivning
Tobacco/Smoking Cessation information/advice given to Patient
Datatyp
boolean
Beskrivning
Tobacco/Smoking Cessation information/advice given to Other
Datatyp
boolean
Beskrivning
In what format was the smoking cessation given (Verbal, Handwritten, Pre-printed)?
Datatyp
integer
Beskrivning
How much alcohol?
Datatyp
string
Beskrivning
How often alcohol?
Datatyp
string
Beskrivning
RECREATIONAL DRUGS
Datatyp
string
Beskrivning
Immunizations
Beskrivning
SPECIALTY CLINIC specific
Beskrivning
Nutrition
Beskrivning
Current Weight
Datatyp
integer
Beskrivning
Have you experienced any unexplained weight loss or gain in the past 6 months?
Datatyp
boolean
Beskrivning
As compared to normal, would you rate your food intake during the past month as either: CHANGED- MORE- LESS
Datatyp
integer
Beskrivning
Assistance / Mobility
Beskrivning
Do you live alone?
Datatyp
boolean
Beskrivning
Does anyone assist you at home?
Datatyp
boolean
Alias
- UMLS CUI 2011AA
- C0578564
- SNOMED CT 2011_0131
- 301887005
Beskrivning
If yes, Name and phone number of person and/or facility that assists
Datatyp
string
Beskrivning
Equipment needed for WOUND(S)
Datatyp
string
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
Beskrivning
How long have you had the wound(s)?
Datatyp
date
Beskrivning
How did the wounds start?
Datatyp
string
Beskrivning
How have you been treating the wound(s)?
Datatyp
string
Similar models
HIS
- StudyEvent: HIS
397669002 (SNOMED CT 2011_0131)
107647005 (SNOMED CT 2011_0131)
10047890 (MedDRA 14.1)
LP18015-5 (LOINC Version 232)
78564009 (SNOMED CT 2011_0131)
10037485 (MedDRA 14.1)
86290005 (SNOMED CT 2011_0131)
10038709 (MedDRA 14.1)
MTHU008344 (LOINC Version 232)
446050000, 59058001 (SNOMED CT 2011_0131)
PCP (HL7 V3 2006_05)
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)
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)
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)
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)
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)