DISCHARGE SUMMARY

Form from HIS OpenVistA

  1. StudyEvent: HIS
    1. HIS
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
DISCHARGE SUMMARY
C0552421 (UMLS CUI-1)
Final Diagnosis
Item
Final Diagnosis
string
C0011900 (UMLS CUI 2011AA)
439401001 (SNOMED CT 2011_0131)
MTHU008876 (LOINC Version 232)
ACTIVE PROBLEM LIST
Item
ACTIVE PROBLEM LIST
string
C0552582 (UMLS CUI 2011AA)
LP73189-0 (LOINC Version 232)
HOSPITALIZATION SUMMARY
Item
HOSPITALIZATION SUMMARY
string
C1317307 (UMLS CUI 2011AA)
LP72467-1 (LOINC Version 232)
OPERATIONS / PROCEDURES
Item
OPERATIONS / PROCEDURES
string
C0087111 (UMLS CUI 2011AA)
LABS: Prior 24 hour labs
Item
Lab Findings
string
C0587081 (UMLS CUI 2011AA)
118246004 (SNOMED CT 2011_0131)
NARRATIVE
Item
NARRATIVE
text
C1135957 (UMLS CUI [1])
Transfusions or tissue transplants
Item
Transfusions/tissue transplants
text
C1879316 (UMLS CUI [1,1])
C0348047 (UMLS CUI [1,2])
Item
CONDITION AT DISCHARGE
integer
C0586514 (UMLS CUI [1])
Code List
CONDITION AT DISCHARGE
CL Item
stable (1)
C0205360 (UMLS CUI-1)
CL Item
improved (2)
C0184511 (UMLS CUI-1)
CL Item
unchanged (3)
C0442739 (UMLS CUI-1)
Condition at discharge comment
Item
Condition at discharge comment
text
C0586514 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
DISCHARGE INSTRUCTIONS
Item
DISCHARGE INSTRUCTIONS
text
LP72753-4 (LOINC Version 232)
C3858559 (UMLS CUI [1])
Item Group
MEDICATIONS
C0013227 (UMLS CUI-1)
Inpatient Medications
Item
Inpatient Medications
text
C0013227 (UMLS CUI [1,1])
C0021562 (UMLS CUI [1,2])
Home Medications
Item
Home Medications
text
C0013227 (UMLS CUI [1,1])
C0442519 (UMLS CUI [1,2])
Discharge Medications
Item
Discharge Medications
string
C0489553 (UMLS CUI 2011AA)
LP72754-2 (LOINC Version 232)
Item Group
Nutrition and Care
C1444313 (UMLS CUI-1)
NUTRITION STATUS
Item
NUTRITION STATUS
text
LP79846-9 (LOINC Version 232)
C0392209 (UMLS CUI [1])
DISCHARGE DIET
Item
DISCHARGE DIET
string
C1657597 (UMLS CUI 2011AA)
LP74004-0 (LOINC Version 232)
HOME CARE
Item
HOME CARE
string
C0204977 (UMLS CUI 2011AA)
Item Group
DISCHARGE RETURN INSTRUCTIONS
C0517773 (UMLS CUI-1)
RETURN TO SEE NURSE
Item
RETURN TO SEE NURSE
boolean
C1319415 (UMLS CUI [1])
Physician follow-up
Item
RETURN TO SEE MD
boolean
C0807395 (UMLS CUI [1])
Next appointment
Item
Next appointment
date
C1272171 (UMLS CUI 2011AA)
389837003 (SNOMED CT 2011_0131)

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