Relevant Patient Information Templates
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## Relevant Patient Information Templates

### TID 9000 Relevant Patient Information for Breast Imaging

This template collects a patient's relevant information as it relates to breast imaging. This template, together with its subordinate templates, describes the history of a patient's reproductive system, hormone medications, past procedures, risk factors, and indicated problems as they relate to breast health.

Type:

  Extensible

Order:

  Significant

Table TID 9000. Relevant Patient Information for Breast Imaging

| NL | Rel with Parent | VT | Concept Name | VM | Req Type | Condition | Value Set Constraint
--- | --- | --- | --- | --- | --- | --- | --- | ---
1 |  |  | CONTAINER | EV (111511, DCM, "Relevant Patient Information for Breast Imaging") | 1 | M |  |
2 | > | HAS CONCEPT MOD | INCLUDE | DTID 1204 “Language of Content Item and Descendants” | 1 | M |  |
3 | > | CONTAINS | INCLUDE | DTID 3114 “Patient Assessment” | 1 | U |  |
4 | > | CONTAINS | INCLUDE | DTID 9001 “Gynecological History” | 1 | U |  |
5 | > | CONTAINS | INCLUDE | DTID 9002 “Medication, Substance, Environmental Exposure” | 1 | U |  | $ContainerConcept = EV (10160-0, LN, "History Of Medication Use") $CodeConcept = EV (111516, DCM, "Medication Type") $CodeValue = DCID 6080 “Gynecological Hormones”
6 | > | CONTAINS | INCLUDE | DTID 9003 “Previous Procedure” | 1 | U |  | $ProcedureList = DCID 6083 “Procedures for Breast” $ProcedureModifier = DCID 6058 “Procedure Modifiers for Breast” $NumConceptName = DCID 6095 “Numeric Properties of Procedures” $LateralityValue = DCID 6022 “Side” $ProcedureResult = DCID 6063 “Interventional Procedure Results” $ComplicationValue = DCID 6062 “Interventional Procedure Complications”
7 | > | CONTAINS | INCLUDE | DTID 9004 “Indicated Problem” | 1 | U |  | $ProblemList = DCID 6055 “Breast Clinical Finding Or Indicated Problem” $LateralityValue = DCID 6022 “Side” $LocationValue = DCID 6018 “Clockface Location or Region”, DCID 6020 “Quadrant Location”
8 | > | CONTAINS | INCLUDE | DTID 9005 “Risk Factor” | 1 | U |  | $RiskList = DCID 6081 “Breast Cancer Risk Factors” $FamilyList = DCID 7451 “Family Member”

### TID 9001 Gynecological History

This general template collects the details of a patient's reproductive system history, such as number of births, and gynecological surgery history.

Type:

  Extensible

Order:

  Significant

Table TID 9001. Gynecological History

| NL | Rel with Parent | VT | Concept Name | VM | Req Type | Condition | Value Set Constraint
--- | --- | --- | --- | --- | --- | --- | --- | ---
1 |  |  | CONTAINER | EV (R-20767, SRT, "Gynecological History") | 1 | M |  |
2 | > | HAS OBS CONTEXT | CODE | EV (111534, DCM, "Role of person reporting") | 1 | U |  | DCID 7450 “Person Roles”
3 | > | CONTAINS | DATE | EV (11955-2, LN, "Date of last menstrual period") | 1 | U |  |
4 | > | CONTAINS | NUM | EV (111518, DCM, "Age when first menstrual period occurred") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
5 | > | CONTAINS | NUM | EV (111519, DCM, "Age at First Full Term Pregnancy") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
6 | > | CONTAINS | NUM | EV (11977-6, LN, "Para") | 1 | U |  | UNITS = EV (1, UCUM, "no units")
7 | > | CONTAINS | NUM | EV (11639-2, LN, "Term") | 1 | U |  | UNITS = EV (1, UCUM, "no units")
8 | > | CONTAINS | NUM | EV (11637-6, LN, "Preterm") | 1 | U |  | UNITS = EV (1, UCUM, "no units")
9 | > | CONTAINS | NUM | EV (11636-8, LN, "Live Births") | 1 | U |  | UNITS = EV (1, UCUM, "no units")
10 | > | CONTAINS | NUM | EV (111593, DCM, "LBW or IUGR") | 1 | U |  | UNITS = EV (1, UCUM, "no units")
11 | > | CONTAINS | NUM | EV (11996-6, LN, "Gravida") | 1 | U |  | UNITS = EV (1, UCUM, "no units")
12 | > | CONTAINS | NUM | EV (11612-9, LN, "Aborta") | 1 | U |  | UNITS = EV (1, UCUM, "no units")
13 | > | CONTAINS | NUM | EV (33065-4, LN, "Ectopic Pregnancies") | 1 | U |  | UNITS = EV (1, UCUM, "no units")
14 | > | CONTAINS | NUM | EV (111520, DCM, "Age at Menopause") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
15 | > | CONTAINS | NUM | EV (111521, DCM, "Age when hysterectomy performed") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
16 | >> | HAS CONCEPT MOD | CODE | EV (R-404ED, SRT, "Extent") | 1 | U |  | EV (R-404F1, SRT, "Complete") EV (R-404FE, SRT, "Partial")
17 | > | CONTAINS | NUM | EV (111522, DCM, "Age when left ovary removed") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
18 | > | CONTAINS | NUM | EV (111523, DCM, "Age when right ovary removed") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
19 | > | CONTAINS | CODE | EV (111543, DCM, "Breast feeding history") | 1 | U |  | DCID 230 “Yes-No”
20 | >> | HAS PROPERTIES | NUM | EV (111544, DCM, "Average breast feeding period") | 1 | U |  | UNITS = EV (wk, UCUM, "Week")
21 | > | CONTAINS | CODE | EV (111532, DCM, "Pregnancy Status") | 1 | U |  | DCID 6096 “Pregnancy Status”
22 | > | CONTAINS | CODE | EV (111391, DCM, "Menstrual Cycle Phase") | 1 | U |  | DCID 6163 “Menstrual Cycle Phase”

### TID 9002 Medication, Substance, Environmental Exposure

This general template provides detailed information on a patient's medication or substance use, or exposure to environmental factors, including type and duration of use or exposure.

Table TID 9002. Parameters

Parameter Name | Parameter Usage
--- | ---
$ContainerConcept | Coded term for the concept name of the CONTAINER, identifying it as medication, substance, or environmental exposure history.
$CodeConcept | Coded term for the concept name of the CODE, identifying it as medication, substance, or environmental exposure.
$CodeValue | Coded term or Context Group for value of the medication, substance, or environmental exposure.

Type:

  Extensible

Order:

  Significant

Table TID 9002. Medication, Substance, Environmental Exposure

| NL | Rel with Parent | VT | Concept Name | VM | Req Type | Condition | Value Set Constraint
--- | --- | --- | --- | --- | --- | --- | --- | ---
1 |  |  | CONTAINER | $ContainerConcept | 1 | M |  |
2 | > | CONTAINS | CODE | $CodeConcept | 1-n | M |  | $CodeValue
3 | >> | HAS CONCEPT MOD | CODE | EV (G-C032, SRT, "Classification") | 1 | U |  |
4 | >> | HAS OBS CONTEXT | CODE | EV (111534, DCM, "Role of person reporting") | 1 | U |  | DCID 7450 “Person Roles”
5 | >> | HAS PROPERTIES | NUM | EV (111524, DCM, "Age Started") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
6 | >> | HAS PROPERTIES | NUM | EV (111525, DCM, "Age Ended") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
7 | >> | HAS PROPERTIES | DATETIME | EV (111526, DCM, "DateTime Started") | 1 | U |  |
8 | >> | HAS PROPERTIES | DATETIME | EV (111527, DCM, "DateTime Ended") | 1 | U |  |
9 | >> | HAS PROPERTIES | NUM | EV (G-7290, SRT, "Duration") | 1 | U |  | UNITS = DCID 6046 “Units of Follow-up Interval”
10 | >> | HAS PROPERTIES | CODE | EV (111528, DCM, "Ongoing") | 1 | U |  | DCID 230 “Yes-No”
11 | >> | HAS PROPERTIES | TEXT | EV (111529, DCM, "Brand Name") | 1 | U |  |
12 | >> | HAS PROPERTIES | NUM | DCID 6092 “Quantitative Concepts for Usage, Exposure” | 1 | U |  | The unit of measure shall be quantity per unit of time
13 | >> | HAS PROPERTIES | CODE | DCID 6093 “Qualitative Concepts for Usage, Exposure Amount” | 1 | U |  | DCID 6090 “Relative Usage, Exposure Amount”
14 | >> | HAS PROPERTIES | CODE | DCID 6094 “Qualitative Concepts for Usage, Exposure Frequency” | 1 | U |  | DCID 6091 “Relative Frequency of Event Values”

Content Item Descriptions

Row 3 "Classification" | No context group is provided for the value set, but it is recommended that values from a standard external coding scheme, such as SRT or NDC, be used.
Rows 13 & 14 | If both of these content items are instantiated, the concept names selected for each should match. For example, use "Relative dose amount" as the concept name for row 13 with "Relative dose frequency" as the concept name for row 14.

### TID 9003 Previous Procedure

This general template provides detailed information on a patient's previous procedure, surgery, or treatment.

Table TID 9003. Parameters

Parameter Name | Parameter Usage
--- | ---
$ProcedureList | Coded term or Context Group for value of Previous Procedure
$ProcedureModifier | Coded term or Context Group for value of Previous Procedure Modifier
$NumConceptName | Coded term or Context Group for the concept name of a numeric property of the Previous Procedure
$LateralityValue | Coded term or Context Group for value of Laterality
$ProcedureResult | Coded term or Context Group for value of Result of Procedure
$ComplicationValue | Coded term or Context Group for value of Complication

Type:

  Extensible

Order:

  Significant

Table TID 9003. Previous Procedure

| NL | Rel with Parent | VT | Concept Name | VM | Req Type | Condition | Value Set Constraint
--- | --- | --- | --- | --- | --- | --- | --- | ---
1 |  |  | CONTAINER | EV (111513, DCM, "Relevant Previous Procedures") | 1 | M |  |
2 | > | CONTAINS | CODE | EV (111531, DCM, "Previous Procedure") | 1-n | M |  | $ProcedureList
3 | >> | HAS CONCEPT MOD | CODE | EV (111464, DCM, "Procedure Modifier") | 1-n | U |  | $ProcedureModifier
4 | >> | HAS OBS CONTEXT | CODE | EV (111534, DCM, "Role of person reporting") | 1 | U |  | DCID 7450 “Person Roles”
5 | >> | HAS PROPERTIES | NUM | $NumConceptName | 1-n | U |  |
6 | >> | HAS PROPERTIES | CODE | EV (G-C171, SRT, "Laterality") | 1 | U |  | $LateralityValue
7 | >> | HAS PROPERTIES | DATETIME | EV (122146, DCM, "Procedure DateTime") | 1 | UC | XOR row 8 |
8 | >> | HAS PROPERTIES | CODE | EV (111395, DCM, "Estimated Timeframe") | 1 | UC | XOR row 7 | BCID 6164 “Time Intervals”
9 | >> | HAS PROPERTIES | NUM | EV (R-42009, SRT, "Number of occurrences") | 1 | U |  | UNITS = EV (1, UCUM, "no units")
10 | >> | HAS PROPERTIES | CODE | EV (DD-60002, SRT, "Complication of procedure") | 1-n | U |  | $ComplicationValue
11 | >>> | HAS PROPERTIES | CODE | EV (111466, DCM, "Severity of Complication") | 1 | U |  | DCID 251 “Severity of Complication”
12 | >> | HAS PROPERTIES | CODE | EV (122177, DCM, "Procedure Result") | 1 | U |  | $ProcedureResult
13 | >> | HAS PROPERTIES | INCLUDE | DTID 4207 “Breast Imaging Pathology Results” | 1-n | U |  |

### TID 9004 Indicated Problem

This general template provides information about indicated problems presented by a patient. For example, indicated breast problems relating to the purpose for a mammographic examination.

Table TID 9004. Parameters

Parameter Name | Parameter Usage
--- | ---
$ProblemList | Coded term or Context Group for value of Indicated Problem
$LateralityValue | Coded term or Context Group for value of Laterality
$LocationValue | Coded term or Context Group for value of Location

Type:

  Extensible

Order:

  Significant

Table TID 9004. Indicated Problem

| NL | Rel with Parent | VT | Concept Name | VM | Req Type | Condition | Value Set Constraint
--- | --- | --- | --- | --- | --- | --- | --- | ---
1 |  |  | CONTAINER | EV (11450-4, LN, "Problem List") | 1 | M |  |
2 | > | CONTAINS | CODE | EV (111533, DCM, "Indicated Problem") | 1-n | M |  | $ProblemList
3 | >> | HAS OBS CONTEXT | CODE | EV (111534, DCM, "Role of person reporting") | 1 | U |  | DCID 7450 “Person Roles”
4 | >> | HAS OBS CONTEXT | DATETIME | EV (111535, DCM, "DateTime problem observed") | 1 | U |  |
5 | >> | HAS PROPERTIES | CODE | EV (G-C171, SRT, "Laterality") | 1 | U |  | $LateralityValue
6 | >> | HAS PROPERTIES | CODE | EV (G-C0E3, SRT, "Finding site") | 1 | U |  | $LocationValue
7 | >> | HAS PROPERTIES | NUM | EV (G-7290, SRT, "Duration") | 1 | U |  |
8 | >> | HAS PROPERTIES | CODE | EV (R-407E7, SRT, "Frequency") | 1 | U |  | DCID 6091 “Relative Frequency of Event Values”
9 | >> | HAS PROPERTIES | DATETIME | EV (111536, DCM, "DateTime of last evaluation") | 1 | U |  |
10 | >> | HAS PROPERTIES | TEXT | EV (121106, DCM, "Comment") | 1 | U |  |

### TID 9005 Risk Factor

This general template provides detailed information on the risk factors for a patient, related to medical history for themselves and family members.

Table TID 9005. Parameters

Parameter Name | Parameter Usage
--- | ---
$RiskList | Coded term or Context Group for value of Risk Factor
$FamilyList | Coded term or Context Group for value of Family Member with Risk Factor

Type:

  Extensible

Order:

  Significant

Table TID 9005. Risk Factor

| NL | Rel with Parent | VT | Concept Name | VM | Req Type | Condition | Value Set Constraint
--- | --- | --- | --- | --- | --- | --- | --- | ---
1 |  |  | CONTAINER | EV (111515, DCM, "Relevant Risk Factors") | 1 | M |  |
2 | > | CONTAINS | CODE | EV (F-01500, SRT, "Risk factor") | 1-n | M |  | $RiskList
3 | >> | HAS CONCEPT MOD | CODE | EV (111530, DCM, "Risk Factor modifier") | 1 | U |  | EV (G-0002, SRT, "Family history of")
4 | >> | HAS PROPERTIES | NUM | EV (18185-9, LN, "Gestational Age") | 1 | UC | IFF value of row 2 is (G-0305, SRT, "History of - premature delivery") |
5 | >> | HAS OBS CONTEXT | CODE | EV (111534, DCM, "Role of person reporting") | 1 | U |  | DCID 7450 “Person Roles”
6 | >> | HAS PROPERTIES | NUM | EV (111538, DCM, "Age at Occurrence") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
7 | >> | HAS PROPERTIES | NUM | EV (G-7290, SRT, "Duration") | 1 | U |  | UNITS = DCID 6046 “Units of Follow-up Interval”
8 | >> | HAS PROPERTIES | TEXT | EV (121106, DCM, "Comment") | 1 | U |  |
9 | >> | INFERRED FROM | CODE | EV (111537, DCM, "Family Member with Risk Factor") | 1-n | U |  | $FamilyList
10 | >>> | HAS PROPERTIES | NUM | EV (111538, DCM, "Age at Occurrence") | 1 | U |  | UNITS = EV (a, UCUM, "Year")
11 | >>> | HAS CONCEPT MOD | CODE | EV (111539, DCM, "Menopausal phase") | 1 | U |  | DCID 6086 “Menopausal Phase”
12 | >>> | HAS CONCEPT MOD | CODE | EV (111540, DCM, "Side of Family") | 1 | U |  | DCID 6097 “Side of Family”

### TID 9006 Obstetric History

This general template collects the details of a patient's obstetric history for a current pregnancy. Information regarding previous pregnancies is conveyed using the Gynecological History Template.

Type:

  Extensible

Order:

  Significant

Table TID 9006. Obstetric History

| NL | Rel with Parent | VT | Concept Name | VM | Req Type | Condition | Value Set Constraint
--- | --- | --- | --- | --- | --- | --- | --- | ---
1 |  | CONTAINS | CONTAINER | EV (R-20658, SRT, "Obstetric History") | 1 | M |  |
2 | > | CONTAINS | DATE | DCID 12003 “OB-GYN Dates” | 1-n | U |  |
3 | > | CONTAINS | NUM | EV (18185-9, LN, "Gestational Age") | 1 | U |  | UNITS = EV (d, UCUM, "day")
4 | > | CONTAINS | TEXT | EV (121106, DCM, "Comment") | 1-n | U |  |

Content Item Descriptions

Row 3 "Gestational Age" | Observation DateTime (0040,A032) for Content Item shall be present, in order to convey the date and time at which this Gestational Age was established.

### TID 9007 General Relevant Patient Information

This template collects a patient's relevant information for general purpose use. This template, together with its subordinate templates, describes the history of a patient's reproductive system, medications, substance use, environmental exposure, past procedures, risk factors, and indicated problems.

Type:

  Extensible

Order:

  Significant

Table TID 9007. General Relevant Patient Information

| NL | Rel with Parent | VT | Concept Name | VM | Req Type | Condition | Value Set Constraint
--- | --- | --- | --- | --- | --- | --- | --- | ---
1 |  |  | CONTAINER | EV (111517, DCM, "Relevant Patient Information") | 1 | M |  |
2 | > | HAS CONCEPT MOD | INCLUDE | DTID 1204 “Language of Content Item and Descendants” | 1 | M |  |
3 | > | CONTAINS | INCLUDE | DTID 3114 “Patient Assessment” | 1 | U |  |
4 | > | CONTAINS | INCLUDE | DTID 9002 “Medication, Substance, Environmental Exposure” | 1 | U |  | $ContainerConcept = EV (10160-0, LN, "History Of Medication Use") $CodeConcept = EV (111516, DCM, "Medication Type")
5 | > | CONTAINS | INCLUDE | DTID 9002 “Medication, Substance, Environmental Exposure” | 1 | U |  | $ContainerConcept = EV (111545, DCM, "Substance Use History") $CodeConcept = EV (111546, DCM, "Used Substance Type") $CodeValue = BCID 6089 “Substances”
6 | > | CONTAINS | INCLUDE | DTID 9002 “Medication, Substance, Environmental Exposure” | 1 | U |  | $ContainerConcept = EV (111547, DCM, "Environmental Exposure History") $CodeConcept = EV (111548, DCM, "Environmental Factor")
7 | > | CONTAINS | INCLUDE | DTID 9003 “Previous Procedure” | 1 | U |  | $LateralityValue = BCID 244 "Laterality"
8 | > | CONTAINS | INCLUDE | DTID 9004 “Indicated Problem” | 1 | U |  | $LateralityValue = BCID 244 "Laterality"
9 | > | CONTAINS | INCLUDE | DTID 9005 “Risk Factor” | 1 | U |  | $RiskList = BCID 6087 “General Risk Factors” $FamilyList = DCID 7451 “Family Member”
10 | > | CONTAINS | INCLUDE | DTID 9001 “Gynecological History” | 1 | U |  |
11 | > | CONTAINS | INCLUDE | DTID 9006 “Obstetric History” | 1 | U |  |
12 | > | CONTAINS | INCLUDE | DTID 3802 “Cardiovascular Patient History” | 1 | U |  |
13 | > | CONTAINS | INCLUDE | DTID 351 “Previous Reports” | 1 | U |  |

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