FamilyHistory-v3.1(2018EN)

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General information

Name: nl.zorg.FamilyHistory NL.png
Version: 3.1
HCIM Status:Final
Release: 2018
Release status: Prepublished
Release date: 01-10-2018


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Metadata

DCM::CoderList Kerngroep Registratie aan de Bron
DCM::ContactInformation.Address *
DCM::ContactInformation.Name *
DCM::ContactInformation.Telecom *
DCM::ContentAuthorList Projectgroep Generieke Overdrachtsgegevens & Kerngroep Registratie aan de Bron
DCM::CreationDate 15-02-2013
DCM::DeprecatedDate
DCM::DescriptionLanguage nl
DCM::EndorsingAuthority.Address
DCM::EndorsingAuthority.Name PM
DCM::EndorsingAuthority.Telecom
DCM::Id 2.16.840.1.113883.2.4.3.11.60.40.3.6.1
DCM::KeywordList familieanamnese, anamnese
DCM::LifecycleStatus Final
DCM::ModelerList Kerngroep Registratie aan de Bron
DCM::Name nl.zorg.Familieanamnese
DCM::PublicationDate 01-10-2018
DCM::PublicationStatus Prepublished
DCM::ReviewerList Projectgroep Generieke Overdrachtsgegevens & Kerngroep Registratie aan de Bron
DCM::RevisionDate 31-12-2017
DCM::Superseeds nl.zorg.Familieanamnese-v3.0
DCM::Version 3.1
HCIM::PublicationLanguage EN

Revision History

Only available in Dutch

Publicatieversie 1.0 (15-02-2013)

Publicatieversie 1.1 (01-07-2013)

Publicatieversie 2.0 (01-04-2015)

ZIB-73 wijzigingsverzoek familieanamnese
ZIB-308 Prefix Overdracht weggehaald bij de generieke bouwstenen

Incl. algemene wijzigingsverzoeken:

ZIB-94 Aanpassen tekst van Disclaimer, Terms of Use & Copyrights
ZIB-154 Consequenties opsplitsing Medicatie bouwstenen voor overige bouwstenen.
ZIB-200 Naamgeving SNOMED CT in tagged values klinische bouwstenen gelijk getrokken.
ZIB-201 Naamgeving OID: in tagged value notes van klinische bouwstenen gelijk getrokken.
ZIB-309 EOI aangepast
ZIB-324 Codelijsten Name en Description beginnen met een Hoofdletter
ZIB-326 Tekstuele aanpassingen conform de kwaliteitsreview kerngroep 2015

Publicatieversie 3.0 (01-05-2016)

ZIB-444 Overlijdensdatum in ZIB Familieanamnese vs. leeftijd waarop persoon is overleden
ZIB-453 Wijziging naamgeving ZIB's en logo's door andere opzet van beheer

Publicatieversie 3.1 (04-09-2017)

ZIB-443 Aanpassing in codes in BiologischeRelatieCodelijst
ZIB-564 Aanpassing/harmonisatie Engelse conceptnamen
ZIB-574 Alleen verwijzen naar het rootconcept van de ZIB.

Concept

The family history describes any health problems of biological relatives that may be relevant. The family history contains information on the medical disorders of the family member and the biological relationship between the patient and the described family member.

Purpose

Recording the patient’s family members’ health problems. This component can be relevant in estimating the risk of these health problems occurring in the patient. This component can also partially influence the decision determining which diagnostics are or are not to be run: a high-risk patient might be more likely to receive extensive diagnostics, while a simpler test could suffice for a low-risk patient.

Information Model


#BiologicalRelationshipCodelist#11301#11300#11299#11304#11303#11308#11306Problem-v4.1.1(2018EN)#11298#11307FamilyHistory-v3.1Model(EN).png


Type Id Concept Card. Definition DefinitionCode Reference
Block.png NL-CM:6.1.1 Arrowdown.pngFamilyHistory Root concept of the FamilyHistory information model. This root concept contains all data elements of the FamilyHistory information model.
TS.png NL-CM:6.1.2 Arrowright.pngDate 0..1 Date on which the family history was entered. A ‘vague’ date is permitted.
Folder.png NL-CM:6.1.3 Arrowdown.pngFamilyMember 1..* Container of the FamilyMember concept. This container contains all data elements of the FamilyMember concept.
CD.png NL-CM:6.1.4 Arrowright.pngBiologicalRelationship 1 Indicates the biological relationship of the family member to the patient.
List2.png BiologicalRelationshipCodelist
ST.png NL-CM:6.1.5 Arrowright.pngComment 0..1 Comment with information on the family member which might be relevant to the family history.
48767-8 Annotation comment [Interpretation] Narrative
BL.png NL-CM:6.1.10 Arrowright.pngDeathIndicator 0..1 An indication stating whether the family member has died.
INT.png NL-CM:6.1.12 Arrowright.pngAgeAtDeath 0..1 The age at which the family member died.
Folder.png NL-CM:6.1.6 Arrowdown.pngDisorder 1..* Container of the Disorder concept. This container contains all data elements of the Disorder concept.
Verwijzing.png NL-CM:6.1.7 Arrowright.pngProblem 1 The health problem of the family member in question, which is recorded for the family history.
Block.png Problem
BL.png NL-CM:6.1.9 Arrowright.pngIsCauseOfDeath 0..1 Indication stating whether the described health problem was the cause of death of the family member.

Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page List2.png

Example Instances

Only available in Dutch

Familieanamnese
Datum Familielid Aandoening
BiologischeRelatie Toelichting Overlijdens
Indicator
OverlijdensDatum Probleem Is
Doodsoorzaak
ProbleemType ProbleemNaam Probleem
Status
Probleem
StatusDatum
1-2-2013 Tante / moeders-
zijde
Ja 1997 Diagnose mammacarcinoom Actueel 1995 Ja
1-2-2013 Biologische moeder moeder heeft vijf zusters Diagnose mammacarcinoom Actueel 21-3-1999
1-2-2013 Biologische vader Ja 2005 Diagnose myocardinfarct Niet actueel 16-6-2001

Instructions

The age at which a family member developed a disorder or the age at which the family member died can be included in the ‘explanation’ field if desired.

The value list BiologicalRelationshipCodeList contains a number of concepts which can be used for both biological and non-biological relatives: a step-father’s brother can be listed as an uncle for lack of specific codes for step-uncle and real uncles. Therefore, when compiling the family history, make sure that only the biological relatives are considered.

Valuesets

BiologicalRelationshipCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.6.1.1 Binding: Extensible
Conceptname Conceptcode Codesystem name Codesystem OID Description
Aunt AUNT RoleCode 2.16.840.1.113883.5.111 Tante
Cousin COUSN RoleCode 2.16.840.1.113883.5.111 Neef/nicht, zoon/dochter van oom/tante
Grandchild GRNDCHILD RoleCode 2.16.840.1.113883.5.111 Kleinkind
Grandparent GRPRN RoleCode 2.16.840.1.113883.5.111 Grootouder
Great grandparent GGRPRN RoleCode 2.16.840.1.113883.5.111 Overgrootouder
Half-brother HBRO RoleCode 2.16.840.1.113883.5.111 Halfbroer
Half-sister HSIS RoleCode 2.16.840.1.113883.5.111 Halfzus
MaternalAunt MAUNT RoleCode 2.16.840.1.113883.5.111 Tante/moederszijde
MaternalCousin MCOUSN RoleCode 2.16.840.1.113883.5.111 Neef/nicht aan moederszijde
MaternalGrandparent MGRPRN RoleCode 2.16.840.1.113883.5.111 Gootouder aan moederszijde
MaternalGreatgrandparent MGGRPRN RoleCode 2.16.840.1.113883.5.111 Overgrootouder aan moederszijde
MaternalUncle MUNCLE RoleCode 2.16.840.1.113883.5.111 Oom/moederszijde
Natural child NCHILD RoleCode 2.16.840.1.113883.5.111 Biologisch kind
Natural daugther DAU RoleCode 2.16.840.1.113883.5.111 Biologische dochter
Natural son SON RoleCode 2.16.840.1.113883.5.111 Biologische zoon
Natural father NFTH RoleCode 2.16.840.1.113883.5.111 Biologische vader
Natural mother NMTH RoleCode 2.16.840.1.113883.5.111 Biologische moeder
Natural brother NBRO RoleCode 2.16.840.1.113883.5.111 Biologische broer
Natural sister NSIS RoleCode 2.16.840.1.113883.5.111 Biologische zus
Nephew NEPHEW RoleCode 2.16.840.1.113883.5.111 Neef, zoon van broer/zus
Niece NIECE RoleCode 2.16.840.1.113883.5.111 Nicht, dochter van broer/zus
PaternalAunt PAUNT RoleCode 2.16.840.1.113883.5.111 Tante/vaderszijde
PaternalCousin PCOUSN RoleCode 2.16.840.1.113883.5.111 Neef/nicht aan vaderszijde
PaternalGrandparent PGRPRN RoleCode 2.16.840.1.113883.5.111 Grootouder aan vaderszijde
PaternalGreatgrandparent PGGRPRN RoleCode 2.16.840.1.113883.5.111 Overgrootouder aan vaderszijde
PaternalUncle PUNCLE RoleCode 2.16.840.1.113883.5.111 Oom/vaderszijde
Uncle UNCLE RoleCode 2.16.840.1.113883.5.111 Oom

This information model in other releases

Information model references

This information model refers to

This inforation model is used in

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Technical specifications in HL7v3 CDA and HL7 FHIR

To exchange information based on health and care information models, additional, more technical specifications are required.
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:

  • HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment Artdecor.jpg
  • HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR Fhir.png

Downloads

This information model is also available as pdf file PDF.png or as spreadsheet Xlsx.png

About this information

The information in this wikipage is based on Prerelease 2018 #1
SNOMED CT and LOINC codes are based on:

  • SNOMED Clinical Terms version: 20180731 [R] (July 2018 Release)
  • LOINC version 2.64

Conditions for use are located on the mainpage List2.png
This page is generated on 01/11/2018 17:35:05 with ZibExtraction v. 2.0.6879.31307


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