DICOM PS3.16 2024e - Content Mapping Resource

TID 3114 Patient Assessment

The Patient Assessment Template allows recording of the assessment of the patient's cardiovascular, neurological, and/or respiratory condition. A particular use of this Template is for "vital signs", which are a specific subset of mandatory patient assessment measurements.

Type:

Extensible

Order:

Significant

Root:

No

Table TID 3114. Patient Assessment

NL

Rel with Parent

VT

Concept Name

VM

Req Type

Condition

Value Set Constraint

1

CODE

EV (121123, DCM, "Patient Status or Event")

1

M

DT (121165, DCM, "Patient Assessment Performed")

DT (61746007, SCT, "Observation of Vital Signs")

2

>

HAS PROPERTIES

INCLUDE

DTID 300 “Measurement”

1

MC

IF Row 1 value = (61746007, SCT, "Observation of Vital Signs")

$Measurement = EV (271649006, SCT, "Systolic blood pressure")

$Units = DCID 3500 “Pressure Unit”

$Method = BCID 3560 “Blood Pressure Method”

3

>

HAS PROPERTIES

INCLUDE

DTID 300 “Measurement”

1

MC

IF Row 1 value = (61746007, SCT, "Observation of Vital Signs")

$Measurement = EV (271650006, SCT, "Diastolic blood pressure")

$Units = DCID 3500 “Pressure Unit”

4

>

HAS PROPERTIES

INCLUDE

DTID 300 “Measurement”

1

MC

IF Row 1 value = (61746007, SCT, "Observation of Vital Signs")

$Measurement = EV (8867-4, LN, "Heart rate")

$Units = EV ({H.B.}/min, UCUM, "BPM")

5

>

HAS PROPERTIES

INCLUDE

DTID 300 “Measurement”

1

MC

IF Row 1 value = (61746007, SCT, "Observation of Vital Signs")

$Measurement = EV (8310-5, LN, "Body temperature")

$Units = EV (Cel, UCUM, "C")

6

>

HAS PROPERTIES

INCLUDE

DTID 300 “Measurement”

1

MC

IF Row 1 value = (61746007, SCT, "Observation of Vital Signs")

$Measurement = DCID 3526 “Blood Gas Saturation”

$Units = EV (%, UCUM, "%")

7

>

HAS PROPERTIES

INCLUDE

DTID 300 “Measurement”

1

MC

IF Row 1 value = (61746007, SCT, "Observation of Vital Signs")

$Measurement = EV (86290005, SCT, "Respiration rate")

$Units = EV (/min, UCUM, "breaths/min")

8

>

HAS PROPERTIES

INCLUDE

DTID 300 “Measurement”

1-n

MC

IF Row 1 value = (61746007, SCT, "Observation of Vital Signs")

$Measurement = EV (122195, DCM, "Pulse Strength")

$Method = BCID 3442 “Peripheral Pulse Method”

$TargetSite = BCID 3440 “Peripheral Pulse Location”

$Units = DT ({0:4}, UCUM, "range 0:4")

9

>

HAS PROPERTIES

INCLUDE

DTID 300 “Measurement”

1

MC

IF Row 1 value = (61746007, SCT, "Observation of Vital Signs")

$Measurement = EV (225908003, SCT, "Pain Score")

$Units = DT ({1:10}, UCUM, "range 1:10")

10

>

HAS PROPERTIES

CODE

DT (8884-9, LN, "Cardiac Rhythm")

1

U

BCID 3415 “Cardiac Rhythm”

11

>

HAS PROPERTIES

CODE

DT (9304-7, LN, "Respiration Rhythm")

1

U

BCID 3416 “Respiration Rhythm”

12

>

HAS PROPERTIES

CODE

DT (364062005, SCT, "Respiration Assessment")

1

U

BCID 3448 “Airway Assessment”

13

>

HAS PROPERTIES

CODE

DT (364528001, SCT, "Skin condition")

1-n

U

BCID 3446 “Skin Condition”

14

>

HAS PROPERTIES

CODE

DT (363871006, SCT, "Patient mental state assessment")

1

U

15

>

HAS PROPERTIES

TEXT

BCID 3441 “Patient Assessment”

1-n

U


Content Item Descriptions

Row 8

Pulse Strength allows the assessment of the patient's pulse at multiple locations using the Topographical concept modifier. It may also be used for a single pulse strength measurement from an unspecified location, as is typical of vital signs assessments.

Row 16

Allows free text description of patient assessments that are not expressible by coded entries of Rows 10 to 14.

DICOM PS3.16 2024e - Content Mapping Resource