TEMPLATE Follow-up schedule for CG (Follow-up schedule for CG)

TEMPLATE ID	Follow-up schedule for CG
Concept	Follow-up schedule for CG
Description	To request the diagnostic tests necessary to monitor the progression of CG.
Purpose	To request the diagnostic tests necessary to monitor the progression of CG.
References
Authors	name: Aitor Eguzkitza; organisation: Universidad Pública de Navarra - Complejo Hospitalario de Navarra; email: aitor.eguzkiza@unavarra.es; date: 2016-07-20
Other Details Language	name: Aitor Eguzkitza; organisation: Universidad Pública de Navarra - Complejo Hospitalario de Navarra; email: aitor.eguzkiza@unavarra.es; date: 2016-07-20
Other Details (Language Independent)	MetaDataSet:Sample Set : Template metadata sample set Copyright: © openEHR Foundation Owner: Aitor Eguzkitza, aitor.eguzkiza@unavarra.es Speciality: Ophthalmology
Language used	en
Citeable Identifier	1013.26.134
Root archetype id	openEHR-EHR-COMPOSITION.request.v1
Request for service	Request for service: Document sent from one treating healthcare provider or organisation to another, for the purpose of requesting advice, a service or transfer of care.
Diagnostic test planning	Diagnostic test planning: Schedules each patient to perform the diagnostic tests necessary to assess a specific disease.
Care Plan	Care Plan: Order or instruction for the creation and sequence of activities to achieve a specified management goal or treatment outcome, carried out by health professionals and/or the subject.
Activity	Activity: Current Activity.
Description
Care Plan Name	Care Plan Name: Identification of the care plan.
Description	Description: Description of the care plan scope, intent and proposed activities.
Indication	Indication: Indication for the care plan. For example: a known diagnosis; or a specific goal.
Date of Onset	Date of Onset: Date of onset for the care plan.
Comment	Comment: Additional narrative about the care plan order not captured in other fields.
Care Plan	Care Plan: Plan or sequence of discrete activities developed to achieve a specified management goal or treatment outcome, carried out by health professionals and/or the patient.
Description
Care Plan Name	Care Plan Name: Name of care plan.
Description	Description: Description of activity performed/enacted against the plan.
Reason	Reason: Reason for activity being performed /enacted against the plan.
Protocol
Care Plan ID	Care Plan ID: Identification of care plan.
Expiry Date	Expiry Date: Anticipated date beyond which the care plan can be deemed 'expired'.
Referral request of VA	Referral request of VA: Request for provision of a specified service by another healthcare provider or organisation.
Request	Request: Current Activity.
Description
Service requested	Service requested: Identification of the service requested. This is often coded with an external terminology.
Description of service	Description of service: A detailed narrative description of the service requested.
Reason for request	Reason for request: A short description of the reason for the request. This is often coded with an external terminology.
Reason description	Reason description: A narrative description explaining the reason for request.
Urgency	Urgency: Urgency of the request. Emergency Urgent Routine
Date &/or time service required	Date &/or time service required: The date and time that the service should be performed or completed.
Latest date service required	Latest date service required: The latest date that is acceptable for the service to be completed.
Supplementary information to follow	Supplementary information to follow: True indicates that additional information has been identified and will be forwarded when available eg incomplete pathology test results.
Supplementary information expected	Supplementary information expected: Details of the nature of supplementary information that is to follow e.g name of laboratory results.
Protocol
Requestor Identifier	Requestor Identifier: The local ID assigned to the order by the healthcare provider or organisation requesting the service. This is also referred to as Placer Order Identifier.
Receiver identifier	Receiver identifier: The ID assigned to the order by the healthcare provider or organisation receiving the request for service. This is also referred to as Filler Order Identifier.
Request status	Request status: The status of the request for service as indicated by the requester. Status is used to denote whether this is the initial request, or a follow-up request to change or provide supplementary information.
Referral request of IOP	Referral request of IOP: Request for provision of a specified service by another healthcare provider or organisation.
Request	Request: Current Activity.
Description
Service requested	Service requested: Identification of the service requested. This is often coded with an external terminology.
Description of service	Description of service: A detailed narrative description of the service requested.
Reason for request	Reason for request: A short description of the reason for the request. This is often coded with an external terminology.
Reason description	Reason description: A narrative description explaining the reason for request.
Urgency	Urgency: Urgency of the request. Emergency Urgent Routine
Date &/or time service required	Date &/or time service required: The date and time that the service should be performed or completed.
Latest date service required	Latest date service required: The latest date that is acceptable for the service to be completed.
Supplementary information to follow	Supplementary information to follow: True indicates that additional information has been identified and will be forwarded when available eg incomplete pathology test results.
Supplementary information expected	Supplementary information expected: Details of the nature of supplementary information that is to follow e.g name of laboratory results.
Protocol
Requestor Identifier	Requestor Identifier: The local ID assigned to the order by the healthcare provider or organisation requesting the service. This is also referred to as Placer Order Identifier.
Receiver identifier	Receiver identifier: The ID assigned to the order by the healthcare provider or organisation receiving the request for service. This is also referred to as Filler Order Identifier.
Request status	Request status: The status of the request for service as indicated by the requester. Status is used to denote whether this is the initial request, or a follow-up request to change or provide supplementary information.
Duration	Duration: Length of time the referral is valid.
Duration	Duration: Duration for which the referral is valid.
Indefinite	Indefinite: If true, referral is for an indefinite period of time.
Imaging examination request NMR	Imaging examination request NMR: Generic request for an imaging examination request.
Request	Request: Current Activity.
Description
Examination requested	Examination requested: Identification of the examination requested. This is often coded with an external terminology.
Description of examination	Description of examination: A detailed narrative description of the examination requested.
Acquisition details on eye fundus images	Acquisition details on eye fundus images: Defines specific details about the acquisition of images from eye fundus.
Laterality	Laterality: Eye/s from which the eye fundus is examined. Left eye Right eye Both eyes
Method	Method: Method chosen to perform the funduscopic examination. Direct Indirect Contact lens biomicroscopy Non-contact lens biomicroscopy Mydriatic retinography Non-mydriatic retinography Angiography Assumed value: Non-mydriatic retinography
Attempts Allowed	Attempts Allowed: Limit on the number of attempts allowed to conduct the acquisition (doesn't compute if test is repeated by a specific recognized technical failure). >=1 Assumed value: 3
Zone of Retina	Zone of Retina: Anatomical structures from retina in which the study of eye fundus is focused. Value set: ac0001
Study Fields Photographed	Study Fields Photographed: Specifies which fields from a specific subdivision of the retina are photographed in the study of eye fundus. Value set: ac0002
Mosaic	Mosaic: If true, the study includes a mosaic image that combines all eye fundus fields acquired into a single picture. Assumed value: false
Reason for request	Reason for request: A short description of the reason for the request. This is often coded with an external terminology.
Reason description	Reason description: A narrative description explaining the reason for request.
Urgency	Urgency: Urgency of the request. Emergency Urgent Routine
Date &/or time service required	Date &/or time service required: The date and time that the service should be performed or completed.
Latest date service required	Latest date service required: The latest date that is acceptable for the service to be completed.
Supplementary information to follow	Supplementary information to follow: True indicates that additional information has been identified and will be forwarded when available eg incomplete pathology test results.
Supplementary information expected	Supplementary information expected: Details of the nature of supplementary information that is to follow e.g name of laboratory results.
Protocol
Requestor Identifier	Requestor Identifier: The local ID assigned to the order by the healthcare provider or organisation requesting the service. This is also referred to as Placer Order Identifier.
Receiver identifier	Receiver identifier: The ID assigned to the order by the healthcare provider or organisation receiving the request for service. This is also referred to as Filler Order Identifier.
Request status	Request status: The status of the request for service as indicated by the requester. Status is used to denote whether this is the initial request, or a follow-up request to change or provide supplementary information.
Imaging examination request OCT	Imaging examination request OCT: Generic request for an imaging examination request.
Request	Request: Current Activity.
Description
Examination requested	Examination requested: Identification of the examination requested. This is often coded with an external terminology.
Description of examination	Description of examination: A detailed narrative description of the examination requested.
Acquisition details on ophthalmic tomography	Acquisition details on ophthalmic tomography: Defines specific details about ophthalmic tomography studies.
Laterality	Laterality: Eye/s included in the study. Left eye Right eye Both eyes
Acquisition method	Acquisition method: Acquisition method chosen to perform the ophthalmic tomography study. It is based on the Table CID 4210 of DICOM standard. Optical Coherence Tomography Scanner Retinal Thickness Analyzer Confocal Scanning Laser Ophthalmoscope Scheimpflug Camera Scanning Laser Polarimeter Elevation-based corneal tomographer Reflection-based corneal topographer Interferometry-based corneal tomographer
Study outcome	Study outcome: Identifies the type of analyses which must be obtained from the study. Transverse image overview 3D reconstruction image analysis Video angiography Thickness analysis Thickness evolution along-time (follow-up) Thickness classification (measured vs normative) Asymmetry analysis
Predefined scan	Predefined scan: Choice among predefined settings provided by the ophthalmic tomography for scanning the eye structure.
Study type	Study type: Subject of study of the ophthalmic tomography. Angle Cornea Iris Sclera Glaucoma Retina
Predefined scans	Predefined scans: Choice of a predefined scan patterns from the device to conduct the study. Angle 1 ACA Angle 2 ACA Angle small Cornea dense Cornea large Cornea scan 08 Cornea scan 11 Cornea small Sclera dense Sclera large Sclera scan 08 Sclera scan 11 Sclera small Sclera vol. bleb Glaucoma dense Glaucoma Fast Glaucoma ONH Glaucoma P. Pole Glaucoma RNFL Retina 7 lines Retina dense Retina detail Retina fast Retina Fast HR Retina Lin HR Retina P. Pole
Custom scan	Custom scan: Description of characteristics for a personalized scan.
Scan pattern	Scan pattern: Defines the pattern used to scan structures inside the eye. Single Radial Star High speed multi-frame High resolution multi-frame
Position of scan pattern	Position of scan pattern: Eye structure in which the scan is centred. Value set: ac0001
Scan size (width or diameter)	Scan size (width or diameter): Width of the frame (or diameter in case of circle scan pattern). Units: ° (UCUM: deg)
Scan size (height)	Scan size (height): Height of the frame. Units: ° (UCUM: deg)
Distance between sections	Distance between sections: Distance between sections scanned consecutively. Units: μm (UCUM: um)
Section scans	Section scans: Number of sections included in the scan. >=1
Reason for request	Reason for request: A short description of the reason for the request. This is often coded with an external terminology.
Reason description	Reason description: A narrative description explaining the reason for request.
Urgency	Urgency: Urgency of the request. Emergency Urgent Routine
Date &/or time service required	Date &/or time service required: The date and time that the service should be performed or completed.
Latest date service required	Latest date service required: The latest date that is acceptable for the service to be completed.
Supplementary information to follow	Supplementary information to follow: True indicates that additional information has been identified and will be forwarded when available eg incomplete pathology test results.
Supplementary information expected	Supplementary information expected: Details of the nature of supplementary information that is to follow e.g name of laboratory results.
Protocol
Requestor Identifier	Requestor Identifier: The local ID assigned to the order by the healthcare provider or organisation requesting the service. This is also referred to as Placer Order Identifier.
Receiver identifier	Receiver identifier: The ID assigned to the order by the healthcare provider or organisation receiving the request for service. This is also referred to as Filler Order Identifier.
Request status	Request status: The status of the request for service as indicated by the requester. Status is used to denote whether this is the initial request, or a follow-up request to change or provide supplementary information.
Imaging examination request of the VF	Imaging examination request of the VF: Generic request for an imaging examination request.
Request	Request: Current Activity.
Description
Examination requested	Examination requested: Identification of the examination requested. This is often coded with an external terminology.
Description of examination	Description of examination: A detailed narrative description of the examination requested.
Acquisition details on visual field test	Acquisition details on visual field test: Defines specific details about perimetry studies.
Laterality	Laterality: Eye/s included in the study. Left eye Right eye Both eyes
Method	Method: Method chosen to study patient's visual field. Goldman Dicon Henson Octopus Humphrey FDP FASTPAC
Test Parameters	Test Parameters: Describe the settings parameters chosen for the test.
Automated test	Automated test: Automated perimetry or manual test chosen instead. Assumed value: true
Test pattern	Test pattern: Test pattern used to distribute visual field measurements during a perimetry study. 24-2 10-2 30-2 60-4 Macula Central 40 Point Central 76 Point Peripheral 60 Point Full Field 81 Point Full Field 120 Point Glaucoma (G) M 07 Low Vision Centra (LVC) Central
Test strategy	Test strategy: Threshold test algorithm chosen to determine patient's sensitivity at each point tested on the visual field. SITA-Standard SITA-SWAP SITA-Fast Full Threshold (FT) FastPac Full From Prior Optima Two-Zone Three-Zone Quantify-Defects TOP Dynamic Normal 1-LT 2-LT LVS GATE GATEi 2LT-Dynamic 2LT-Normal Fast Threshold CLIP CLASS Strategy
Screening test mode	Screening test mode: Mode for determining the starting luminance for screening test points. Age corrected Threshold related Single luminance Foveal sensitivity related Related to non macular sensitivity User chosen value
Device configuration	Device configuration: Configuration of the perimeter during the visual field test.
Fixation monitoring strategy	Fixation monitoring strategy: Configuration used to monitor the patient's fixation. Automated Optical Blind Spot Monitoring Macular Fixation Testing Observation by Examiner None
Stimulus	Stimulus: Properties of the light chosen to stimulate patients.
Stimulus area	Stimulus area: Area of light stimulus presented to the patient. Coded Text Goldmann size I Goldmann size II Goldmann size III Goldmann size IV Goldmann size V Quantity>=0 ° (UCUM: deg)
Stimulus colour	Stimulus colour: Colour of light stimulus presented to the patient. Value set: ac0001
Background	Background: Properties of the background chosen for the test.
Background luminance	Background luminance: Background luminance of the device, in candelas per square meter (cd/m²) or apostilbs (ASB). Coded Text 4 ASB 31.5 ASB 100 ASB 1000 ASB QuantityUnits: asb
Background illumination colour	Background illumination colour: Colour chosen to illuminate the background of the visual field device so as to make the light stimulus contrast optimal. Value set: ac0002
Reason for request	Reason for request: A short description of the reason for the request. This is often coded with an external terminology.
Reason description	Reason description: A narrative description explaining the reason for request.
Urgency	Urgency: Urgency of the request. Emergency Urgent Routine
Date &/or time service required	Date &/or time service required: The date and time that the service should be performed or completed.
Latest date service required	Latest date service required: The latest date that is acceptable for the service to be completed.
Supplementary information to follow	Supplementary information to follow: True indicates that additional information has been identified and will be forwarded when available eg incomplete pathology test results.
Supplementary information expected	Supplementary information expected: Details of the nature of supplementary information that is to follow e.g name of laboratory results.
Protocol
Requestor Identifier	Requestor Identifier: The local ID assigned to the order by the healthcare provider or organisation requesting the service. This is also referred to as Placer Order Identifier.
Receiver identifier	Receiver identifier: The ID assigned to the order by the healthcare provider or organisation receiving the request for service. This is also referred to as Filler Order Identifier.
Request status	Request status: The status of the request for service as indicated by the requester. Status is used to denote whether this is the initial request, or a follow-up request to change or provide supplementary information.
Other contributors	Jose Andonegui, Complejo hospitalario de Navarra (CHN), jose.andonegui.navarro@cfnavarra.es; Luis Serrano, Universidad Pública de Navarra (UPNA), lserrano@unavarra.es; Jesús D. Trigo, Universidad Pública de Navarra (UPNA), jesusdaniel.trigo@unavarra.es