Sentinel General Practices - Tick bites - suspicion of Lyme disease (SGP_lyme)
- Status: inactive
- How to create a CSV file for this data collection?
- Start date: 12/04/2016
- End date creation: 12/08/2024
- End date submission: 12/08/2024
- End date comments: 12/08/2024
1 Identification
Section help
Dit formulier is enkel bestemd voor artsen die deelnemen aan de huisartsenpeilpraktijken, een register bedoeld voor wetenschappelijk onderzoek.
Indien u interesse heeft om deel te nemen aan deze registratie, graag eerst contact opnemen met Viviane.VanCasteren@wiv-isp.be vooraleer te registreren.
Tekenbeten en/of vermoeden van ziekte van lyme
De registratie van tekenbeten omvat de EERSTE consultatie voor een BEVESTIGDE tekenbeet. Bij een bevestigde tekenbeet is de teek nog aanwezig of de patiënt bevestigt dat de teek verwijderd is. Het gaat zowel over bevestigde tekenbeten MET en ZONDER BIJKOMENDE SYMPTOMEN.
De registratie van het VERMOEDEN van de ziekte van Lyme omvat alle EERSTE consultaties voor een vermoeden van die ziekte op basis van de klinische symptomen, ongeacht of er een tekenbeet in de voorgeschiedenis was of niet. Als er een bevestigde tekenbeet in de voorgeschiedenis was die u nog niet registreerde, gelieve dan ook alle vragen over tekenbeten te beantwoorden.
NIHDI number of the treating physician
Technical specs
CSV column name:
nihdi_number_of_the_treating_physician
Length:
100
Reference list:
PHYSICIAN
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Caregiver
Data element:
CareGiverIdentificationNumber
National registry ID of the patient
Help
Please encode a social security identification number (SSIN). Please note that the patient ID is always pseudonymised before being transferred to Healthdata.
Technical specs
CSV column name:
patient_id
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Patient
Data element:
PatientIdentificationNumber
Validation
The validity of the national register number is checked with the mod97 check.
Fields
Section help
Please encode a social security identification number (SSIN). Please note that the patient ID is always pseudonymised before being transferred to Healthdata.
Internal patient ID
Help
This field can be used to enter an internal ID or reference number. It is available for internal use only and is not transferred to Healthdata. If there is an integration between HD4DP and your organisation's patient administration system, additional patient identification information such as date of birth, sex and SSIN can be automatically enriched based on this internal patient ID. Please do not encode the social security identification number (SSIN) in this field. The SSIN must be encoded in the field 'National registry ID of the patient'.
Technical specs
CSV column name:
patient_id|internal_patient_id
Length:
50
Required:
false
Generated
Help
The patient_id|generated column can be set to 'TRUE' for an automatically generated patient_id.This column should only be added in case the patient_id is empty. If the column is set to 'TRUE', a patient_id is automatically generated based on the name, first name, date of birth and sex of the patient.
Technical specs
CSV column name:
patient_id|generated
Required:
false
Options
| Label | Value |
| Yes | TRUE |
| No | FALSE |
Name
Help
The name of the patient is never transferred to Healthdata and is available for your information only.
Technical specs
CSV column name:
patient_id|name
Length:
50
Required:
noSSIN(Needed only if no national register number is entered)
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Patient
Data element:
LastName
First name
Help
The first name of the patient is never transferred and is available for your information only.
Technical specs
CSV column name:
patient_id|first_name
Length:
50
Required:
noSSIN(Needed only if no national register number is entered)
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Patient
Data element:
FirstNames
Date of birth
Technical specs
Format:
DD/MM/YYYY
CSV column name:
patient_id|date_of_birth
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Patient
Data element:
DateOfBirth
Validation
- The date of birth cannot be in the future (error)
Sex
Technical specs
CSV column name:
patient_id|sex
Required:
true
Options
| Label | Value |
| Male | M |
| Female | F |
| Unknown | U |
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Patient
Data element:
Gender
Place of residence
Technical specs
CSV column name:
patient_id|place_of_residence
Length:
5
Reference list:
POSTAL_CODE
Required:
false
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Patient
Data element:
Postcode
Deceased?
Technical specs
CSV column name:
patient_id|deceased
Required:
false
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Patient
Data element:
DeathIndicator
Options
| Label | Value |
| Yes | TRUE |
| No | FALSE |
Date of death
Technical specs
Format:
DD/MM/YYYY
CSV column name:
patient_id|date_of_death
Only when:
Required:
false
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Patient
Data element:
DateOfDeath
Validation
- The date of death cannot be in the future (error)
2 Tick bite
Confirmed tick bite?
Technical specs
CSV column name:
confirmed_tick_bite
Required:
true
Options
| Label | Value |
| Yes | 1 |
| No | 0 |
| Unknown | 9 |
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.TransferConcern
Data element:
ProblemName
Did the tick bite occur in Belgium?
Technical specs
CSV column name:
did_the_tick_bite_occur_in_belgium
Only when:
Required:
false
Options
| Label | Value |
| Yes | 1 |
| No | 0 |
Province where tick bite occurred
Technical specs
CSV column name:
country_where_tick_bite_occurred
Only when:
Required:
false
Options
| Label | Value |
| Antwerpen | BE-VAN |
| Oost-Vlaanderen | BE-VOV |
| Vlaams-Brabant | BE-VBR |
| Limburg | BE-VLI |
| West-Vlaanderen | BE-VWV |
| Hainaut | BE-WHT |
| Liège | BE-WLG |
| Luxembourg | BE-WLX |
| Namur | BE-WNA |
| Brabant wallon | BE-WBR |
Anatomical location of tick bite
Technical specs
CSV column name:
anatomical_location_of_tick_bite
Only when:
Required:
false
Options
| Label | Value |
| Head | head |
| Torso | torso |
| Upper limbs | upper_limbs |
| Lower limbs | lower_limbs |
Number of hours between tick bite and removal of the tick
Technical specs
CSV column name:
number_of_hours_between_tick_bite_and_removal_of_the_tick
Only when:
Required:
false
Validation
- cannot be negative. (error)
- cannot be more than 1 week (error)
3 Symptoms, diagnosis and treatment
Symptoms
Technical specs
CSV column name:
symptoms
Required:
true
Options
| Label | Value |
| Infection of skin due to lyme | infection_of_skin_due_to_lyme |
| Lyme arthritis | lyme_arthritis |
| Neurological symptoms due to lyme | neurological_symptoms_due_to_lyme |
| Lyme carditis | lyme_carditis |
| Other symptoms caused by lyme (eg. conjunctivitis, uveitis, keratitis, ear disease,...) | other_symptoms_caused_by_lyme_eg_conjunctivitis_uveitis_keratitis_ear_disease |
| No symptoms | no_symptoms |
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.TransferConcern
Data element:
ProblemName
Nested option fields
- When infection_of_skin_due_to_lyme Is selected:multichoice
Specify
Technical specs
CSV column name:
symptoms|specify
Required:
false
Options
Label Value Erythema chronica migrans 1 Other 2 Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.TransferConcern
Data element:
ProblemName
Nested option fields
- When 2 Is selected:text
Please specify
Technical specs
CSV column name:
symptoms|specify|please_specify
Length:
200
Required:
false
- When 2 Is selected:
- When lyme_arthritis Is selected:multichoice
Specify
Technical specs
CSV column name:
symptoms|specify_1
Required:
false
Options
Label Value Arthralgia / Arthritis 1 Other 2 Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.TransferConcern
Data element:
ProblemName
Mapping:
{ "choice_mapping": { "1": [ "L70.02", "M25.50", "M25.5", "M19.90", "M19.9" ] } }Nested option fields
- When 2 Is selected:text
Please specify
Technical specs
CSV column name:
symptoms|specify_1|please_specify
Length:
200
Required:
false
- When 2 Is selected:
- When other_symptoms_caused_by_lyme_eg_conjunctivitis_uveitis_keratitis_ear_disease Is selected:text
Specify
Technical specs
CSV column name:
symptoms|specify_4
Length:
200
Required:
false
Validation
- Symptoms: the option 'No symptoms' cannot be combined with other options (error)
Did you request a serological test?
Technical specs
CSV column name:
did_you_request_a_serological_test
Required:
true
Options
| Label | Value |
| Yes | 1 |
| No | 0 |
| Unknown | 9 |
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.TransferPlannedCareActivity
Data element:
OrderStatus
Certainty of diagnosis (only in case of suspicion of Lyme)
Technical specs
CSV column name:
certainty_of_diagnosis_only_in_case_of_suspicion_of_lyme
Required:
false
Options
| Label | Value |
| Sure | 1 |
| Rather sure | 2 |
| Rather unsure | 3 |
| Unsure | 4 |
Treatment
Technical specs
CSV column name:
treatment
Required:
true
Options
| Label | Value |
| Antibiotics | antibiotics |
| Other treatment | other_treatment |
| No treatment | no_treatment |
Nested option fields
- When antibiotics Is selected:choice
Specify
Technical specs
CSV column name:
treatment|specify
Required:
false
Options
Label Value Amoxicillin 1 Azithromycin 2 Cefotaxime 3 Ceftriaxone 4 Cefuroxime 5 Doxycycline 6 Penicillin G 7 Penicillin V 8 Other 9 Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.MedicationPrescription
Data element:
ProductCode
Nested option fields
- When 9 Is selected:text
Specify
Technical specs
CSV column name:
treatment|specify|specify
Length:
200
Required:
false
numberNumber of days of treatment
Help
Only numbers are accepted
Technical specs
CSV column name:
treatment|number_of_days_of_treatment
Required:
false
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.MedicationPrescription
Data element:
StartDate
- When 9 Is selected:
- When other_treatment Is selected:text
Specify
Technical specs
CSV column name:
treatment|specify_5
Length:
200
Required:
false
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.MedicationPrescription
Data element:
ProductCode
Validation
- Treatment: the option 'No treatment' cannot be combined with other options (error)
4 Follow-up
Result of serological test
Technical specs
CSV column name:
result_of_serological_test
Only when:
,
Required:
true
Options
| Label | Value |
| Positive | 1 |
| Negative | 0 |
| Unknown | 9 |
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.TransferLaboratoryResult
Data element:
Result
Nested option fields
- When 1 Is selected:choice
Result of confirmation test
Technical specs
CSV column name:
result_of_serological_test|result_of_confirmation_test
Required:
false
Options
Label Value Positive 1 Negative 0 Unknown 9 Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.TransferLaboratoryResult
Data element:
Result
