Problem-oriented Medical Record Ontology
type: Ontology
creator: Chimezie Ogbuji
description: ## Accessibility ## This Semantic Web Ontology document (for self-hosted Medical Records) was written with a [faithful rendition](http://www.w3.org/2004/01/rdxh/spec#sec_rend) (GRDDL) in mind for consumption by Semantic Web Agents, lay people, logicians, *and* more ubiquitous markup user agents. It is generated by a Python software library which takes an OWL/XML document with the following additional (embedded) formats: * Markdown * RDF Vocabularies: [SKOS](http://www.w3.org/TR/swbp-skos-core-spec) / Ontology of Biomedical Investigation ([OBO](http://obi.sourceforge.net/)) vocabulary / Dublin Core ([DC](http://dublincore.org/documents/dces/)) .. and generates a host XHTML document with the following (embeded) formats: * GRDDL (OWL RDF/XML) * Manchester OWL [Syntax](http://owl-workshop.man.ac.uk/acceptedLong/submission_9.pdf) * LaTex (eventually)
description: ## Definition ## The goal is to define a minimal set of terms that connect representations from well defined healthcare information & process models (such as [HL7 RIM](http://www.hl7.org/library/data-model/RIM/C30202/rim.htm)) with more expressive [foundational](http://ontology.buffalo.edu/bio/OBR.pdf) ontologies of biology (both domain-agnostic and those specific to the domains of life sciences and healthcare) through the use of the criteria [outlined](http://www.pkc.com/papers/pomr.pdf) in the traditional Problem-oriented Medical Record structure. ## Meeting CPR Requirements ## This is an attempt to demonstrate how a few best practices in ontology and software engineering can be applied to address the problem of the lack of a unified vocabulary for Computer-based Patient Records (CPR) ## Problem-oriented Medical Record Methodology ## > The fundamental motivation for the design and philosophy of the Problem-Oriented Medical Record (POMR) > is the belief that the medical record is the central medium of communication and the first repository > of knowledge in the practice of clinical medicine ## KR Methodology ## Elisabeth Bayegan's methodology (outlined in full within her PhD [thesis](http://www.idi.ntnu.no/~bayegan/pub/ebthesis.pdf)) is followed as a means for capturing clinical content in an RDF knowledge base with syntactic and semantic extensions for *DLP* (and RIF?) expressivity (RDFLib) ## KR (Description Logic) Syntax ## Wherever possible, the Manchester OWL Syntax (@@TODO References) is adopted to capture axiomatic semantics of DL terminologies. ## GALEN' Role classes ## GALEN's role classes are used heavily to categorize (for instance): * Clinical social roles (physician, nurse, patient, etc..) * Other roles: DiagnosisRole, SignRole, SymptomRole, .. ## OBO Links ## The dependent OBO ontologies can be [browsed](http://www.bioontology.org/ncbo/faces/pages/ontology_list.xhtml) ## Anatomical Ontology ## Foundational Model of Anatomy [FMA](http://www.bioontology…
format: Manchester OWL
format: Markdown
format: OWL-DL
format: RDF
format: XHTML
comment: This Semantic Web Ontology document (for self-hosted Medical Records) was written with a faithful rendition (GRDDL) in mind for consumption by Semantic Web Agents, lay people, logicians, *and* more ubiquitous markup user agents.
imports: OBI.owl
imports: relationship.owl
imports: protege-dc.owl
imports: DOLCE-Lite.owl
imports: ExtendedDnS.owl
imports: InformationObjects.owl
imports: time
version info: 0.5
maker: chime

clinical-act
type: Class
definition: An activity associated with the clinical care process model
description: ### GALEN Definition NAMEDVolitionalAct newSub ClinicalAct. ### Knowledge Representation for Relevance Ranking of Patient-Record Contents in Primary-Care Situations Elisabeth Bayegan follows the clinical headings set as a framework for a class of 'clinical acts': > The NHS Clinical Headings Project’s main objective has been to identify a limited number of headings that will perform > the jobs that are needed for clinical communicationand navigation and that can be agreed upon by every participant > involved in clinical communication. The project produced a well-established framework of clinical headings > compatible with HL7 and CEN TC251’s standardization work on electronic patient records. Clinical Headings refer > to a set of words and phrases that clinicians use to name sections of their communications (e.g., symptoms, examination > findings, test results, diagnosis, etc.). Clinical headings have no formal syntax or definition, therefore, our content > ontology represents the formal data structures needed to strictly define concepts in the patient record. Her methodology (outlined in full within her PhD [thesis](http://www.idi.ntnu.no/~bayegan/pub/ebthesis.pdf)) is followed as a means for capturing clinical content in an RDF knowledge base. The support for a abstract clinical workflow is also an asset in possible combinations with the HCLS Advanced Clinical Protocols and Pathways ontology being developed in the W3C. ### Care Acts and Agents - Modeling the Clinical Workflow Bayegan: > We distinguish between the direct observations (the patient's problem statement and > physician's observations) and the interpretations that are done on these observations > (assessment, diagnostics, and treatment actions). This distinction between the input > to a process and the actions based on the input is also reflected in our CareActType > ontology (Figure 8.5). The CareActType ontology has four main classes that jut out > from the root concept THING (1) case history, (2) asse…
references: ebthesis.pdf
subclass of: ClinicalAct
subclass of: Restriction
  on property: participant
  some values from: Person
editorial note: Should this be a subclass of edns:activity (provide linkage to DOLCE's more generic workflow semantics)? The participant restriction becomes redundant if so

clinical description
type: Class
definition: Corresponds (at least syntactically) with the HL7 RIM Act Class, insofar as it is the class of clinical recordings (a REPRESENTATIONAL ARTIFACT) of a natural phenomenon (cpr:medical-problem, cpr:clinical-act, and anything else of clinical relevance) by an individual. Collections of such recordings, each of which is related to a person, manifests as the patient record.
description: ### Reconciling HL7 RIM Inconsistencies The *cpr:clinical-description* class is an attempt to reconcile the ontological inconsistencies with the archetype of a recording of an act and the thing the recording describes (which could be either a continuant / endurant or an occurrant / perdurant). ### about > The relation between information objects and entities they are about. The difference with 'expresses' is that the last > requires a situation to be about something. E.g. Dante's Comedy is about facts like Dante's travel to the hereafter. > The Comedy expresses a script as well as various related meanings, while the facts talked about are not 'expressed'. > Given that descriptions are expressed by at least one IO, and that interpretations of IOs requires conceiving a description, > and the (plausible) claim that being about something can only be done in context, i.e. within a situation, we can propose > that the conceived description is satisfied by the situation (the context) of the entity the IO is about.On this basis, > about would result to be a mediated relation. This is still a proposal, then we keep about here as a primitive for some time. ### depiction > An information realization consisting of depicted images/signs of any sort (e.g. graffiti, drawings, inscriptions, pictures, > sculptures, etc.), which are inscripted on a medium that lasts longer than the depicting act. It also includes any early form > of inscripted iconic expression, which can be considered as original bodily expressions. ### REPRESENTATIONAL ARTIFACT > A representation that is fixed in some medium in such a way that it can serve to make the cognitive representations existing in the minds of separate > subjects publicly accessible in some enduring fashion. Examples are: a text, a diagram, a map legend, a list, a clinical record, or a controlled > vocabulary. ### Act (HL7 RIM) > A record of something that is being done, has been done, can be done, or is intended or requested to be done. On…
subclass of: depiction
subclass of: Restriction
  cardinality: 1
  on property: creator
intersection of: g58
intersection of: g59
intersection of: g60
editorial note: Should clinical-descriptions *only* be about people, problems, or acts?
editorial note: The extension of this class does not include intent or requests ala HL7 RIM
editorial note: With regards to temporal provenance, a clinical description can be associated with a date (of initial creation or last modification). This is not to be confused with the temporal qualities of the phenomenon it describes.

clinical-examination
type: Class
definition: The process by which a health care provider investigates the body of a patient for signs of disease
description: ### Wikipedia definition > Physical examination or clinical examination is the process by which a health care provider investigates the body of a patient for signs > of disease. It generally follows the taking of the medical history - an account of the symptoms > as experienced by the patient. Together with the medical history, the physical examination aids > in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record.
references: Clinical examination
subclass of: diagnostic act
equivalent class: Restriction
  all values from: ExaminationFinding
  on property: realizes

described by
type: ObjectProperty
defnition: Relation between a phenomena and the clinical-description which records it in a patient record
range: clinical description
sub property of: OBO REL agent in
inverse of: description of

description of
type: ObjectProperty
defnition: Relation between a clinical-description and what it describes
domain: clinical description
sub property of: OBO REL has agent
inverse of: described by

diagnosis
type: Class
definition: Identification of a disease from its symptoms
description: ### Diagnosis Role Both GALEN and OBI define diagnosis roles: ### GALEN Diagnosis (Phenomenon whichG playsConsultationRole DiagnosisRole) name Diagnosis. ### OBI Diagnosis Role (OBI_159) > A diagnostic role is a role which is assigned to an entity when it is used to identify the nature or cause of some phenomenon (i.e. a diagnosis). - http://wordnet.princeton.edu/perl/webwn?s=diagnosis
references: http://wordnet.princeton.edu/perl/webwn
subclass of: medical problem
equivalent class: Diagnosis
editorial note: This may eventually be aligned with obi:OBI_159

diagnostic act
type: Class
definition: Any activity which is undertaken to find out more information about a patient/client's state of health and social well-being
description: ### GALEN Defnition(s) (ClinicalAct whichG isToDetermine Phenomenon) name InvestigationAct. (ClinicalAct whichG hasSubprocess ExaminingProcess) name ExaminationAct. ### DOLCE's Definition of an information realization > Any physical entity that realizes an information object.
references: draftinfo.asp
subclass of: clinical-act
subclass of: information-realization

disease
type: Class
definition: an impairment of health or a condition of abnormal functioning
description: ### Alignment with OBI **TODO** Align with OBI_155 once it settles ### Ontology of Biomedical Reality > Relying on the FMAs definition of anatomical structure, we distinguish anatomical (normal) > from pathological (abnormal) material entities; the latter resulting from processes other than those > governed by the organism’s structural genes. We also extend the FMAs representation of material entities
references: http://wordnet.princeton.edu/perl/webwn
comment: Wordnet:
subclass of: Disposition
editorial note: This may eventually be aligned with obi:OBI_155

interpretant-of
type: ObjectProperty
defnition: Relation between a medical sign and the entity which causes the objective indication interpreted by a clinician
references: relation30.html
domain: medical sign

lab test
type: Class
definition: A quantitative or qualitative test of a substance (especially an ore or a drug) to determine its components;
description: ### Wordnet Defnitions Assay: > A quantitative or qualitative test of a substance (especially an ore or a drug) to determine its components; > frequently used to test for the presence or concentration of infectious agents or antibodies etc.) Diagnostic test: > An assay conducted for diagnostic purposes.
references: http://wordnet.princeton.edu/perl/webwn
subclass of: diagnostic act

medical device
type: Class
subclass of: Device
editorial note: Placeholder for medical devices ontology

medical history screening act
type: Class
definition: Any diagnostic act which attempts to determine / realize anamnesis
description: ### WIkipedia Definition > The medical history or anamnesis[1] of a patient is information gained by a physician or other > healthcare professional by asking specific questions, either of the patient or of other people > who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis), > with the aim of obtaining information useful in formulating a diagnosis and providing medical care > to the patient. This kind of information is called the symptoms, in contrast with clinical signs, > which are ascertained by direct examination. Rather than explicitely referring (within the patient record) to instances of a class called 'history' (which act as input to activities in the care process), information-objects realized by instances of this class are assumed to be considered a case history (relative - temporaly - to the screening acts)
references: http://wordnet.princeton.edu/perl/webwn
subclass of: diagnostic act

medical problem
type: Class
definition: The class of entities or particulars which play a galen:SignOrSymptomRole or a galen:DiagnosisRole
description: ### POMR Definition Consists mainly of problems that clearly require the intervention of a health care professional. These include acute problems requiring hospitalization and chronic problems requiring long-term management. Such problems usually offer at least some risk of impairment or disability especially if diagnosis or management is not handled properly. ### Relation to GALEN's "Basic Template for Signs and Symptoms" This 'defined class' can be considered equivalent to GALEN's SignSymptomOrDiagnosis.
references: pomr.pdf
subclass of: Class
  intersection of: Restriction
    on property: has-quality
    some values from: TemporalEntity
  intersection of: Restriction
    min cardinality: 1
    on property: hasSeverity
editorial note: Does the POMR methodology require that all medical-problems are occurrents? Do they include endurants (continuants) and / or qualities?
editorial note: Is galen:hasSeverity an appropriate relation to use to capture the severity of medical problems

medical sign
type: Class
definition: An "objective" (determined by a clnician) indication of some medical fact or quality that is detected by a physician during a physical examination of a patient
description: ### Wordnet Wordnet definition of a medical sign: > .. any objective evidence of the presence of a disorder or disease ### Wikipedia Wikipedia [definition](http://en.wikipedia.org/wiki/Medical_sign) > a medical sign is an objective indication of some medical fact or quality > that is detected by a physician during a physical examination of a patient—such > as elevated blood pressure, or a clubbing of the fingers (which may be a sign > of lung disease), or arcus senilis. ### Representation Theory - Laboratory for Applied Ontology (LOA) : Medical Theories > In principle, a theory of signs admits that anything can be used to describe anything else. > In practice, there are severe limitations on the use of some entity as interpretant of another, > and these limitations derive from the cultural and local context, from the symbolic system used, > and from the cognitive and ontological underlying motivations. This is a theory which only > describes the use of signs as a post-hoc issue, after some intentionality has decided what is an > interpretant of what. Interpretant is a relation which holds between any two entities, where the > first is used to describe or explain the second. There are background conditions for being an > interpretant: an agent should be aware of both the interpretant and the reference, and a context > should encompass the agent and the entities involved. Interpretant is reflexive, while symmetry > and transitivity are debatable. Symmetry seems inappropriate, since usually some entity is USED > as interpretant, and the process is not reverted (not an equivalence). Transitivity holds only > if metaphor and metonymy are discarded as possible sense sources in the domain of interpretation.
references: Medical sign
subclass of: medical problem
intersection of: g62
intersection of: g63
editorial note: Are class axioms in conflict? *Any* interpretation by a doctor is a medical sign, but *all* medical signs must be medical problems?

medical therapy
type: Class
subclass of: therapeutic act

medication
type: Class
definition: (medicine) something that treats or prevents or alleviates the symptoms of disease
description: ### Laboratory for Applied Ontology (LOA) > A substance used in the treatment, diagnosis, prevention, or analysis of normal and abnormal body function. This includes substances that occur naturally in the body and are administered therapeutically.
references: http://wordnet.princeton.edu/perl/webwn
subclass of: NAMEDDrug
editorial note: Placeholder for drug ontology

Patient Record
type: Class
definition: An information object (a obi:digital_entity?) which includes relevant healthcare content about (similar to foaf:primaryTopic) a patient
subclass of: information-object
intersection of: g56
intersection of: g57
editorial note: No longer a subclass of foaf:Document and inf:linguistic-object. Now is a sole subclass of edns:information-object

person
type: Class
definition: (a human being) "there was too much for one person to do" - http://wordnet.princeton.edu/perl/webwn?s=person
subclass of: Person

physical therapy
type: Class
definition: Therapy that uses physical agents: exercise and massage and other modalities
references: http://wordnet.princeton.edu/perl/webwn
subclass of: therapeutic act

psychological therapy
type: Class
subclass of: therapeutic act

screening act
type: Class
definition: Process of data collection with pre-defined and standardized screening questionnaires in order to discover problems.
description: ### Problem-oriented Medical Record Definition > .. screening information can be subdivided into at least four major areas: (1) wellness > screening, (2) physical examination, (3) medical history, and (4) mental health screening. > Additional categories or sub-categories may be introduced for special needs (such as breast > cancer screening). For each of these areas we expect to record findings indicating the patient's > current status and condition, and recommended actions (in response to the findings) that may > require follow-up and monitoring. ### Laboratory for Applied Ontology (LOA) - Medical-procedures Theory > A procedure, method, or technique used to determine the nature or identity of a disease or disorder. This excludes procedures which are primarily carried out on specimens in a laboratory. ### HL7 RIM Observation Definition > An Act of recognizing and noting information about the subject, and whose immediate and primary outcome (post-condition) is new data about a subject. ### GALEN Definition ClinicalAct whichG isToDetermine (Existentiality which isExistenceOf PathologicalPhenomenon)) name ScreeningAct. OBO\_REL\_has\_improper\_part is used to relate a screening act with the acts that compose it (history taking and physical examination)
references: draftinfo.asp
references: pomr.pdf
subclass of: diagnostic act
intersection of: g64
intersection of: g65

medical therapy
type: Class
definition: The act of introducing or otherwise applying a substance to the patient
description: ### GALEN Definition (MechanicalPropulsion whichG < actsSpecificallyOn Drug hasUniqueAssociatedDisplacement (Displacement which isDisplacementTo BodyStructure)> ) name DrugAdministration. ### HL7 RIM Defnition (SubstanceAdministration-cls) > The act of introducing or otherwise applying a substance to the subject. > Discussion: The effect of the substance is typically established on a biochemical basis, > however, that is not a requirement. For example, radiotherapy can largely be described in > the same way, especially if it is a systemic therapy such as radio-iodine. This class also > includes the application of chemical treatments to an area.
references: SubstanceAdministration-cls
comment: The act of introducing or otherwise applying a substance to the subject.
label: substance administration
subclass of: medical therapy
editorial note: How should this relate to the cpr:medication being administered?

surgical procedure
type: Class
definition: A medical procedure involving an incision with instruments; performed to repair damage or arrest disease in a living body)
description: ### GALEN Definition (Process whichG playsClinicalRole SurgicalRole) name SurgicalDeed.
references: http://wordnet.princeton.edu/perl/webwn
subclass of: therapeutic act

symptom
type: Class
definition: A sensation or change in health function experienced by a patient
description: ### Wordnet Definition See: [symptom](http://wordnet.princeton.edu/perl/webwn?s=symptom) ### Wikipedia Definition See: [Symptom](http://en.wikipedia.org/wiki/Symptom): > Strict ly, a symptom is a sensation or change in health function experienced by a patient. Thus, symptoms may be > loosely classified as strong, mild or weak. In this, medically correct, sense of the word, it is a subjective > report, as opposed to a sign, which is objective evidence of the presence of a disease or disorder. Examples of > symptoms are fatigue/tiredness, pain, or nausea. In contrast, elevated blood pressure, or abnormal appearance of > the retina, would be a medical sign indicating the nature of the disease. ### GALEN (GRAIL) Definition(s) (Phenomenon whichG playsConsultationRole SymptomRole) name Symptom. interpetant-of can be thought of as somewhat related to how isConsultationRolePlayedBy relates a SymptomRole with the phenomenon which 'plays' it
references: Symptom
subclass of: medical problem
subclass of: Restriction
  all values from: Patient
  on property: interpreted-by
equivalent class: Symptom

therapeutic act
type: Class
definition: Any activity which is undertaken to maintain or improve a patient/client's state of health and well-being, relieve distress or reduce risk
description: ### Wordnet Definition > ..care provided to improve a situation (especially medical procedures or applications that are intended to relieve illness or injury) ### GALEN Defintion ClinicalAct newSub TreatmentAct. ### NHS Clinical Headings > Any activity which is undertaken to maintain or improve a patient/client's state of health and well-being, relieve distress or reduce risk ### HL7 RIM Definition > An Act whose immediate and primary outcome (post-condition) is the alteration of the physical condition of the subject. ### Laboratory for Applied Ontology (LOA) > A procedure, method, or technique designed to prevent a disease or a disorder, or to improve physical function, or used in the process of treating a disease or injury.
references: draftinfo.asp
subclass of: clinical-act

indicates
type: ObjectProperty
comment: Property relating a foaf:Image to a medical sign it indicates
domain: Image
range: medical sign
inverse of: interpretant-of

patient-record
type: Patient Record
type: g56
type: g57
date: 2000-04-07
OBO REL has proper part: g0
OBO REL has proper part: g1
OBO REL has proper part: g2
OBO REL has proper part: g3
OBO REL has proper part: g4
OBO REL has proper part: g5
OBO REL has proper part: g6
OBO REL has proper part: g7
OBO REL has proper part: g9
OBO REL has proper part: g11
OBO REL has proper part: g13
OBO REL has proper part: g15
OBO REL has proper part: g16
OBO REL has proper part: g17
OBO REL has proper part: g18
OBO REL has proper part: g19
OBO REL has proper part: g20
OBO REL has proper part: g21
OBO REL has proper part: g22
OBO REL has proper part: g23
OBO REL has proper part: g24
OBO REL has proper part: g25
OBO REL has proper part: g26
OBO REL has proper part: g27
OBO REL has proper part: g28
OBO REL has proper part: g29
OBO REL has proper part: g30
OBO REL has proper part: g31
OBO REL has proper part: g32
OBO REL has proper part: g33
OBO REL has proper part: g34
OBO REL has proper part: g35
OBO REL has proper part: g36
OBO REL has proper part: g37
OBO REL has proper part: g38
OBO REL has proper part: g39
OBO REL has proper part: g40
OBO REL has proper part: g41
OBO REL has proper part: g42
OBO REL has proper part: g44
OBO REL has proper part: g46
OBO REL has proper part: g47
OBO REL has proper part: g48
OBO REL has proper part: g49
OBO REL has proper part: g50
OBO REL has proper part: g51
OBO REL has proper part: g52
OBO REL has proper part: g53
OBO REL has proper part: g54
OBO REL has proper part: g55
about: Patient
  family name: Levin
  first name: Henry
maker: Person
  family name: Dolin
  first name: Robert

g0
type: clinical description
type: g58
type: g59
type: g60
description of: clinical diagnosis
  type: screening act
  type: g64
  type: g65
  described by: g0
  date: 1950
  realizes: Asthma

g1
type: clinical description
type: g58
type: g59
type: g60
description of: clinical diagnosis
  type: screening act
  type: g64
  type: g65
  described by: g1
  realizes: HTN

g2
type: clinical description
type: g58
type: g59
type: g60
description of: clinical diagnosis
  type: screening act
  type: g64
  type: g65
  described by: g2
  has specific location: Knee joint
  realizes: Osteoarthritis
    type: diagnosis
    type: medical problem
    type: g61
    has specific location: Knee joint

g3
type: clinical description
type: g58
type: g59
type: g60
description of: Theodur 200mg BID
  type: medical therapy
  described by: g3
  v3dose quantity: 200
    unit: mg
  v3effective time: 12
    type: v3period
    unit: h

g4
type: clinical description
type: g58
type: g59
type: g60
description of: Proventil inhaler 2puffs QID PRN
  type: medical therapy
  described by: g4
  v3dose quantity: 2
  v3effective time: 6
    type: v3period
    unit: h

g5
type: clinical description
type: g58
type: g59
type: g60
description of: Prednisone 20mg qd
  type: medical therapy
  described by: g5
  v3dose quantity: 20
    unit: mg
  v3effective time: 24
    type: v3period
    unit: h

g6
type: clinical description
type: g58
type: g59
type: g60
description of: HCTZ 25mg qd
  type: medical therapy
  described by: g6
  v3effective time: 24
    type: v3period
    unit: h

g7
type: clinical description
type: g58
type: g59
type: g60
description of: history taking (procedure)
  type: screening act
  type: g64
  type: g65
  described by: g7
  OBO REL has improper part: history taking (procedure)
    type: medical history screening act
    type: g66
    realizes: Allergy to penicillin

Allergy to penicillin
type: medical sign
type: g62
type: g63
interpretant-of: Hives
  type: symptom
  indicates: Allergy to penicillin

g9
type: clinical description
type: g58
type: g59
type: g60
description of: history taking (procedure)
  type: screening act
  type: g64
  type: g65
  described by: g9
  OBO REL has improper part: history taking (procedure)
    type: medical history screening act
    type: g66
    realizes: Allergy to aspirin

Allergy to aspirin
type: medical sign
type: g62
type: g63
interpretant-of: Wheezing
  type: symptom
  indicates: Allergy to aspirin

g11
type: clinical description
type: g58
type: g59
type: g60
description of: history taking (procedure)
  type: screening act
  type: g64
  type: g65
  described by: g11
  OBO REL has improper part: history taking (procedure)
    type: medical history screening act
    type: g66
    realizes: Adverse reaction to drug

Adverse reaction to drug
type: medical sign
type: g62
type: g63
interpretant-of: Pruritis
  type: symptom
  indicates: Adverse reaction to drug

g13
type: clinical description
type: g58
type: g59
type: g60
description of: history taking (procedure)
  type: screening act
  type: g64
  type: g65
  described by: g13
  OBO REL has improper part: medical-history-screening-act
    type: medical history screening act
    type: g66
    realizes: g14

g14
type: medical sign
type: g62
type: g63
interpretant-of: Nausea
  type: symptom
  indicates: g14

g15
type: clinical description
type: g58
type: g59
type: g60
description of: history taking (procedure)
  type: screening act
  type: g64
  type: g65
  described by: g15
  date: 1970
  OBO REL has improper part: history taking (procedure)
    type: medical history screening act
    type: g66
    realizes: MI
      date: 1970

g17
type: clinical description
type: g58
type: g59
type: g60
description of: history taking (procedure)
  type: screening act
  type: g64
  type: g65
  described by: g17
  OBO REL has improper part: history taking (procedure)
    type: medical history screening act
    type: g66
    realizes: No family history of diabetes

g18
type: clinical description
type: g58
type: g59
type: g60
description of: Tobacco use and exposure
  type: screening act
  type: g64
  type: g65
  described by: g18
  realizes: ex-heavy cigarette smoker (20-39/day)

g19
type: clinical description
type: g58
type: g59
type: g60
description of: Date ceased smoking
  type: screening act
  type: g64
  type: g65
  described by: g19
  realizes: medical-problem
    type: medical problem
    type: g61

g20
type: clinical description
type: g58
type: g59
type: g60
description of: Alcohol intake
  type: screening act
  type: g64
  type: g65
  described by: g20
  realizes: Trivial drinker - less than 1/day

g21
type: clinical description
type: g58
type: g59
type: g60
description of: Body height measure
  type: screening act
  type: g64
  type: g65
  described by: g21
  date: 2000-04-07T14:30:00
  realizes: 1.77
    type: medical problem
    type: g61
    unit: m
  realizes: 69.7
    type: medical problem
    type: g61
    unit: [in_I]

g22
type: clinical description
type: g58
type: g59
type: g60
description of: Body weight measure
  type: screening act
  type: g64
  type: g65
  described by: g22
  date: 2000-04-07T14:30:00
  realizes: 194.0
    type: medical problem
    type: g61
    unit: [lb_ap]
  realizes: 88.0
    type: medical problem
    type: g61
    unit: kg

g23
type: clinical description
type: g58
type: g59
type: g60
description of: Body mass index
  type: screening act
  type: g64
  type: g65
  described by: g23
  date: 2000-04-07T14:30:00
  realizes: medical-problem
    type: medical problem
    type: g61

g24
type: clinical description
type: g58
type: g59
type: g60
description of: Body surface area
  type: screening act
  type: g64
  type: g65
  described by: g24
  date: 2000-04-07T14:30:00
  realizes: 2.05
    type: medical problem
    type: g61
    unit: ar

g25
type: clinical description
type: g58
type: g59
type: g60
description of: Body temperature
  type: screening act
  type: g64
  type: g65
  described by: g25
  date: 2000-04-07T14:30:00
  realizes: 36.9
    type: medical problem
    type: g61
    unit: Cel
  realizes: 98.5
    type: medical problem
    type: g61
    unit: [degF]

g26
type: clinical description
type: g58
type: g59
type: g60
description of: Heart rate
  type: screening act
  type: g64
  type: g65
  described by: g26
  date: 2000-04-07T14:30:00
  realizes: medical-problem
    type: medical problem
    type: g61

g27
type: clinical description
type: g58
type: g59
type: g60
description of: Heart rate
  type: screening act
  type: g64
  type: g65
  described by: g27
  date: 2000-04-07T15:30:00
  realizes: medical-problem
    type: medical problem
    type: g61

g28
type: clinical description
type: g58
type: g59
type: g60
description of: Regularity of heart rhythm
  type: screening act
  type: g64
  type: g65
  described by: g28
  date: 2000-04-07T14:30:00
  realizes: Heart regular

g29
type: clinical description
type: g58
type: g59
type: g60
description of: Regularity of heart rhythm
  type: screening act
  type: g64
  type: g65
  described by: g29
  date: 2000-04-07T15:30:00
  realizes: Heart regular

g30
type: clinical description
type: g58
type: g59
type: g60
description of: Respiratory rate
  type: screening act
  type: g64
  type: g65
  described by: g30
  date: 2000-04-07T14:30:00
  realizes: medical-problem
    type: medical problem
    type: g61

g31
type: clinical description
type: g58
type: g59
type: g60
description of: Respiratory pattern
  type: screening act
  type: g64
  type: g65
  described by: g31
  date: 2000-04-07T14:30:00
  realizes: Breathing easily

g32
type: clinical description
type: g58
type: g59
type: g60
description of: Respiratory rate
  type: screening act
  type: g64
  type: g65
  described by: g32
  date: 2000-04-07T15:30:00
  realizes: medical-problem
    type: medical problem
    type: g61

g33
type: clinical description
type: g58
type: g59
type: g60
description of: Cuff blood pressure
  type: screening act
  type: g64
  type: g65
  described by: g33
  date: 2000-04-07T14:30:00
  has specific location: Left arm
  OBO REL has improper part: clinical-examination
    type: g66
    date: 2000-04-07T15:30:00
    realizes: 132
      type: AbsoluteMeasurement
      unit: mm[Hg]
      preferred label: Systolic BP
  OBO REL has improper part: clinical-examination
    type: g66
    date: 2000-04-07T15:30:00
    realizes: 86
      type: AbsoluteMeasurement
      unit: mm[Hg]
      preferred label: Diastolic BP

g34
type: clinical description
type: g58
type: g59
type: g60
description of: Cuff blood pressure
  type: screening act
  type: g64
  type: g65
  described by: g34
  date: 2000-04-07T15:30:00
  has specific location: Left arm
  OBO REL has improper part: clinical-examination
    type: g66
    date: 2000-04-07T15:30:00
    realizes: 135
      type: AbsoluteMeasurement
      unit: mm[Hg]
      preferred label: Systolic BP
  OBO REL has improper part: clinical-examination
    type: g66
    date: 2000-04-07T15:30:00
    realizes: 88
      type: AbsoluteMeasurement
      unit: mm[Hg]
      preferred label: Diastolic BP

g35
type: clinical description
type: g58
type: g59
type: g60
description of: Skin finding
  type: screening act
  type: g64
  type: g65
  described by: g35
  has specific location: Skin of palmer surface of index finger
  realizes: Rash

g36
type: clinical description
type: g58
type: g59
type: g60
description of: Respiratory sounds
  type: screening act
  type: g64
  type: g65
  described by: g36
  realizes: Chest clear

g38
type: clinical description
type: g58
type: g59
type: g60
description of: Auscultation
  type: screening act
  type: g64
  type: g65
  described by: g38
  realizes: Normal heart rate

g41
type: clinical description
type: g58
type: g59
type: g60
description of: Auscultation
  type: screening act
  type: g64
  type: g65
  described by: g41
  realizes: Fourth heart sound inaudible

g42
type: clinical description
type: g58
type: g59
type: g60
description of: Imaging interpretation
  type: screening act
  type: g64
  type: g65
  described by: g42
  realizes: Chest hyperinflated

Chest hyperinflated
type: medical problem
type: medical sign
type: g61
type: g62
type: g63
interpretant-of: Chest-X-ray
  type: DiagnosingImage
  type: Image
  type: g67
  indicates: Chest hyperinflated

g44
type: clinical description
type: g58
type: g59
type: g60
description of: Imaging interpretation
  type: screening act
  type: g64
  type: g65
  described by: g44
  realizes: g45

g45
type: medical problem
type: medical sign
type: g61
type: g62
type: g63
interpretant-of: Chest-X-ray
  type: DiagnosingImage
  type: Image
  type: g67
  indicates: g45

g47
type: clinical description
type: g58
type: g59
type: g60
description of: Peak flow
  type: screening act
  type: g64
  type: g65
  described by: g47
  date: 2000-04-07
  realizes: medical-problem
    type: medical problem
    type: g61

g48
type: clinical description
type: g58
type: g59
type: g60
description of: Suture removal
  type: therapeutic act
  described by: g48
  date: 2000-04-07T14:30:00
  has specific location: Left forearm

g49
type: clinical description
type: g58
type: g59
type: g60
description of: Established diagnosis
  type: screening act
  type: g64
  type: g65
  described by: g49
  date: 2000-04-07T15:30:00
  realizes: Asthma

g50
type: clinical description
type: g58
type: g59
type: g60
description of: Established diagnosis
  type: screening act
  type: g64
  type: g65
  described by: g50
  date: 2000-04-07T15:30:00
  realizes: Essential hypertension

g51
type: clinical description
type: g58
type: g59
type: g60
description of: Established diagnosis
  type: screening act
  type: g64
  type: g65
  described by: g51
  date: 2000-04-07T15:30:00
  has specific location: Skin of palmer surface of index finger
  realizes: Contact dermatitis
    type: diagnosis
    type: medical problem
    type: g61
    has specific location: Skin of palmer surface of index finger

g54
type: clinical description
type: g58
type: g59
type: g60
description of: prednisone 20qOD alternating with 18qOD.
  type: medical therapy
  described by: g54

g55
type: clinical description
type: g58
type: g59
type: g60
description of: Hydrocortisone cream to finger BID.
  type: medical therapy
  described by: g55
  v3effective time: 12
    type: v3period
    unit: h

g59
type: Restriction
min cardinality: 1
on property: about

g62
type: Restriction
min cardinality: 1
on property: interpretant-of