醫療保險理賠實作指引 - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Document Subject
Document Content
文件識別碼:A0001 (https://www.cgh.org.tw)
文件狀態:Final (CompositionStatus#final)
文件種類:Charge ticket or encounter form ( LOINC#64291-8)
文件創建日期:2023-08-21T14:30:00+08:00
文件創建單位:Organization/Organization-min "國泰醫療財團法人國泰綜合醫院"
病人:Patient/Patient-C1 "郝美麗"
section.entry[iClaim]:Claim/Claim-C1
section.entry[condition]:Condition/Condition-C1
section.entry[diagnosticReport]:DiagnosticReport/DiagnosticReport-C1
section.entry[encounter]:Encounter/Encounter-C1
section.entry[coverage]:Coverage/Coverage-C1
section.entry[payor]:Organization/Organization-cathay
section.entry[practitioner]:Practitioner/Practitioner-Chen
section.entry[practitioner]:Practitioner/Practitioner-Ciou
section.entry[practitioner]:Practitioner/Practitioner-Wang1
section.entry[observation]:Observation/Observation-C1
Entry 1 - fullUrl = https://claim.cgh.org.tw/iclaim/Composition/Composition-C1
Resource Composition:
Composition
文件識別碼:A0001 (https://www.cgh.org.tw)
文件狀態:Final (CompositionStatus#final)
文件種類:Charge ticket or encounter form ( LOINC#64291-8)
文件創建日期:2023-08-21T14:30:00+08:00
文件創建單位:Organization/Organization-min "國泰醫療財團法人國泰綜合醫院"
病人:Patient/Patient-C1 "郝美麗"
section.entry[iClaim]:Claim/Claim-C1
section.entry[condition]:Condition/Condition-C1
section.entry[diagnosticReport]:DiagnosticReport/DiagnosticReport-C1
section.entry[encounter]:Encounter/Encounter-C1
section.entry[coverage]:Coverage/Coverage-C1
section.entry[payor]:Organization/Organization-cathay
section.entry[practitioner]:Practitioner/Practitioner-Chen
section.entry[practitioner]:Practitioner/Practitioner-Ciou
section.entry[practitioner]:Practitioner/Practitioner-Wang1
section.entry[observation]:Observation/Observation-C1
Entry 2 - fullUrl = https://claim.cgh.org.tw/iclaim/Claim/Claim-C1
Resource Claim:
理賠申請書編號:A0001 (https://www.cgh.org.tw)
理賠申請書狀態: Active (Financial Resource Status Codes#active)
理賠申請書類別: Institutional (Claim Type Codes#institutional)
理賠申請書用途: Claim (Use#claim)
病人: Patient/Patient-C1 "郝美麗"
理賠申請書日期: 2023-08-07
醫院: Organization/Organization-min "國泰醫療財團法人國泰綜合醫院"
處理優先順序: Immediate (Process Priority Codes#stat)
診斷證明書:
順序 Diagnosis[x] 1 Condition/Condition-C1 保險:
順序 Focal Coverage 1 true Coverage/Coverage-C1 收據:
費用序號: 1
自付金額(base price)/減免(discount): 自付金額 (InvoicePriceComponentType#base)
費用項目: 掛號費 (費用項目-健保#REGISTRATION)
就醫身分: 自費 (Coverage SelfPay Codes#pay)
收據日期: 2023-08-07
自付金額:150
費用序號: 2
費用項目: 掛號費 (費用項目-健保#REGISTRATION)
就醫身分: 健保 (ActCode#PUBLICPOL)
收據日期: 2023-08-07
健保點數:580
總費用:150
Entry 3 - fullUrl = https://claim.cgh.org.tw/iclaim/Patient/Patient-C1
Resource Patient:
病人基本資料
識別碼型別:National Person Identifier ( Identifier Type Codes#NNxxx [extension: Identifier Suffix]:TWN)
身分證字號(official)C251401029 (http://www.moi.gov.tw)識別碼型別:Medical record number ( Identifier Type Codes#MR)
病歷號(official):ADCM9487 (https://www.cgh.org.tw)姓名(official):郝美麗
性別:Female ( AdministrativeGender#female)
出生日期:1990-04-22
職業[extension: Occupation]:內勤人員 ( Occupation#00010010)
聯絡地址:台北市北投區明德路365號
縣/市(district):台北市
鄉/鎮/市/區(city):北投區
路/街(line):明德路
號(number)[extension: tw-number]:365號
國家(country):臺灣
Entry 4 - fullUrl = https://claim.cgh.org.tw/iclaim/Organization/Organization-min
Resource Organization:
醫事機構基本資料
機構名稱:國泰醫療財團法人國泰綜合醫院
識別碼型別:Provider number( IdentifierType#PRN)
機構代碼(official):1101020018 (https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/organization-identifier-tw)機構種類:Healthcare Provider ( OrganizationType#prov)
Entry 5 - fullUrl = https://claim.cgh.org.tw/iclaim/Coverage/Coverage-C1
Resource Coverage:
status: active ( FinancialResourceStatusCodes#active )
beneficiary: Patient/Patient-C1 "郝美麗"
payor: Organization/Organization-cathay "國泰人壽保險股份有限公司"
Entry 6 - fullUrl = https://claim.cgh.org.tw/iclaim/Organization/Organization-cathay
Resource Organization:
公司行號基本資料
機構名稱:國泰人壽保險股份有限公司
識別碼型別:Unified Business number( 臺灣識別碼類型#UBN)
公司或企業統一編號(official):03374707 (https://gcis.nat.gov.tw)機構種類:Non-Healthcare Business or Corporation ( OrganizationType#bus)
Entry 7 - fullUrl = https://claim.cgh.org.tw/iclaim/Condition/Condition-C1
Resource Condition:
病情、問題或診斷資料
病情、問題或診斷識別碼:1080108642
臨床狀態:Active ( ConditionClinicalStatusCodes#active)
病情、問題或診斷類別:Encounter Diagnosis ( Condition Category Codes#encounter-diagnosis)
病情、問題或診斷識別:手其他部位扭傷及拉傷 ( NHIICD9CM#842.19)
病人:Patient/Patient-C1 "郝美麗"
就醫(Encounter)紀錄:Encounter/Encounter-C1
記錄日期:2023-08-07
主治醫師:PractitionerRole/PractitionerRole-pri "陳健骨"
負責醫師(院長):PractitionerRole/PractitionerRole-res "邱榮一"
診斷報告:DiagnosticReport/DiagnosticReport-C1
醫療摘要:手扭傷後,關節局部腫脹,關節彎曲受限,伸不直或彎曲不了
Entry 8 - fullUrl = https://claim.cgh.org.tw/iclaim/DiagnosticReport/DiagnosticReport-C1
Resource DiagnosticReport:
診斷報告
診斷狀態:Final ( DiagnosticReportStatus#final)
診斷報告名稱:Surgery of the hand Outpatient Progress note ( LOINC實驗室檢驗檢查報告名稱#100537-0)
病人:Patient/Patient-C1 "郝美麗"
Entry 9 - fullUrl = https://claim.cgh.org.tw/iclaim/Observation/Observation-C1
Resource Observation:
檢驗檢查資料
收件編號(檢驗單號):096H004 (https://www.cgh.org.tw)
狀態:final ( ObservationStatus#final)
檢驗類型:Laboratory ( Observation Category Codes#laboratory)
檢驗項目名稱:CD3+CD4+ (T4 helper) cells/100 cells in Blood mononuclear cells ( LOINC實驗室檢驗檢查值集#100856-4)
病人: Patient/Patient-C1 "郝美麗"
採檢日期:2023-08-07
報告日期:2023-08-07 17:00:14+08:00
醫檢師: PractitionerRole/PractitionerRole-tech "王大郎"
報告者: PractitionerRole/PractitionerRole-rep "陳健骨"
檢驗部位:Right wrist ( SNOMED CT Body Structures#9736006)
檢驗值:4000 /uL
H/L:Off scale low ( v3 Code System ObservationInterpretation#<)
參考範圍:
參考最低值 參考最高值 4500 10000 檢驗結果說明:無
Entry 10 - fullUrl = https://claim.cgh.org.tw/iclaim/Practitioner/Practitioner-Chen
Resource Practitioner:
健康照護服務提供人員基本資料
識別碼型別:Medical License number ( Identifier Type Codes#MD)
員工編號(official):031932 (https://www.cgh.org.tw)姓名(official):陳健骨
Entry 11 - fullUrl = https://claim.cgh.org.tw/iclaim/Practitioner/Practitioner-Ciou
Resource Practitioner:
健康照護服務提供人員基本資料
姓名(official):邱榮一
Entry 12 - fullUrl = https://claim.cgh.org.tw/iclaim/Practitioner/Practitioner-Wang1
Resource Practitioner:
健康照護服務提供人員基本資料
姓名(official):王大郎
Entry 13 - fullUrl = https://claim.cgh.org.tw/iclaim/PractitionerRole/PractitionerRole-pri
Resource PractitionerRole:
醫師角色基本資料
健康照護服務提供者:Practitioner/Practitioner-Chen "陳健骨"
角色:主治醫師(Attending physician (occupation)) ( SNOMED CT#405279007)
Entry 14 - fullUrl = https://claim.cgh.org.tw/iclaim/PractitionerRole/PractitionerRole-res
Resource PractitionerRole:
醫師角色基本資料
健康照護服務提供者:Practitioner/Practitioner-Ciou "邱榮一"
角色:負責醫師(院長) ( 醫事人員類別#responsiblePhysician)
Entry 15 - fullUrl = https://claim.cgh.org.tw/iclaim/PractitionerRole/PractitionerRole-tech
Resource PractitionerRole:
醫師角色基本資料
健康照護服務提供者:Practitioner/Practitioner-Wang1 "王大郎"
角色:醫檢師(Medical technician) ( SNOMED CT#307988006)
Entry 16 - fullUrl = https://claim.cgh.org.tw/iclaim/PractitionerRole/PractitionerRole-rep
Resource PractitionerRole:
醫師角色基本資料
健康照護服務提供者:Practitioner/Practitioner-Chen "陳健骨"
角色:報告者 ( 醫事人員類別#reporter
Entry 17 - fullUrl = https://claim.cgh.org.tw/iclaim/PractitionerRole/PractitionerRole-rec
Resource PractitionerRole:
醫師角色基本資料
健康照護服務提供者:Practitioner/Practitioner-Wang1 "王大郎"
角色:開單醫師 ( 醫事人員類別#recordedPhysician
Entry 18 - fullUrl = https://claim.cgh.org.tw/iclaim/Encounter/Encounter-C1
Resource Encounter:
就醫資料
識別碼:1286481 ( 國泰醫療財團法人國泰綜合醫院)
就醫現況:finished ( EncounterStatus#finished)
病人來源:ambulatory ( ActEncounterCode#AMB)
應診科別:骨科 ( Department#06)
病人:Patient/Patient-C1 "郝美麗"
開單醫師:PractitionerRole/PractitionerRole-rec "王大郎"
就醫的開始和結束時間:2023-08-07 17:00:14-0500 --> 2023-08-07 18:00:14-0500
就醫天數:1天 (Details: UCUM code d = 'd')
就醫身分: 自費 (Coverage SelfPay Codes#pay)