醫療保險理賠實作指引
0.1.3 - CI Build

This page is part of the 醫療保險理賠實作指引 (v0.1.3: Releases Ballot 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Bundle: Bundle-C3-1


Composition

文件識別碼:A0003 (https://www.vghtpe.gov.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 "臺北榮民總醫院"

病人Patient/Patient-C3 "玳健康"

section.entry[iClaim]Claim/Claim-C3-1

section.entry[condition]Condition/Condition-C3

section.entry[diagnosticReport]DiagnosticReport/DiagnosticReport-C3

section.entry[encounter]Encounter/Encounter-C3

section.entry[encounter]Encounter/Encounter-C3-1

section.entry[encounter]Encounter/Encounter-C3-2

section.entry[coverage]Coverage/Coverage-C3

section.entry[payor]Organization/Organization-cathay

section.entry[practitioner]Practitioner/Practitioner-Yao

section.entry[practitioner]Practitioner/Practitioner-Ciou

section.entry[practitioner]Practitioner/Practitioner-Wang1

section.entry[observation]Observation/Observation-C3


理賠用收據-診斷證明-檢驗紀錄


Additional Document Content


2. https://claim.cgh.org.tw/iclaim/Claim/Claim-C3-1 (Claim/Claim-C3-1)

理賠申請書編號:A0003 (https://www.vghtpe.gov.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-C3 "康美女"

理賠申請書日期: 2023-08-10

醫院Organization/Organization-min "臺北榮民總醫院"

處理優先順序: Immediate (Process Priority Codes#stat)

診斷證明書

-順序Diagnosis[x]
*1Condition/Condition-C3

保險

-順序FocalCoverage
*1trueCoverage/Coverage-C3

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: 手術費 (費用項目-健保#SURGICAL)

就醫身分: 自費 (Coverage SelfPay Codes#pay)

收據日期: 2023-08-10

自付金額:168237

費用序號: 2

費用項目: 手術費 (費用項目-健保#SURGICAL)

就醫身分: 健保 (ActCode#PUBLICPOL)

收據日期: 2023-08-10

健保點數:8580

總費用:168237


3. https://claim.cgh.org.tw/iclaim/Patient/Patient-C3 (Patient/Patient-C3)

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)P137786694 (http://www.moi.gov.tw/)

識別碼型別:Medical record number Identifier Type Codes#MR)
病歷號(official):ADCM9527 (https://www.vghtpe.gov.tw/)

姓名(official):玳健康

性別:Male ( AdministrativeGender#male)

出生日期:2002-02-22

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


4. https://claim.cgh.org.tw/iclaim/Organization/Organization-min (Organization/Organization-min)

醫事機構基本資料

機構名稱:臺北榮民總醫院

識別碼型別:Provider numberIdentifierType#PRN)
機構代碼(official):0601160016 (https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/organization-identifier-tw)

機構種類:Healthcare Provider ( OrganizationType#prov)


5. https://claim.cgh.org.tw/iclaim/Coverage/Coverage-C3 (Coverage/Coverage-C3)

status: active FinancialResourceStatusCodes#active )

beneficiaryPatient/Patient-C3 "玳健康"

payorOrganization/Organization-cathay "國泰人壽保險股份有限公司"


6. https://claim.cgh.org.tw/iclaim/Organization/Organization-cathay (Organization/Organization-cathay)

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)


7. https://claim.cgh.org.tw/iclaim/Condition/Condition-C3 (Condition/Condition-C3)

病情、問題或診斷資料

病情、問題或診斷識別碼:1080108644

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:臉及頭之燒傷,水泡,表皮脫落(第二度) ( NHIICD9CM#941.20)

病人Patient/Patient-C3 "玳健康"

就醫(Encounter)紀錄Encounter/Encounter-C3

記錄日期:2023-08-10

主治醫師Practitioner/Practitioner-Yao "姚漂亮"

負責醫師(院長)Practitioner/Practitioner-Ciou "邱榮一"

診斷報告DiagnosticReport/DiagnosticReport-C3

醫療摘要:住院:2023-08-10至2023-08-15急診住燒傷加護病房,2023-08-16至2023-08-31住燒傷普通病房


8. https://claim.cgh.org.tw/iclaim/DiagnosticReport/DiagnosticReport-C3 (DiagnosticReport/DiagnosticReport-C3)

診斷報告

診斷狀態:Final ( DiagnosticReportStatus#final)

診斷報告名稱:Hematology Outpatient Progress note ( LOINC實驗室檢驗檢查報告名稱#100473-8)

診斷結果Observation/Observation-C3


9. https://claim.cgh.org.tw/iclaim/Observation/Observation-C3 (Observation/Observation-C3)

檢驗檢查資料

收件編號(檢驗單號):096H006 (https://www.vghtpe.gov.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-C3 "玳健康"

採檢日期:2023-08-13

報告日期:2023-08-15 17:00:14+08:00

醫檢師Practitioner/Practitioner-Wang1 "王大郎"

報告者Practitioner/Practitioner-Yao "姚漂亮"

檢驗部位:Intervertebral disc space of twelfth thoracic vertebra ( SNOMED CT Body Structures#8091003)

檢驗值:8000 /uL

參考範圍

參考最低值參考最高值
450010000

檢驗結果說明:無


10. https://claim.cgh.org.tw/iclaim/Practitioner/Practitioner-Yao (Practitioner/Practitioner-Yao)

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):031934 (https://www.vghtpe.gov.tw/)

姓名(official):姚漂亮


11. https://claim.cgh.org.tw/iclaim/Practitioner/Practitioner-Ciou (Practitioner/Practitioner-Ciou)

健康照護服務提供人員基本資料

姓名(official):邱榮一


12. https://claim.cgh.org.tw/iclaim/Practitioner/Practitioner-Wang1 (Practitioner/Practitioner-Wang1)

健康照護服務提供人員基本資料

姓名(official):王大郎


13. https://claim.cgh.org.tw/iclaim/Encounter/Encounter-C3 (Encounter/Encounter-C3)

就醫資料

識別碼:1286483 ( 臺北榮民總醫院)

就醫現況:finished ( EncounterStatus#finished)

病人來源:home health ( ActEncounterCode#HH)

應診科別:整形外科 ( Department#15)

病人Patient/Patient-C3 "玳健康"

開單醫師Practitioner/Practitioner-Wang1 "王大郎"

就醫的開始和結束時間:2023-08-10 17:00:14-0500 --> 2023-08-31 18:00:14-0500

就醫天數:22天 (Details: UCUM code d = 'd')


14. https://claim.cgh.org.tw/iclaim/Encounter/Encounter-C3-1 (Encounter/Encounter-C3-1)

就醫資料

識別碼:1286483 ( 臺北榮民總醫院)

就醫現況:finished ( EncounterStatus#finished)

病人來源:home health ( ActEncounterCode#HH)

特殊診斷類別:燒燙傷病房 ( CathayParticularDiagnosis#B)

應診科別:整形外科 ( Department#15)

病人Patient/Patient-C3 "玳健康"

開單醫師Practitioner/Practitioner-Wang1 "王大郎"

就醫的開始和結束時間:2023-08-10 17:00:14-0500 --> 2023-08-15 18:00:14-0500

就醫天數:6天 (Details: UCUM code d = 'd')

此次就醫是哪次就醫的一部份Encounter/Encounter-C3


15. https://claim.cgh.org.tw/iclaim/Encounter/Encounter-C3-2 (Encounter/Encounter-C3-2)

就醫資料

識別碼:1286483 ( 臺北榮民總醫院)

就醫現況:finished ( EncounterStatus#finished)

病人來源:home health ( ActEncounterCode#HH)

應診科別:整形外科 ( Department#15)

病人Patient/Patient-C3 "玳健康"

開單醫師Practitioner/Practitioner-Wang1 "王大郎"

就醫的開始和結束時間:2023-08-16 17:00:14-0500 --> 2023-08-31 18:00:14-0500

就醫天數:16天 (Details: UCUM code d = 'd')

此次就醫是哪次就醫的一部份Encounter/Encounter-C3