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:A0003 (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-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
Entry 1 - fullUrl = https://claim.cgh.org.tw/iclaim/Composition/Composition-C3-1
Resource Composition:
Composition
文件識別碼:A0003 (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-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
Entry 2 - fullUrl = https://claim.cgh.org.tw/iclaim/Claim/Claim-C3-1
Resource Claim:
理賠申請書編號:A0003 (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-C3 "康美女"
理賠申請書日期: 2023-08-10
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-C3 保險:
順序 Focal Coverage 1 true Coverage/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
Entry 3 - fullUrl = https://claim.cgh.org.tw/iclaim/Patient/Patient-C3
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)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.cgh.org.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
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-C3
Resource Coverage:
status: active ( FinancialResourceStatusCodes#active )
beneficiary: Patient/Patient-C3 "玳健康"
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-C3
Resource Condition:
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:PractitionerRole/PractitionerRole-pri3 "姚漂亮"
負責醫師(院長):PractitionerRole/PractitionerRole-res "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
Entry 8 - fullUrl = https://claim.cgh.org.tw/iclaim/DiagnosticReport/DiagnosticReport-C3
Resource DiagnosticReport:
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)
病人:Patient/Patient-C3 "玳健康"
Entry 9 - fullUrl = https://claim.cgh.org.tw/iclaim/Observation/Observation-C3
Resource Observation:
檢驗檢查資料
收件編號(檢驗單號):096H006 (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-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: PractitionerRole/PractitionerRole-tech "王大郎"
報告者: PractitionerRole/PractitionerRole-rep3 "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 4500 10000 檢驗結果說明:無
Entry 10 - fullUrl = https://claim.cgh.org.tw/iclaim/Practitioner/Practitioner-Yao
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):031934 (https://www.cgh.org.tw)姓名(official):姚漂亮
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/Encounter/Encounter-C3
Resource Encounter:
就醫資料
識別碼:1286483 ( 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: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:PractitionerRole/PractitionerRole-rec "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')
Entry 14 - fullUrl = https://claim.cgh.org.tw/iclaim/Encounter/Encounter-C3-1
Resource Encounter:
就醫資料
識別碼:1286483 ( 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: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:PractitionerRole/PractitionerRole-rec "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
Entry 15 - fullUrl = https://claim.cgh.org.tw/iclaim/Encounter/Encounter-C3-2
Resource Encounter:
就醫資料
識別碼:1286483 ( 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: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:PractitionerRole/PractitionerRole-rec "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
Entry 16 - fullUrl = https://claim.cgh.org.tw/iclaim/PractitionerRole/PractitionerRole-pri3
Resource PractitionerRole:
醫師角色基本資料
健康照護服務提供者:Practitioner/Practitioner-Yao "姚漂亮"
角色:主治醫師(Attending physician (occupation)) ( SNOMED CT#405279007)
Entry 17 - 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 18 - 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 19 - fullUrl = https://claim.cgh.org.tw/iclaim/PractitionerRole/PractitionerRole-rep3
Resource PractitionerRole:
醫師角色基本資料
健康照護服務提供者:Practitioner/Practitioner-Yao "姚漂亮"
角色:報告者 ( 醫事人員類別#reporter
Entry 20 - 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