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-C4-1


Composition

文件識別碼:A0004 (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-C4-1

section.entry[condition]Condition/Condition-C4

section.entry[diagnosticReport]DiagnosticReport/DiagnosticReport-C4

section.entry[encounter]Encounter/Encounter-C4

section.entry[coverage]Coverage/Coverage-C3

section.entry[payor]Organization/Organization-cathay

section.entry[practitioner]Practitioner/Practitioner-Wang

section.entry[practitioner]Practitioner/Practitioner-Ciou2

section.entry[practitioner]Practitioner/Practitioner-Wang2

section.entry[observation]Observation/Observation-C4


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-C4-1 (Claim/Claim-C4-1)

理賠申請書編號:A0004 (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 "玳健康"

理賠申請書日期: 2023-08-15

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-C4

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: 掛號費 (費用項目-健保#REGISTRATION)

就醫身分: 自費 (Coverage SelfPay Codes#pay)

收據日期: 2023-08-15

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: 2023-08-15

健保點數:580

費用序號: 3

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: 2023-08-17

自付金額:150

費用序號: 4

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: 2023-08-17

健保點數:580

總費用:300


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-C4 (Condition/Condition-C4)

病情、問題或診斷資料

病情、問題或診斷識別碼:1080108645

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:便秘 ( NHIICD9CM#564.0)

病人Patient/Patient-C3 "玳健康"

就醫(Encounter)紀錄Encounter/Encounter-C4

記錄日期:2023-08-15

主治醫師Practitioner/Practitioner-Wang "王建胃"

負責醫師(院長)Practitioner/Practitioner-Ciou2 "邱榮二"

診斷報告DiagnosticReport/DiagnosticReport-C4

醫療摘要:腹部的膨脹感、腹痛、腸脹氣,而且在排便之後才能得到緩解。


8. https://claim.cgh.org.tw/iclaim/DiagnosticReport/DiagnosticReport-C4 (DiagnosticReport/DiagnosticReport-C4)

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-C4


9. https://claim.cgh.org.tw/iclaim/Observation/Observation-C4 (Observation/Observation-C4)

檢驗檢查資料

收件編號(檢驗單號):096H007 (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:2023-08-15

報告日期:2023-08-15 17:00:14+08:00

醫檢師Practitioner/Practitioner-Wang2 "王二郎"

報告者Practitioner/Practitioner-Wang "王建胃"

檢驗部位:Submucosa of anal canal ( SNOMED CT Body Structures#7892006)

檢驗值:2 HPF

參考範圍

參考最低值參考最高值
03

檢驗結果說明:無


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

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):031933 (https://www.vghtpe.gov.tw/)

姓名(official):王建胃


11. https://claim.cgh.org.tw/iclaim/Practitioner/Practitioner-Ciou2 (Practitioner/Practitioner-Ciou2)

健康照護服務提供人員基本資料

姓名(official):邱榮二


12. https://claim.cgh.org.tw/iclaim/Practitioner/Practitioner-Wang2 (Practitioner/Practitioner-Wang2)

健康照護服務提供人員基本資料

姓名(official):王二郎


13. https://claim.cgh.org.tw/iclaim/Encounter/Encounter-C4 (Encounter/Encounter-C4)

就醫資料

識別碼:1286483 ( 臺北榮民總醫院)

就醫現況:finished ( EncounterStatus#finished)

就醫分類:ambulatory ( ActEncounterCode#AMB)

應診科別:家醫科 ( Department#01)

病人Patient/Patient-C3 "玳健康"

開單醫師Practitioner/Practitioner-Wang2 "王二郎"

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

就醫天數:1天 (Details: UCUM code d = 'd')