醫療保險理賠實作指引
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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

: Claim-C3-1 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "Claim-C3-1"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://claim.cgh.org.tw/iclaim/StructureDefinition/claim-iclaim"^^xsd:anyURI ;
fhir:link <https://claim.cgh.org.tw/iclaim/StructureDefinition/claim-iclaim>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>理賠申請書編號</b>：A0003 (https://www.cgh.org.tw)</p><p><b>理賠申請書狀態</b>: Active <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://hl7.org/fhir/R4/codesystem-fm-status.html\">Financial Resource Status Codes</a>#active)</span></p><p><b>理賠申請書類別</b>: Institutional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#institutional)</span></p><p><b>理賠申請書用途</b>: Claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://hl7.org/fhir/R4/codesystem-claim-use.html\">Use</a>#claim)</span></p><p><b>病人</b>： <a href=\"Patient-Patient-C3.html\">Patient/Patient-C3</a> \"康美女\"</p><p><b>理賠申請書日期</b>: 2023-08-10</p><p><b>醫院</b>： <a href=\"Organization-Organization-min.html\">Organization/Organization-min</a> \"國泰醫療財團法人國泰綜合醫院\"</p><p><b>處理優先順序</b>: Immediate <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#stat)</span></p><p><b>診斷證明書</b>：</p><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>順序</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Condition-Condition-C3.html\">Condition/Condition-C3</a></td></tr></table><p><b>保險</b>：</p><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>順序</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-Coverage-C3.html\">Coverage/Coverage-C3</a></td></tr></table><blockquote><p><b>收據</b>：</p><p><b>費用序號</b>: 1</p><p><b>自付金額（base price）/減免（discount）</b>: 自付金額 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://hl7.org/fhir/R4/codesystem-invoice-priceComponentType.html\">InvoicePriceComponentType</a>#base)</span></p><p><b>費用項目</b>: 手術費 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"CodeSystem-cathay-chargeitemcode-values.html\">費用項目-健保</a>#SURGICAL)</span></p><p><b>就醫身分</b>: 自費 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-coverage-selfpay.html\">Coverage SelfPay Codes</a>#pay)</span></p><p><b>收據日期</b>: 2023-08-10</p><p><b>自付金額</b>：168237</p><p><b>費用序號</b>: 2</p><p><b>費用項目</b>: 手術費 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"CodeSystem-cathay-chargeitemcode-values.html\">費用項目-健保</a>#SURGICAL)</span></p><p><b>就醫身分</b>: 健保 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"https://terminology.hl7.org/5.0.0/CodeSystem-v3-ActCode.html\">ActCode</a>#PUBLICPOL)</span></p><p><b>收據日期</b>: 2023-08-10</p><p><b>健保點數</b>：8580</p><p><b>總費用</b>：168237</p></blockquote></div>"
  ] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "https://www.cgh.org.tw"^^xsd:anyURI ] ;
fhir:value [ fhir:v "A0003" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "institutional" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:patient [
fhir:reference [ fhir:v "Patient/Patient-C3" ]
  ] ; # 
  fhir:created [ fhir:v "2023-08-10"^^xsd:date] ; # 
  fhir:provider [
fhir:reference [ fhir:v "Organization/Organization-min" ]
  ] ; # 
  fhir:priority [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
fhir:code [ fhir:v "stat" ]     ] )
  ] ; # 
  fhir:diagnosis ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:diagnosis [
a fhir:Reference ;
fhir:reference [ fhir:v "Condition/Condition-C3" ]     ]
  ] ) ; # 
  fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/Coverage-C3" ]     ]
  ] ) ; # 
  fhir:item ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/invoice-priceComponentType"^^xsd:anyURI ] ;
fhir:code [ fhir:v "base" ]       ] )     ] ;
fhir:productOrService [
      ( fhir:coding [
fhir:system [ fhir:v "https://claim.cgh.org.tw/iclaim/CodeSystem/cathay-chargeitemcode-values"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURGICAL" ]       ] )     ] ;
    ( fhir:modifier [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-selfpay"^^xsd:anyURI ] ;
fhir:code [ fhir:v "pay" ]       ] )     ] ) ;
fhir:serviced [ fhir:v "2023-08-10"^^xsd:date ] ;
fhir:net [
fhir:value [ fhir:v "168237"^^xsd:decimal ]     ]
  ] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:productOrService [
      ( fhir:coding [
fhir:system [ fhir:v "https://claim.cgh.org.tw/iclaim/CodeSystem/cathay-chargeitemcode-values"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURGICAL" ]       ] )     ] ;
    ( fhir:modifier [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PUBLICPOL" ]       ] )     ] ) ;
fhir:serviced [ fhir:v "2023-08-10"^^xsd:date ] ;
fhir:net [
fhir:value [ fhir:v "8580"^^xsd:decimal ]     ]
  ] ) ; # 
  fhir:total [
fhir:value [ fhir:v "168237"^^xsd:decimal ]
  ] . #