醫療保險理賠實作指引
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: Claim-C4-1 - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="Claim-C4-1"/>
  <meta>
    <profile
             value="https://claim.cgh.org.tw/iclaim/StructureDefinition/claim-iclaim"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>理賠申請書編號</b>：A0004 (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> "玳健康"</p><p><b>理賠申請書日期</b>: 2023-08-15</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-C4.html">Condition/Condition-C4</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>: 掛號費 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(<a href="CodeSystem-cathay-chargeitemcode-values.html">費用項目-健保</a>#REGISTRATION)</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>: 2023-08-15</p><p><b>自付金額</b>：150</p><p><b>費用序號</b>: 2</p><p><b>費用項目</b>: 掛號費 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(<a href="CodeSystem-cathay-chargeitemcode-values.html">費用項目-健保</a>#REGISTRATION)</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>: 2023-08-15</p><p><b>健保點數</b>：580</p><p><b>費用序號</b>: 3</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>: 掛號費 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(<a href="CodeSystem-cathay-chargeitemcode-values.html">費用項目-健保</a>#REGISTRATION)</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>: 2023-08-17</p><p><b>自付金額</b>：150</p><p><b>費用序號</b>: 4</p><p><b>費用項目</b>: 掛號費 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(<a href="CodeSystem-cathay-chargeitemcode-values.html">費用項目-健保</a>#REGISTRATION)</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>: 2023-08-17</p><p><b>健保點數</b>：580</p><p><b>總費用</b>：300</p></blockquote></div>
  </text>
  <identifier>
    <system value="https://www.cgh.org.tw"/>
    <value value="A0004"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="institutional"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>🔗 
    <reference value="Patient/Patient-C3"/>
  </patient>
  <created value="2023-08-15"/>
  <provider>🔗 
    <reference value="Organization/Organization-min"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="stat"/>
    </coding>
  </priority>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisReference>🔗 
      <reference value="Condition/Condition-C4"/>
    </diagnosisReference>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>🔗 
      <reference value="Coverage/Coverage-C3"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <category>
      <coding>
        <system value="http://hl7.org/fhir/invoice-priceComponentType"/>
        <code value="base"/>
      </coding>
    </category>
    <productOrService>
      <coding>
        <system
                value="https://claim.cgh.org.tw/iclaim/CodeSystem/cathay-chargeitemcode-values"/>
        <code value="REGISTRATION"/>
      </coding>
    </productOrService>
    <modifier>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/coverage-selfpay"/>
        <code value="pay"/>
      </coding>
    </modifier>
    <servicedDate value="2023-08-15"/>
    <net>
      <value value="150"/>
    </net>
  </item>
  <item>
    <sequence value="2"/>
    <productOrService>
      <coding>
        <system
                value="https://claim.cgh.org.tw/iclaim/CodeSystem/cathay-chargeitemcode-values"/>
        <code value="REGISTRATION"/>
      </coding>
    </productOrService>
    <modifier>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="PUBLICPOL"/>
      </coding>
    </modifier>
    <servicedDate value="2023-08-15"/>
    <net>
      <value value="580"/>
    </net>
  </item>
  <item>
    <sequence value="3"/>
    <category>
      <coding>
        <system value="http://hl7.org/fhir/invoice-priceComponentType"/>
        <code value="base"/>
      </coding>
    </category>
    <productOrService>
      <coding>
        <system
                value="https://claim.cgh.org.tw/iclaim/CodeSystem/cathay-chargeitemcode-values"/>
        <code value="REGISTRATION"/>
      </coding>
    </productOrService>
    <modifier>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/coverage-selfpay"/>
        <code value="pay"/>
      </coding>
    </modifier>
    <servicedDate value="2023-08-17"/>
    <net>
      <value value="150"/>
    </net>
  </item>
  <item>
    <sequence value="4"/>
    <productOrService>
      <coding>
        <system
                value="https://claim.cgh.org.tw/iclaim/CodeSystem/cathay-chargeitemcode-values"/>
        <code value="REGISTRATION"/>
      </coding>
    </productOrService>
    <modifier>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="PUBLICPOL"/>
      </coding>
    </modifier>
    <servicedDate value="2023-08-17"/>
    <net>
      <value value="580"/>
    </net>
  </item>
  <total>
    <value value="300"/>
  </total>
</Claim>