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

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{
  "resourceType" : "Claim",
  "id" : "Claim-C4",
  "meta" : {
    "profile" : [
      🔗 "https://claim.cgh.org.tw/iclaim/StructureDefinition/claim-iclaim"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<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>總費用</b>：150</p></blockquote></div>"
  },
  "identifier" : [
    {
      "system" : "https://www.cgh.org.tw",
      "value" : "A0004"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "institutional"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    🔗 "reference" : "Patient/Patient-C3"
  },
  "created" : "2023-08-15",
  "provider" : {
    🔗 "reference" : "Organization/Organization-min"
  },
  "priority" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
        "code" : "stat"
      }
    ]
  },
  "diagnosis" : [
    {
      "sequence" : 1,
      "diagnosisReference" : {
        🔗 "reference" : "Condition/Condition-C4"
      }
    }
  ],
  "insurance" : [
    {
      "sequence" : 1,
      "focal" : true,
      "coverage" : {
        🔗 "reference" : "Coverage/Coverage-C3"
      }
    }
  ],
  "item" : [
    {
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/invoice-priceComponentType",
            "code" : "base"
          }
        ]
      },
      "productOrService" : {
        "coding" : [
          {
            "system" : "https://claim.cgh.org.tw/iclaim/CodeSystem/cathay-chargeitemcode-values",
            "code" : "REGISTRATION"
          }
        ]
      },
      "modifier" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/coverage-selfpay",
              "code" : "pay"
            }
          ]
        }
      ],
      "servicedDate" : "2023-08-15",
      "net" : {
        "value" : 150
      }
    },
    {
      "sequence" : 2,
      "productOrService" : {
        "coding" : [
          {
            "system" : "https://claim.cgh.org.tw/iclaim/CodeSystem/cathay-chargeitemcode-values",
            "code" : "REGISTRATION"
          }
        ]
      },
      "modifier" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code" : "PUBLICPOL"
            }
          ]
        }
      ],
      "servicedDate" : "2023-08-15",
      "net" : {
        "value" : 580
      }
    }
  ],
  "total" : {
    "value" : 150
  }
}