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Packagetw.gov.mohw.nhi.pas
Resource TypeClaim
IdClaim-cla-imm.json
FHIR VersionR4

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Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: Claim cla-imm

ClaimEncounter: Encounter: status = planned; class = ambulatory (ActCode#AMB); serviceType = 胸腔暨重症加護

status: Active

type: Institutional

subType: 送核

use: Preauthorization

patient: 王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))

created: 2024-05-30

enterer: Practitioner: identifier = National Person Identifier where the xxx is the ISO table 3166 3-character (alphabetic) country code,Medical License number

provider: Organization 臺北市立聯合醫院

priority: 一般事前審查申請

supportingInfo

sequence: 1

category: 病人體重

value: 59.65 kg (Details: UCUM codekg = 'kg')

supportingInfo

sequence: 2

category: 病人身高

value: 170 cm (Details: UCUM codecm = 'cm')

supportingInfo

sequence: 3

category: 病人血型

value: Observation ABO and Rh group [Type] in Blood

supportingInfo

sequence: 4

category: 影像報告

value: Diagnostic Report for 'B34JZZ3' for '->王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))'

supportingInfo

sequence: 6

category: 檢查報告

value: Diagnostic Report for 'Prostate Pathology biopsy report' for '->王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))'

supportingInfo

sequence: 8

category: 檢驗(查)

value: Observation Platelets [#/volume] in Blood by Automated count

supportingInfo

sequence: 9

category: 檢驗(查)

value: Observation CBC panel - Blood by Automated count

supportingInfo

sequence: 10

category: 病人狀態評估

value: Observation Functional capacity NYHA

supportingInfo

sequence: 11

category: 用藥品項

value: MedicationRequest: status = completed; statusReason = Try another treatment first; intent = order; category = 健保; medication[x] = ANTI-COUGH SYRUP "WASHINGTON"

supportingInfo

sequence: 12

category: 放射/照光治療

value: Procedure D7Y08ZZ

supportingInfo

sequence: 13

category: 治療計畫文件

value: DocumentReference: status = current; category = 治療計畫文件

supportingInfo

sequence: 14

category: 病歷資料

value: DocumentReference: status = current; category = 病歷資料

supportingInfo

sequence: 15

category: 結果資訊

value: Observation International Working Group(IWG) Consensus Criteria

supportingInfo

sequence: 16

category: 門診病歷

value: Composition 門診病歷

supportingInfo

sequence: 17

category: 過敏史

value: AllergyIntolerance

Diagnoses

-ExtensionSequenceDiagnosis[x]Type
*1I50.812Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI

Procedures

-SequenceDateProcedure[x]
*12024-01-013E0Y704

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active

item

RequestedService: MedicationRequest: status = on-hold; intent = plan; medication[x] = Alunbrig film-coated tablets 30mg

sequence: 1

productOrService: 藥品

modifier: 初次使用, 第一線治療

programCode: ALK陽性的晚期非小細胞肺癌第一線治療

quantity: 52 {tbl} (Details: UCUM code{tbl} = '{tbl}')

item

RequestedService: MedicationRequest: status = on-hold; intent = plan; medication[x] = Herzuma Inj. 440mg, Lyophilized powder for injection

sequence: 2

productOrService: 藥品

modifier: 初次使用, 第一線治療

programCode: 早期乳癌-未發生腋下淋巴結轉移

quantity: 70 {tbl} (Details: UCUM code{tbl} = '{tbl}')

Source1

{
  "resourceType": "Claim",
  "id": "cla-imm",
  "meta": {
    "profile": [
      "https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-immunologic-agent-twpas"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-claim-encounter",
      "valueReference": {
        "reference": "Encounter/enc-min"
      }
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "institutional"
      }
    ]
  },
  "subType": {
    "coding": [
      {
        "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-type",
        "code": "1",
        "display": "送核"
      }
    ]
  },
  "use": "preauthorization",
  "patient": {
    "reference": "Patient/pat-min"
  },
  "created": "2024-05-30",
  "enterer": {
    "reference": "Practitioner/pra-min"
  },
  "provider": {
    "reference": "Organization/org-hosp-example"
  },
  "priority": {
    "coding": [
      {
        "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-tmhb-type",
        "code": "1",
        "display": "一般事前審查申請"
      }
    ]
  },
  "supportingInfo": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "weight"
          }
        ]
      },
      "valueQuantity": {
        "value": 59.65,
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    {
      "sequence": 2,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "height"
          }
        ]
      },
      "valueQuantity": {
        "value": 170,
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    {
      "sequence": 3,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "bloodgroup"
          }
        ]
      },
      "valueReference": {
        "reference": "Observation/obs-blood-group"
      }
    },
    {
      "sequence": 4,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "imagingReport"
          }
        ]
      },
      "valueReference": {
        "reference": "DiagnosticReport/diaRep-ima-min"
      }
    },
    {
      "sequence": 6,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "examinationReport"
          }
        ]
      },
      "valueReference": {
        "reference": "DiagnosticReport/diaRep-min"
      }
    },
    {
      "sequence": 8,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "tests"
          }
        ]
      },
      "valueReference": {
        "reference": "Observation/obs-lab-min"
      }
    },
    {
      "sequence": 9,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "tests"
          }
        ]
      },
      "valueReference": {
        "reference": "Observation/obs-lab-cbc"
      }
    },
    {
      "sequence": 10,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "patientAssessment"
          }
        ]
      },
      "valueReference": {
        "reference": "Observation/obs-pat-nyha"
      }
    },
    {
      "sequence": 11,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "medicationRequest"
          }
        ]
      },
      "valueReference": {
        "reference": "MedicationRequest/medReq-treat"
      }
    },
    {
      "sequence": 12,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "radiotherapy"
          }
        ]
      },
      "valueReference": {
        "reference": "Procedure/pro-min"
      }
    },
    {
      "sequence": 13,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "carePlanDocument"
          }
        ]
      },
      "valueReference": {
        "reference": "DocumentReference/doc-careplan-min"
      }
    },
    {
      "sequence": 14,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "medicalRecord"
          }
        ]
      },
      "valueReference": {
        "reference": "DocumentReference/doc-medicalRecord-min"
      }
    },
    {
      "sequence": 15,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "treatmentAssessment"
          }
        ]
      },
      "valueReference": {
        "reference": "Observation/obs-tx-min"
      }
    },
    {
      "sequence": 16,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "opd"
          }
        ]
      },
      "valueReference": {
        "reference": "Composition/opd"
      }
    },
    {
      "sequence": 17,
      "category": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
            "code": "allergy"
          }
        ]
      },
      "valueReference": {
        "reference": "AllergyIntolerance/all-min"
      }
    }
  ],
  "diagnosis": [
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate",
          "valueDate": "2024-01-01"
        }
      ],
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw",
            "code": "I50.812"
          }
        ]
      },
      "type": [
        {
          "text": "Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI"
        }
      ]
    }
  ],
  "procedure": [
    {
      "sequence": 1,
      "date": "2024-01-01",
      "procedureCodeableConcept": {
        "coding": [
          {
            "system": "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-pcs-2023-tw",
            "code": "3E0Y704"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/cov-min"
      }
    }
  ],
  "item": [
    {
      "extension": [
        {
          "url": "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-requestedService",
          "valueReference": {
            "reference": "MedicationRequest/medReq-apply"
          }
        }
      ],
      "sequence": 1,
      "productOrService": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-order-type",
            "code": "1",
            "display": "藥品"
          }
        ]
      },
      "modifier": [
        {
          "coding": [
            {
              "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-continuation-status",
              "code": "1",
              "display": "初次使用"
            }
          ]
        },
        {
          "coding": [
            {
              "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-line-of-therapy",
              "code": "1",
              "display": "第一線治療"
            }
          ]
        }
      ],
      "programCode": [
        {
          "text": "ALK陽性的晚期非小細胞肺癌第一線治療"
        }
      ],
      "quantity": {
        "value": 52,
        "system": "http://unitsofmeasure.org",
        "code": "{tbl}"
      }
    },
    {
      "extension": [
        {
          "url": "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-requestedService",
          "valueReference": {
            "reference": "MedicationRequest/medReq-apply-2"
          }
        }
      ],
      "sequence": 2,
      "productOrService": {
        "coding": [
          {
            "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-order-type",
            "code": "1",
            "display": "藥品"
          }
        ]
      },
      "modifier": [
        {
          "coding": [
            {
              "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-continuation-status",
              "code": "1",
              "display": "初次使用"
            }
          ]
        },
        {
          "coding": [
            {
              "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-line-of-therapy",
              "code": "1",
              "display": "第一線治療"
            }
          ]
        }
      ],
      "programCode": [
        {
          "coding": [
            {
              "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-reason",
              "code": "C50P1"
            }
          ]
        }
      ],
      "quantity": {
        "value": 70,
        "system": "http://unitsofmeasure.org",
        "code": "{tbl}"
      }
    }
  ]
}