Package | tw.gov.mohw.nhi.pas |
Type | StructureDefinition |
Id | Id |
FHIR Version | R4 |
Source | https://twcore.mohw.gov.tw/ig/pas/https://twcore.mohw.gov.tw/ig/pas/1.0.1/StructureDefinition-Claim-twpas.html |
Url | https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/Claim-twpas |
Version | 1.0.1 |
Status | active |
Date | 2024-12-12T17:02:42+08:00 |
Name | ClaimTWPAS |
Title | 事前審查-Claim TWPAS |
Experimental | False |
Realm | tw |
Authority | national |
Description | 此事前審查-Claim TWPAS Profile說明本IG如何進一步定義FHIR的Claim Resource以呈現癌藥事前審查之內容 |
Type | Claim |
Kind | resource |
CapabilityStatement | |
CapabilityStatementTWPASClient | 臺灣癌藥事前審查-用戶端(TWPAS Client) |
CapabilityStatementTWPASServer | 臺灣癌藥事前審查-伺服端(TWPAS Server) |
https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/Bundle-twpas | 事前審查-Bundle TWPAS |
https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/ClaimResponse-twpas | 事前審查回覆-ClaimResponse TWPAS |
Note: links and images are rebased to the (stated) source
Generated Narrative: StructureDefinition Claim-twpas
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization sequence-1: diagnosis.sequence一定會有一個「1」,且只能出現一次。 supportingInfo: 至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。 applType: 當Claim.subType(申報類別)為2(送核補件)、3(申復)、4(爭議審議)或5(申復補件)時,院所才需於Claim.identifier填寫原送核案件之受理編號。目前IG僅針對申報類別為3(申復)進行檢核。 |
Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
encounter | S | 1..1 | Reference(就醫科別-Encounter TWPAS) | 就醫科別,為細分科之就醫科別,作為審查分科用。【此為參考Da Vinci PAS IG的extension設計】 URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-claim-encounter |
identifier | S | 0..1 | Identifier | 原受理編號。院所上傳送核(subType = #1)案件時,不需填寫「原受理編號」資訊,受理成功後會由系統自動產生受理編號。當Claim.subType(申報類別)為2(送核補件)、3(申復)、4(爭議審議)或5(申復補件)時,院所才需於Claim.identifier填寫原送核案件之受理編號。 |
status | 1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active | |
type | 1..1 | CodeableConcept | Category or discipline Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: institutional | |
subType | S | 1..1 | CodeableConcept | 申報類別,1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。院所上傳送核(subType = #1)案件時,不需填寫「原受理編號」資訊,受理成功後會由系統自動產生受理編號。當Claim.subType(申報類別)為2(送核補件)、3(申復)、4(爭議審議)或5(申復補件)時,院所才需於Claim.identifier填寫原送核案件之受理編號。 Binding: NHI-健保事前審查-申報類別值集 (required) |
coding | 1..1 | Coding | Code defined by a terminology system | |
system | 1..1 | uri | Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-apply-type | |
code | 1..1 | code | 申報類別,1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。當申報類別為2(送核補件)、3(申復)、4(爭議審議)、5(申復補件)時,院所才需於Claim.identifier填寫原送核案件之受理編號。 | |
use | 1..1 | code | claim | preauthorization | predetermination Required Pattern: preauthorization | |
patient | S | 1..1 | Reference(病人資訊-Patient TWPAS) | 病人資訊 |
created | S | 1..1 | dateTime | 申請日期,YYYY-MM-DD,機構自填。健保署收案後另建受理日期,將呈現在ClaimResponse的disposition和created欄位。 |
enterer | S | 1..1 | Reference(醫事人員-Practitioner TWPAS) | 申請醫師,必須存在於醫事人員基本資料檔內,並於合約生效起迄日內。 |
provider | S | 1..1 | Reference(醫事機構-Organization TWPAS) | 醫事機構代碼,必須存在於醫事機構基本資料檔內。 |
priority | S | 1..1 | CodeableConcept | 申請案件類別,1:一般事前審查申請 | 3:自主審查報備 | 4:緊急報備;專審系統識別用,對應PXXT_CODE(TMHB,001)。 Binding: NHI-健保事前審查-申請案件類別值集 (required) |
Slices for supportingInfo | 2..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category | |
supportingInfo:All Slices | Content/Rules for all slices | |||
sequence | 1..1 | positiveInt | 因FHIR設計而必填、自動流水號(建議每次加1)、不得重複,作為每筆supportingInfo的唯一識別碼。最後一筆sequence號碼即表示總筆數。 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: NHI-健保事前審查-補充資訊類別值集 (required) | |
supportingInfo:weight | 1..1 | BackboneElement | 病人體重 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: weight | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | Quantity | Data to be provided |
value | SC | 1..1 | decimal | 體重,整數至多3位數及小數至多2位數。 HTWT: 整數至多3位數及小數至多2位數 |
system | 1..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org | |
code | 1..1 | code | Coded form of the unit Required Pattern: kg | |
supportingInfo:height | 1..1 | BackboneElement | 病人身高 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: height | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | Quantity | Data to be provided |
value | SC | 1..1 | decimal | 身高(cm),整數至多3位數及小數至多2位數。 HTWT: 整數至多3位數及小數至多2位數 |
system | 1..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org | |
code | 1..1 | code | Coded form of the unit Required Pattern: cm | |
supportingInfo:pregnancy | 0..1 | BackboneElement | 是否懷孕或哺乳 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pregnancyBreastfeedingStatus | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | boolean | 是否懷孕或哺乳,false:未懷孕或哺乳 | true:有懷孕或哺乳 |
supportingInfo:imagingReport | 0..* | BackboneElement | 影像報告 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: imagingReport | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | Reference(影像報告-DiagnosticReport Image TWPAS) | 影像報告 |
supportingInfo:cancerStage | 0..* | BackboneElement | 癌症分期量表 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: cancerStage | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | Reference(癌症分期量表-Observation Cancer Stage TWPAS) | 癌症分期量表 |
supportingInfo:examinationReport | 0..* | BackboneElement | 檢查報告 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: examinationReport | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | Reference(檢查報告-DiagnosticReport TWPAS) | 檢查報告 |
supportingInfo:geneInfo | 0..* | BackboneElement | 基因資訊 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: geneInfo | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | Reference(基因資訊-Observation Diagnostic TWPAS) | 基因資訊 |
supportingInfo:tests | 0..* | BackboneElement | 檢驗(查) | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: tests | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | Reference(檢驗檢查-Observation Laboratory Result TWPAS) | 檢驗(查) |
supportingInfo:patientAssessment | 0..* | BackboneElement | 病人狀態評估 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientAssessment | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | Reference(病人狀態評估-Observation Patient Assessment TWPAS) | 病人狀態評估 |
supportingInfo:medicationRequest | 0..* | BackboneElement | 用藥品項 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: medicationRequest | |
timing[x] | 0..0 | |||
value[x] | S | 1..1 | Reference(用藥品項-MedicationRequest Treat TWPAS) | 用藥品項 |
supportingInfo:radiotherapy | 0..* | BackboneElement | 放射治療 | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |