Belgian MyCareNet eAttestation Profiles
1.0.0 - STU Belgium flag

Belgian MyCareNet eAttestation Profiles, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/eattestation/ and changes regularly. See the Directory of published versions

Logical Model: BeModelEAttestation

Official URL: https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-model-eattestation Version: 1.0.0
Draft as of 2024-03-14 Computable Name: BeModelEAttestation

Usage:

  • This Logical Model Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Element

NameFlagsCard.TypeDescription & Constraintsdoco
.. be-model-eattestation 0..*Element
Elements defined in Ancestors: @id, extension
Base for all elements
Instances of this logical model are not marked to be the target of a Reference
... serviceProvider 1..1IdentifierNIHDI number (identification number) of the service provider/organization that certifies the eAttest
... patient 1..1IdentifierPatient identification - INSZ (RR or BIS)
... attestationType 1..1CodeableConceptIdentification of the type of eAttestation. Ex: physiotherapy - see codesystem eAgreement
... cancelReason 0..1CodeableConceptcancellation request justification - reuse list that is already used Values: A = Patient error B = Provider error C = Error in one of the elements of the ASD D = Double encoding E = eAttestation replaced by e-Fact F = eAttestation replaced by ASD paper G = Situation not allowing the establishment of an eAttestation
... totalFee 1..1MoneyAmount (in euros) charged to the patient for all services, limited to the legal fee.
... supplement 0..1MoneyAmount (in euros) of the supplement paid by the patient in addition to the legal fee.
... collector 1..1IdentifierCBE number of the collecting entity.
... treatmentCauses 0..1CodeableConceptCauses of treatment (NIHDI specific for eInvoicing third-party payer). This zone allows you to give a first accounting orientation to the eAttestation Values: See 'Instructions for electronic invoicing' (RT20Z17 - record type 20 value Z17)
... service 0..*BackboneElementData of the prescription concerned by the request
.... provider 1..1IdentifierHealthcare provider, Identification of the provider. NIHDI number of the provider
.... identifier 1..1Identifier(pseudo-)nomenclature code of the service performed.
.... standard 1..1CodeableConceptThis code provides certain necessary information for pricing. Values: See 'Electronic invoicing instructions' (RT50Z3)
.... related 1..1CodeableConceptThe related service must be completed when the reimbursement of the service depends on the performance of another service. It is the latter which must be mentioned as a related service.
.... toothNumber 0..1CodeableConceptThe services for which a tooth number must be mentioned are indicated in the list of prices for dental services published on the NIHDI website
.... laterality 0..1CodeableConceptIn this zone, it is mentioned, by means of a code, whether the treatment was carried out on a left or right limb.
.... transplantation 0..1CodeableConceptThis field must be completed for organ or bone marrow transplants. Values: See 'Electronic invoicing instructions' (RT50Z48)
.... identical 0..1CodeableConceptFor certain services, the rules for applying the nomenclature provide for a maximum number of services in a certain period. In certain cases, the nomenclature also provides for derogations from this maximum number. Such derogations can be communicated in this area. The supporting documents for the derogation are made available to the insurers for a posteriori checks. This area is also used to indicate that it is indeed a second (or third or following) identical service on the same day for services without maximum rules (eg consultations or visits by general practitioners). Values: See 'Electronic invoicing instructions' (RT50Z23)
.... date 1..1dateTimeDate on which the service was performed.
.... location 0..1BackboneElementPlace where the service was performed. (RT50Z14) When the service was not performed in a particular place, this field is not present.
..... identifier 1..1IdentifierNIHDI number of the place of service
..... department 0..1IdentifierWhen the place of service is a hospital, the service code must also be added. The service code can be found in the invoicing instructions (RT50Z13)
.... prescription 0..1BackboneElementPrescription
..... requester 0..1BackboneElementmentioned for the services listed on the 'prescriber list', forming part of the electronic invoicing instructions for third-party payment.
...... identifier 0..1IdentifierIdentification of the prescriber This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... authoredOn 0..1dateTimeDate of prescription This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... standard 1..1CodeableConceptPrescriber standard Values: See 'Electronic invoicing instructions' (RT50Z26) in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique. pdf
.... auxiliaryProvider 0..2BackboneElementAuxiliary provider (RT50Z49) - look for 'type 50 zone 49' in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique.pdf
..... GMF 0..1IdentifierIdentification of the Physician holding the patient's GMF (Dutch: GMD, French: DMG). Mentioned when the 'G' concept is applied, if the physician is not the holder thereof.
..... trainee 0..1IdentifierWhen it is a service certified by a physician (training supervisor) but carried out by a trainee physician, then this zone is completed by the identification number of the trainee physician who carried out the service.
..... oralHygienist 0..1IdentifierWhen it is a service delegated by a dentist but carried out by an oral hygienist then this field is completed by the identification number of the oral hygienist who performed the service
.... count 1..1positiveIntNumber of units The number of times a service was provided on the date indicated OR The number of supplies that were delivered on the date indicated
.... fee 1..1MoneyAmount charged to the patient for the service, limited to the legal fee.
.... supplement 0..1MoneyAmount of the supplement paid by the patient for the service in addition to the legal fee.
.... medicalAdvisorDecisionNr 0..1IdentifierThe reference number of a medical decision following a request for agreement
.... patientIdentityDocument 0..1BackboneElementPatient identity document. This item contains the reading data of the patient's identity document.
..... readingDate 0..1dateDate of reading of the patient's identity document See 'Electronic invoicing instructions' (RT52Z6)
..... readingTime 0..1timeTime of reading of the patient's identity document See 'Electronic billing instructions' (RT52Z12-13)
..... entryType 1..1CodeableConceptEntry type of the patient's identity document See 'Electronic invoicing instructions' (RT52Z9)
..... reasonManual 0..1CodeableConceptReason for manual encoding See 'Electronic invoicing instructions' (RT52Z3)
..... medium 1..1CodeableConceptType of medium of the patient's identity document See 'Instructions for electronic invoicing' (RT52Z10)
..... stickerReason 0..1CodeableConceptReason for using sticker See 'Electronic invoicing instructions' (RT52Z11)
..... serialNumber 0..1stringMedia serial number See 'Electronic invoicing instructions' (RT52Z16)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. be-model-eattestation 0..*Element
Elements defined in Ancestors: @id, extension
Base for all elements
Instances of this logical model are not marked to be the target of a Reference
... serviceProvider 1..1IdentifierNIHDI number (identification number) of the service provider/organization that certifies the eAttest
... patient 1..1IdentifierPatient identification - INSZ (RR or BIS)
... attestationType 1..1CodeableConceptIdentification of the type of eAttestation. Ex: physiotherapy - see codesystem eAgreement
... cancelReason 0..1CodeableConceptcancellation request justification - reuse list that is already used Values: A = Patient error B = Provider error C = Error in one of the elements of the ASD D = Double encoding E = eAttestation replaced by e-Fact F = eAttestation replaced by ASD paper G = Situation not allowing the establishment of an eAttestation
... totalFee 1..1MoneyAmount (in euros) charged to the patient for all services, limited to the legal fee.
... supplement 0..1MoneyAmount (in euros) of the supplement paid by the patient in addition to the legal fee.
... collector 1..1IdentifierCBE number of the collecting entity.
... treatmentCauses 0..1CodeableConceptCauses of treatment (NIHDI specific for eInvoicing third-party payer). This zone allows you to give a first accounting orientation to the eAttestation Values: See 'Instructions for electronic invoicing' (RT20Z17 - record type 20 value Z17)
... service 0..*BackboneElementData of the prescription concerned by the request
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... provider 1..1IdentifierHealthcare provider, Identification of the provider. NIHDI number of the provider
.... identifier 1..1Identifier(pseudo-)nomenclature code of the service performed.
.... standard 1..1CodeableConceptThis code provides certain necessary information for pricing. Values: See 'Electronic invoicing instructions' (RT50Z3)
.... related 1..1CodeableConceptThe related service must be completed when the reimbursement of the service depends on the performance of another service. It is the latter which must be mentioned as a related service.
.... toothNumber 0..1CodeableConceptThe services for which a tooth number must be mentioned are indicated in the list of prices for dental services published on the NIHDI website
.... laterality 0..1CodeableConceptIn this zone, it is mentioned, by means of a code, whether the treatment was carried out on a left or right limb.
.... transplantation 0..1CodeableConceptThis field must be completed for organ or bone marrow transplants. Values: See 'Electronic invoicing instructions' (RT50Z48)
.... identical 0..1CodeableConceptFor certain services, the rules for applying the nomenclature provide for a maximum number of services in a certain period. In certain cases, the nomenclature also provides for derogations from this maximum number. Such derogations can be communicated in this area. The supporting documents for the derogation are made available to the insurers for a posteriori checks. This area is also used to indicate that it is indeed a second (or third or following) identical service on the same day for services without maximum rules (eg consultations or visits by general practitioners). Values: See 'Electronic invoicing instructions' (RT50Z23)
.... date 1..1dateTimeDate on which the service was performed.
.... location 0..1BackboneElementPlace where the service was performed. (RT50Z14) When the service was not performed in a particular place, this field is not present.
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... identifier 1..1IdentifierNIHDI number of the place of service
..... department 0..1IdentifierWhen the place of service is a hospital, the service code must also be added. The service code can be found in the invoicing instructions (RT50Z13)
.... prescription 0..1BackboneElementPrescription
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... requester 0..1BackboneElementmentioned for the services listed on the 'prescriber list', forming part of the electronic invoicing instructions for third-party payment.
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... identifier 0..1IdentifierIdentification of the prescriber This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... authoredOn 0..1dateTimeDate of prescription This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... standard 1..1CodeableConceptPrescriber standard Values: See 'Electronic invoicing instructions' (RT50Z26) in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique. pdf
.... auxiliaryProvider 0..2BackboneElementAuxiliary provider (RT50Z49) - look for 'type 50 zone 49' in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique.pdf
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... GMF 0..1IdentifierIdentification of the Physician holding the patient's GMF (Dutch: GMD, French: DMG). Mentioned when the 'G' concept is applied, if the physician is not the holder thereof.
..... trainee 0..1IdentifierWhen it is a service certified by a physician (training supervisor) but carried out by a trainee physician, then this zone is completed by the identification number of the trainee physician who carried out the service.
..... oralHygienist 0..1IdentifierWhen it is a service delegated by a dentist but carried out by an oral hygienist then this field is completed by the identification number of the oral hygienist who performed the service
.... count 1..1positiveIntNumber of units The number of times a service was provided on the date indicated OR The number of supplies that were delivered on the date indicated
.... fee 1..1MoneyAmount charged to the patient for the service, limited to the legal fee.
.... supplement 0..1MoneyAmount of the supplement paid by the patient for the service in addition to the legal fee.
.... medicalAdvisorDecisionNr 0..1IdentifierThe reference number of a medical decision following a request for agreement
.... patientIdentityDocument 0..1BackboneElementPatient identity document. This item contains the reading data of the patient's identity document.
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... readingDate 0..1dateDate of reading of the patient's identity document See 'Electronic invoicing instructions' (RT52Z6)
..... readingTime 0..1timeTime of reading of the patient's identity document See 'Electronic billing instructions' (RT52Z12-13)
..... entryType 1..1CodeableConceptEntry type of the patient's identity document See 'Electronic invoicing instructions' (RT52Z9)
..... reasonManual 0..1CodeableConceptReason for manual encoding See 'Electronic invoicing instructions' (RT52Z3)
..... medium 1..1CodeableConceptType of medium of the patient's identity document See 'Instructions for electronic invoicing' (RT52Z10)
..... stickerReason 0..1CodeableConceptReason for using sticker See 'Electronic invoicing instructions' (RT52Z11)
..... serialNumber 0..1stringMedia serial number See 'Electronic invoicing instructions' (RT52Z16)

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. be-model-eattestation 0..*Element
Elements defined in Ancestors: @id, extension
Base for all elements
Instances of this logical model are not marked to be the target of a Reference
... @id 0..1stringUnique id for inter-element referencing
... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... serviceProvider 1..1IdentifierNIHDI number (identification number) of the service provider/organization that certifies the eAttest
... attestationType 1..1CodeableConceptIdentification of the type of eAttestation. Ex: physiotherapy - see codesystem eAgreement
... attestationID 0..1IdentifiereAttestation ID (created by the AO that is in the claim response) in order to cancel
... cancelReason 0..1CodeableConceptcancellation request justification - reuse list that is already used Values: A = Patient error B = Provider error C = Error in one of the elements of the ASD D = Double encoding E = eAttestation replaced by e-Fact F = eAttestation replaced by ASD paper G = Situation not allowing the establishment of an eAttestation
... totalFee 1..1MoneyAmount (in euros) charged to the patient for all services, limited to the legal fee.
... supplement 0..1MoneyAmount (in euros) of the supplement paid by the patient in addition to the legal fee.
... collector 1..1IdentifierCBE number of the collecting entity.
... treatmentCauses 0..1CodeableConceptCauses of treatment (NIHDI specific for eInvoicing third-party payer). This zone allows you to give a first accounting orientation to the eAttestation Values: See 'Instructions for electronic invoicing' (RT20Z17 - record type 20 value Z17)
... service 0..*BackboneElementData of the prescription concerned by the request
.... @id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... provider 1..1IdentifierHealthcare provider, Identification of the provider. NIHDI number of the provider
.... identifier 1..1Identifier(pseudo-)nomenclature code of the service performed.
.... standard 1..1CodeableConceptThis code provides certain necessary information for pricing. Values: See 'Electronic invoicing instructions' (RT50Z3)
.... related 1..1CodeableConceptThe related service must be completed when the reimbursement of the service depends on the performance of another service. It is the latter which must be mentioned as a related service.
.... toothNumber 0..1CodeableConceptThe services for which a tooth number must be mentioned are indicated in the list of prices for dental services published on the NIHDI website
.... laterality 0..1CodeableConceptIn this zone, it is mentioned, by means of a code, whether the treatment was carried out on a left or right limb.
.... transplantation 0..1CodeableConceptThis field must be completed for organ or bone marrow transplants. Values: See 'Electronic invoicing instructions' (RT50Z48)
.... identical 0..1CodeableConceptFor certain services, the rules for applying the nomenclature provide for a maximum number of services in a certain period. In certain cases, the nomenclature also provides for derogations from this maximum number. Such derogations can be communicated in this area. The supporting documents for the derogation are made available to the insurers for a posteriori checks. This area is also used to indicate that it is indeed a second (or third or following) identical service on the same day for services without maximum rules (eg consultations or visits by general practitioners). Values: See 'Electronic invoicing instructions' (RT50Z23)
.... date 1..1dateTimeDate on which the service was performed.
.... location 0..1BackboneElementPlace where the service was performed. (RT50Z14) When the service was not performed in a particular place, this field is not present.
..... @id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... identifier 1..1IdentifierNIHDI number of the place of service
..... department 0..1IdentifierWhen the place of service is a hospital, the service code must also be added. The service code can be found in the invoicing instructions (RT50Z13)
.... prescription 0..1BackboneElementPrescription
..... @id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... requester 0..1BackboneElementmentioned for the services listed on the 'prescriber list', forming part of the electronic invoicing instructions for third-party payment.
...... @id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... identifier 0..1IdentifierIdentification of the prescriber This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... authoredOn 0..1dateTimeDate of prescription This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... standard 1..1CodeableConceptPrescriber standard Values: See 'Electronic invoicing instructions' (RT50Z26) in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique. pdf
.... auxiliaryProvider 0..2BackboneElementAuxiliary provider (RT50Z49) - look for 'type 50 zone 49' in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique.pdf
..... @id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... GMF 0..1IdentifierIdentification of the Physician holding the patient's GMF (Dutch: GMD, French: DMG). Mentioned when the 'G' concept is applied, if the physician is not the holder thereof.
..... trainee 0..1IdentifierWhen it is a service certified by a physician (training supervisor) but carried out by a trainee physician, then this zone is completed by the identification number of the trainee physician who carried out the service.
..... oralHygienist 0..1IdentifierWhen it is a service delegated by a dentist but carried out by an oral hygienist then this field is completed by the identification number of the oral hygienist who performed the service
.... count 1..1positiveIntNumber of units The number of times a service was provided on the date indicated OR The number of supplies that were delivered on the date indicated
.... fee 1..1MoneyAmount charged to the patient for the service, limited to the legal fee.
.... supplement 0..1MoneyAmount of the supplement paid by the patient for the service in addition to the legal fee.
.... medicalAdvisorDecisionNr 0..1IdentifierThe reference number of a medical decision following a request for agreement
.... patientIdentityDocument 0..1BackboneElementPatient identity document. This item contains the reading data of the patient's identity document.
..... @id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... readingDate 0..1dateDate of reading of the patient's identity document See 'Electronic invoicing instructions' (RT52Z6)
..... readingTime 0..1timeTime of reading of the patient's identity document See 'Electronic billing instructions' (RT52Z12-13)
..... entryType 1..1CodeableConceptEntry type of the patient's identity document See 'Electronic invoicing instructions' (RT52Z9)
..... reasonManual 0..1CodeableConceptReason for manual encoding See 'Electronic invoicing instructions' (RT52Z3)
..... medium 1..1CodeableConceptType of medium of the patient's identity document See 'Instructions for electronic invoicing' (RT52Z10)
..... stickerReason 0..1CodeableConceptReason for using sticker See 'Electronic invoicing instructions' (RT52Z11)
..... serialNumber 0..1stringMedia serial number See 'Electronic invoicing instructions' (RT52Z16)

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Element

Summary

Mandatory: 0 element (16 nested mandatory elements)

Differential View

This structure is derived from Element

NameFlagsCard.TypeDescription & Constraintsdoco
.. be-model-eattestation 0..*Element
Elements defined in Ancestors: @id, extension
Base for all elements
Instances of this logical model are not marked to be the target of a Reference
... serviceProvider 1..1IdentifierNIHDI number (identification number) of the service provider/organization that certifies the eAttest
... patient 1..1IdentifierPatient identification - INSZ (RR or BIS)
... attestationType 1..1CodeableConceptIdentification of the type of eAttestation. Ex: physiotherapy - see codesystem eAgreement
... cancelReason 0..1CodeableConceptcancellation request justification - reuse list that is already used Values: A = Patient error B = Provider error C = Error in one of the elements of the ASD D = Double encoding E = eAttestation replaced by e-Fact F = eAttestation replaced by ASD paper G = Situation not allowing the establishment of an eAttestation
... totalFee 1..1MoneyAmount (in euros) charged to the patient for all services, limited to the legal fee.
... supplement 0..1MoneyAmount (in euros) of the supplement paid by the patient in addition to the legal fee.
... collector 1..1IdentifierCBE number of the collecting entity.
... treatmentCauses 0..1CodeableConceptCauses of treatment (NIHDI specific for eInvoicing third-party payer). This zone allows you to give a first accounting orientation to the eAttestation Values: See 'Instructions for electronic invoicing' (RT20Z17 - record type 20 value Z17)
... service 0..*BackboneElementData of the prescription concerned by the request
.... provider 1..1IdentifierHealthcare provider, Identification of the provider. NIHDI number of the provider
.... identifier 1..1Identifier(pseudo-)nomenclature code of the service performed.
.... standard 1..1CodeableConceptThis code provides certain necessary information for pricing. Values: See 'Electronic invoicing instructions' (RT50Z3)
.... related 1..1CodeableConceptThe related service must be completed when the reimbursement of the service depends on the performance of another service. It is the latter which must be mentioned as a related service.
.... toothNumber 0..1CodeableConceptThe services for which a tooth number must be mentioned are indicated in the list of prices for dental services published on the NIHDI website
.... laterality 0..1CodeableConceptIn this zone, it is mentioned, by means of a code, whether the treatment was carried out on a left or right limb.
.... transplantation 0..1CodeableConceptThis field must be completed for organ or bone marrow transplants. Values: See 'Electronic invoicing instructions' (RT50Z48)
.... identical 0..1CodeableConceptFor certain services, the rules for applying the nomenclature provide for a maximum number of services in a certain period. In certain cases, the nomenclature also provides for derogations from this maximum number. Such derogations can be communicated in this area. The supporting documents for the derogation are made available to the insurers for a posteriori checks. This area is also used to indicate that it is indeed a second (or third or following) identical service on the same day for services without maximum rules (eg consultations or visits by general practitioners). Values: See 'Electronic invoicing instructions' (RT50Z23)
.... date 1..1dateTimeDate on which the service was performed.
.... location 0..1BackboneElementPlace where the service was performed. (RT50Z14) When the service was not performed in a particular place, this field is not present.
..... identifier 1..1IdentifierNIHDI number of the place of service
..... department 0..1IdentifierWhen the place of service is a hospital, the service code must also be added. The service code can be found in the invoicing instructions (RT50Z13)
.... prescription 0..1BackboneElementPrescription
..... requester 0..1BackboneElementmentioned for the services listed on the 'prescriber list', forming part of the electronic invoicing instructions for third-party payment.
...... identifier 0..1IdentifierIdentification of the prescriber This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... authoredOn 0..1dateTimeDate of prescription This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... standard 1..1CodeableConceptPrescriber standard Values: See 'Electronic invoicing instructions' (RT50Z26) in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique. pdf
.... auxiliaryProvider 0..2BackboneElementAuxiliary provider (RT50Z49) - look for 'type 50 zone 49' in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique.pdf
..... GMF 0..1IdentifierIdentification of the Physician holding the patient's GMF (Dutch: GMD, French: DMG). Mentioned when the 'G' concept is applied, if the physician is not the holder thereof.
..... trainee 0..1IdentifierWhen it is a service certified by a physician (training supervisor) but carried out by a trainee physician, then this zone is completed by the identification number of the trainee physician who carried out the service.
..... oralHygienist 0..1IdentifierWhen it is a service delegated by a dentist but carried out by an oral hygienist then this field is completed by the identification number of the oral hygienist who performed the service
.... count 1..1positiveIntNumber of units The number of times a service was provided on the date indicated OR The number of supplies that were delivered on the date indicated
.... fee 1..1MoneyAmount charged to the patient for the service, limited to the legal fee.
.... supplement 0..1MoneyAmount of the supplement paid by the patient for the service in addition to the legal fee.
.... medicalAdvisorDecisionNr 0..1IdentifierThe reference number of a medical decision following a request for agreement
.... patientIdentityDocument 0..1BackboneElementPatient identity document. This item contains the reading data of the patient's identity document.
..... readingDate 0..1dateDate of reading of the patient's identity document See 'Electronic invoicing instructions' (RT52Z6)
..... readingTime 0..1timeTime of reading of the patient's identity document See 'Electronic billing instructions' (RT52Z12-13)
..... entryType 1..1CodeableConceptEntry type of the patient's identity document See 'Electronic invoicing instructions' (RT52Z9)
..... reasonManual 0..1CodeableConceptReason for manual encoding See 'Electronic invoicing instructions' (RT52Z3)
..... medium 1..1CodeableConceptType of medium of the patient's identity document See 'Instructions for electronic invoicing' (RT52Z10)
..... stickerReason 0..1CodeableConceptReason for using sticker See 'Electronic invoicing instructions' (RT52Z11)
..... serialNumber 0..1stringMedia serial number See 'Electronic invoicing instructions' (RT52Z16)

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. be-model-eattestation 0..*Element
Elements defined in Ancestors: @id, extension
Base for all elements
Instances of this logical model are not marked to be the target of a Reference
... serviceProvider 1..1IdentifierNIHDI number (identification number) of the service provider/organization that certifies the eAttest
... patient 1..1IdentifierPatient identification - INSZ (RR or BIS)
... attestationType 1..1CodeableConceptIdentification of the type of eAttestation. Ex: physiotherapy - see codesystem eAgreement
... cancelReason 0..1CodeableConceptcancellation request justification - reuse list that is already used Values: A = Patient error B = Provider error C = Error in one of the elements of the ASD D = Double encoding E = eAttestation replaced by e-Fact F = eAttestation replaced by ASD paper G = Situation not allowing the establishment of an eAttestation
... totalFee 1..1MoneyAmount (in euros) charged to the patient for all services, limited to the legal fee.
... supplement 0..1MoneyAmount (in euros) of the supplement paid by the patient in addition to the legal fee.
... collector 1..1IdentifierCBE number of the collecting entity.
... treatmentCauses 0..1CodeableConceptCauses of treatment (NIHDI specific for eInvoicing third-party payer). This zone allows you to give a first accounting orientation to the eAttestation Values: See 'Instructions for electronic invoicing' (RT20Z17 - record type 20 value Z17)
... service 0..*BackboneElementData of the prescription concerned by the request
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... provider 1..1IdentifierHealthcare provider, Identification of the provider. NIHDI number of the provider
.... identifier 1..1Identifier(pseudo-)nomenclature code of the service performed.
.... standard 1..1CodeableConceptThis code provides certain necessary information for pricing. Values: See 'Electronic invoicing instructions' (RT50Z3)
.... related 1..1CodeableConceptThe related service must be completed when the reimbursement of the service depends on the performance of another service. It is the latter which must be mentioned as a related service.
.... toothNumber 0..1CodeableConceptThe services for which a tooth number must be mentioned are indicated in the list of prices for dental services published on the NIHDI website
.... laterality 0..1CodeableConceptIn this zone, it is mentioned, by means of a code, whether the treatment was carried out on a left or right limb.
.... transplantation 0..1CodeableConceptThis field must be completed for organ or bone marrow transplants. Values: See 'Electronic invoicing instructions' (RT50Z48)
.... identical 0..1CodeableConceptFor certain services, the rules for applying the nomenclature provide for a maximum number of services in a certain period. In certain cases, the nomenclature also provides for derogations from this maximum number. Such derogations can be communicated in this area. The supporting documents for the derogation are made available to the insurers for a posteriori checks. This area is also used to indicate that it is indeed a second (or third or following) identical service on the same day for services without maximum rules (eg consultations or visits by general practitioners). Values: See 'Electronic invoicing instructions' (RT50Z23)
.... date 1..1dateTimeDate on which the service was performed.
.... location 0..1BackboneElementPlace where the service was performed. (RT50Z14) When the service was not performed in a particular place, this field is not present.
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... identifier 1..1IdentifierNIHDI number of the place of service
..... department 0..1IdentifierWhen the place of service is a hospital, the service code must also be added. The service code can be found in the invoicing instructions (RT50Z13)
.... prescription 0..1BackboneElementPrescription
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... requester 0..1BackboneElementmentioned for the services listed on the 'prescriber list', forming part of the electronic invoicing instructions for third-party payment.
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... identifier 0..1IdentifierIdentification of the prescriber This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... authoredOn 0..1dateTimeDate of prescription This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... standard 1..1CodeableConceptPrescriber standard Values: See 'Electronic invoicing instructions' (RT50Z26) in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique. pdf
.... auxiliaryProvider 0..2BackboneElementAuxiliary provider (RT50Z49) - look for 'type 50 zone 49' in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique.pdf
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... GMF 0..1IdentifierIdentification of the Physician holding the patient's GMF (Dutch: GMD, French: DMG). Mentioned when the 'G' concept is applied, if the physician is not the holder thereof.
..... trainee 0..1IdentifierWhen it is a service certified by a physician (training supervisor) but carried out by a trainee physician, then this zone is completed by the identification number of the trainee physician who carried out the service.
..... oralHygienist 0..1IdentifierWhen it is a service delegated by a dentist but carried out by an oral hygienist then this field is completed by the identification number of the oral hygienist who performed the service
.... count 1..1positiveIntNumber of units The number of times a service was provided on the date indicated OR The number of supplies that were delivered on the date indicated
.... fee 1..1MoneyAmount charged to the patient for the service, limited to the legal fee.
.... supplement 0..1MoneyAmount of the supplement paid by the patient for the service in addition to the legal fee.
.... medicalAdvisorDecisionNr 0..1IdentifierThe reference number of a medical decision following a request for agreement
.... patientIdentityDocument 0..1BackboneElementPatient identity document. This item contains the reading data of the patient's identity document.
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... readingDate 0..1dateDate of reading of the patient's identity document See 'Electronic invoicing instructions' (RT52Z6)
..... readingTime 0..1timeTime of reading of the patient's identity document See 'Electronic billing instructions' (RT52Z12-13)
..... entryType 1..1CodeableConceptEntry type of the patient's identity document See 'Electronic invoicing instructions' (RT52Z9)
..... reasonManual 0..1CodeableConceptReason for manual encoding See 'Electronic invoicing instructions' (RT52Z3)
..... medium 1..1CodeableConceptType of medium of the patient's identity document See 'Instructions for electronic invoicing' (RT52Z10)
..... stickerReason 0..1CodeableConceptReason for using sticker See 'Electronic invoicing instructions' (RT52Z11)
..... serialNumber 0..1stringMedia serial number See 'Electronic invoicing instructions' (RT52Z16)

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. be-model-eattestation 0..*Element
Elements defined in Ancestors: @id, extension
Base for all elements
Instances of this logical model are not marked to be the target of a Reference
... @id 0..1stringUnique id for inter-element referencing
... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... serviceProvider 1..1IdentifierNIHDI number (identification number) of the service provider/organization that certifies the eAttest
... attestationType 1..1CodeableConceptIdentification of the type of eAttestation. Ex: physiotherapy - see codesystem eAgreement
... attestationID 0..1IdentifiereAttestation ID (created by the AO that is in the claim response) in order to cancel
... cancelReason 0..1CodeableConceptcancellation request justification - reuse list that is already used Values: A = Patient error B = Provider error C = Error in one of the elements of the ASD D = Double encoding E = eAttestation replaced by e-Fact F = eAttestation replaced by ASD paper G = Situation not allowing the establishment of an eAttestation
... totalFee 1..1MoneyAmount (in euros) charged to the patient for all services, limited to the legal fee.
... supplement 0..1MoneyAmount (in euros) of the supplement paid by the patient in addition to the legal fee.
... collector 1..1IdentifierCBE number of the collecting entity.
... treatmentCauses 0..1CodeableConceptCauses of treatment (NIHDI specific for eInvoicing third-party payer). This zone allows you to give a first accounting orientation to the eAttestation Values: See 'Instructions for electronic invoicing' (RT20Z17 - record type 20 value Z17)
... service 0..*BackboneElementData of the prescription concerned by the request
.... @id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... provider 1..1IdentifierHealthcare provider, Identification of the provider. NIHDI number of the provider
.... identifier 1..1Identifier(pseudo-)nomenclature code of the service performed.
.... standard 1..1CodeableConceptThis code provides certain necessary information for pricing. Values: See 'Electronic invoicing instructions' (RT50Z3)
.... related 1..1CodeableConceptThe related service must be completed when the reimbursement of the service depends on the performance of another service. It is the latter which must be mentioned as a related service.
.... toothNumber 0..1CodeableConceptThe services for which a tooth number must be mentioned are indicated in the list of prices for dental services published on the NIHDI website
.... laterality 0..1CodeableConceptIn this zone, it is mentioned, by means of a code, whether the treatment was carried out on a left or right limb.
.... transplantation 0..1CodeableConceptThis field must be completed for organ or bone marrow transplants. Values: See 'Electronic invoicing instructions' (RT50Z48)
.... identical 0..1CodeableConceptFor certain services, the rules for applying the nomenclature provide for a maximum number of services in a certain period. In certain cases, the nomenclature also provides for derogations from this maximum number. Such derogations can be communicated in this area. The supporting documents for the derogation are made available to the insurers for a posteriori checks. This area is also used to indicate that it is indeed a second (or third or following) identical service on the same day for services without maximum rules (eg consultations or visits by general practitioners). Values: See 'Electronic invoicing instructions' (RT50Z23)
.... date 1..1dateTimeDate on which the service was performed.
.... location 0..1BackboneElementPlace where the service was performed. (RT50Z14) When the service was not performed in a particular place, this field is not present.
..... @id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... identifier 1..1IdentifierNIHDI number of the place of service
..... department 0..1IdentifierWhen the place of service is a hospital, the service code must also be added. The service code can be found in the invoicing instructions (RT50Z13)
.... prescription 0..1BackboneElementPrescription
..... @id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... requester 0..1BackboneElementmentioned for the services listed on the 'prescriber list', forming part of the electronic invoicing instructions for third-party payment.
...... @id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... identifier 0..1IdentifierIdentification of the prescriber This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... authoredOn 0..1dateTimeDate of prescription This content must be filled in if the prescriber standard is different from 3. This content is absent if the prescriber standard is equal to 3.
..... standard 1..1CodeableConceptPrescriber standard Values: See 'Electronic invoicing instructions' (RT50Z26) in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique. pdf
.... auxiliaryProvider 0..2BackboneElementAuxiliary provider (RT50Z49) - look for 'type 50 zone 49' in https://www.inami.fgov.be/SiteCollectionDocuments/instructions_facturation_electronique.pdf
..... @id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... GMF 0..1IdentifierIdentification of the Physician holding the patient's GMF (Dutch: GMD, French: DMG). Mentioned when the 'G' concept is applied, if the physician is not the holder thereof.
..... trainee 0..1IdentifierWhen it is a service certified by a physician (training supervisor) but carried out by a trainee physician, then this zone is completed by the identification number of the trainee physician who carried out the service.
..... oralHygienist 0..1IdentifierWhen it is a service delegated by a dentist but carried out by an oral hygienist then this field is completed by the identification number of the oral hygienist who performed the service
.... count 1..1positiveIntNumber of units The number of times a service was provided on the date indicated OR The number of supplies that were delivered on the date indicated
.... fee 1..1MoneyAmount charged to the patient for the service, limited to the legal fee.
.... supplement 0..1MoneyAmount of the supplement paid by the patient for the service in addition to the legal fee.
.... medicalAdvisorDecisionNr 0..1IdentifierThe reference number of a medical decision following a request for agreement
.... patientIdentityDocument 0..1BackboneElementPatient identity document. This item contains the reading data of the patient's identity document.
..... @id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... readingDate 0..1dateDate of reading of the patient's identity document See 'Electronic invoicing instructions' (RT52Z6)
..... readingTime 0..1timeTime of reading of the patient's identity document See 'Electronic billing instructions' (RT52Z12-13)
..... entryType 1..1CodeableConceptEntry type of the patient's identity document See 'Electronic invoicing instructions' (RT52Z9)
..... reasonManual 0..1CodeableConceptReason for manual encoding See 'Electronic invoicing instructions' (RT52Z3)
..... medium 1..1CodeableConceptType of medium of the patient's identity document See 'Instructions for electronic invoicing' (RT52Z10)
..... stickerReason 0..1CodeableConceptReason for using sticker See 'Electronic invoicing instructions' (RT52Z11)
..... serialNumber 0..1stringMedia serial number See 'Electronic invoicing instructions' (RT52Z16)

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Element

Summary

Mandatory: 0 element (16 nested mandatory elements)

 

Other representations of profile: CSV, Excel