臺灣長期照顧實作指引(TW LTC IG), published by 經濟部產業發展署. 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/Lorex/TWLongTermCare_IG_Build/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: 長照支付審查－個案服務紀錄申報（DA01 交通接送）範例 - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="ltc-claim-feeapply-da01-example"/>
  <meta>
    <profile
             value="http://ltc-ig.fhir.tw/StructureDefinition/LTCClaimFeeApply"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Claim ltc-claim-feeapply-da01-example</b></p><a name="ltc-claim-feeapply-da01-example"> </a><a name="hcltc-claim-feeapply-da01-example"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-LTCClaimFeeApply.html">長照支付審查－個案服務紀錄申報</a></p></div><p><b>identifier</b>: <code>http://ltc-ig.fhir.tw/identifier/feeaudit/objid</code>/00000000000000000006, <code>http://ltc-ig.fhir.tw/identifier/feeaudit/trans-no</code>/A0001, <code>http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm</code>/201901</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}">Professional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href="Patient-ltc-patient-sdk-example.html">王小明 Male, DoB: 1950-01-01 ( Provider number (use: official, ))</a></p><p><b>created</b>: 2019-02-05 10:00:00+0800</p><p><b>provider</b>: <a href="Organization-ltc-organization-sdk-example.html">Organization OOO長期照顧管理中心</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><h3>CareTeams</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><a href="Practitioner-ltc-practitioner-sdk-example.html">Practitioner 李小華</a></td></tr></table><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info addrFrom}">出發地</span></p><p><b>value</b>: <a href="Location-ltc-location-feeapply-home-example.html">Location 個案住家</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info addrTo}">目的地</span></p><p><b>value</b>: <a href="Location-ltc-location-feeapply-hospital-example.html">Location 亞東醫院</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info carNo}">車號</span></p><p><b>value</b>: 1111-AA</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 4</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info driver}">駕駛員</span></p><p><b>value</b>: 黃OO</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 5</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info milage}">里程數</span></p><p><b>value</b>: 12 公里<span style="background: LightGoldenRodYellow"> (Details: UCUM  codekm = 'km')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 6</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info lastSvc}">臨終日照顧</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 7</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info missedVisit}">訪視/服務未遇</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 8</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info applyAA09}">是否申報AA09</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 9</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info aa10Status}">AA10申報狀態</span></p><p><b>code</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-aa10-status 0}">未申報</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 10</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info remark}">備註</span></p><p><b>value</b>: 1</p></blockquote><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</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>長期照顧給付及支付基準</td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-fee-type 1}">補助</span></p><p><b>productOrService</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-service-item DA01}">交通接送</span></p><p><b>serviced</b>: 2019-01-05 13:30:00+0800 --&gt; 2019-01-05 14:00:00+0800</p><p><b>location</b>: <a href="Location-ltc-location-feeapply-hospital-example.html">Location 亞東醫院</a></p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>430</td><td>New Taiwan dollar</td></tr></table><h3>Nets</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>430</td><td>New Taiwan dollar</td></tr></table></blockquote><h3>Totals</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>430</td><td>New Taiwan dollar</td></tr></table></div>
  </text>
  <identifier>
    <system value="http://ltc-ig.fhir.tw/identifier/feeaudit/objid"/>
    <value value="00000000000000000006"/>
  </identifier>
  <identifier>
    <system value="http://ltc-ig.fhir.tw/identifier/feeaudit/trans-no"/>
    <value value="A0001"/>
  </identifier>
  <identifier>
    <system value="http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm"/>
    <value value="201901"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>🔗 
    <reference value="Patient/ltc-patient-sdk-example"/>
  </patient>
  <created value="2019-02-05T10:00:00+08:00"/>
  <provider>🔗 
    <reference value="Organization/ltc-organization-sdk-example"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="normal"/>
    </coding>
  </priority>
  <careTeam>
    <sequence value="1"/>
    <provider>🔗 
      <reference value="Practitioner/ltc-practitioner-sdk-example"/>
    </provider>
  </careTeam>
  <supportingInfo>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="addrFrom"/>
      </coding>
    </category>
    <valueReference>🔗 
      <reference value="Location/ltc-location-feeapply-home-example"/>
    </valueReference>
  </supportingInfo>
  <supportingInfo>
    <sequence value="2"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="addrTo"/>
      </coding>
    </category>
    <valueReference>🔗 
      <reference value="Location/ltc-location-feeapply-hospital-example"/>
    </valueReference>
  </supportingInfo>
  <supportingInfo>
    <sequence value="3"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="carNo"/>
      </coding>
    </category>
    <valueString value="1111-AA"/>
  </supportingInfo>
  <supportingInfo>
    <sequence value="4"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="driver"/>
      </coding>
    </category>
    <valueString value="黃OO"/>
  </supportingInfo>
  <supportingInfo>
    <sequence value="5"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="milage"/>
      </coding>
    </category>
    <valueQuantity>
      <value value="12"/>
      <unit value="公里"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="km"/>
    </valueQuantity>
  </supportingInfo>
  <supportingInfo>
    <sequence value="6"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="lastSvc"/>
      </coding>
    </category>
    <valueBoolean value="false"/>
  </supportingInfo>
  <supportingInfo>
    <sequence value="7"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="missedVisit"/>
      </coding>
    </category>
    <valueBoolean value="false"/>
  </supportingInfo>
  <supportingInfo>
    <sequence value="8"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="applyAA09"/>
      </coding>
    </category>
    <valueBoolean value="false"/>
  </supportingInfo>
  <supportingInfo>
    <sequence value="9"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="aa10Status"/>
      </coding>
    </category>
    <code>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-aa10-status"/>
        <code value="0"/>
        <display value="未申報"/>
      </coding>
    </code>
  </supportingInfo>
  <supportingInfo>
    <sequence value="10"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info"/>
        <code value="remark"/>
      </coding>
    </category>
    <valueString value="1"/>
  </supportingInfo>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <display value="長期照顧給付及支付基準"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-fee-type"/>
        <code value="1"/>
        <display value="補助"/>
      </coding>
    </category>
    <productOrService>
      <coding>
        <system
                value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-service-item"/>
        <code value="DA01"/>
        <display value="交通接送"/>
      </coding>
    </productOrService>
    <servicedPeriod>
      <start value="2019-01-05T13:30:00+08:00"/>
      <end value="2019-01-05T14:00:00+08:00"/>
    </servicedPeriod>
    <locationReference>🔗 
      <reference value="Location/ltc-location-feeapply-hospital-example"/>
    </locationReference>
    <quantity>
      <value value="1"/>
    </quantity>
    <unitPrice>
      <value value="430"/>
      <currency value="TWD"/>
    </unitPrice>
    <net>
      <value value="430"/>
      <currency value="TWD"/>
    </net>
  </item>
  <total>
    <value value="430"/>
    <currency value="TWD"/>
  </total>
</Claim>