臺灣長期照顧實作指引(TW LTC IG)
1.0.0 - STU 1.0.0
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
{
"resourceType" : "ClaimResponse",
"id" : "ltc-claimresponse-feeaudit-example",
"meta" : {
"profile" : [
🔗 "http://ltc-ig.fhir.tw/StructureDefinition/LTCClaimResponseFeeAudit"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse ltc-claimresponse-feeaudit-example</b></p><a name=\"ltc-claimresponse-feeaudit-example\"> </a><a name=\"hcltc-claimresponse-feeaudit-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-LTCClaimResponseFeeAudit.html\">長照支付審查－分案審核明細</a></p></div><blockquote><p><b>長照支付審查－分案審核統計與承辦資訊</b></p><ul><li>records: 3</li><li>cases: 2</li><li>approveCaseNum: 2</li><li>approveRecordCount: 1</li><li>tempPaymentStatus: 1: 等待暫付總表</li><li>transNo: 00106</li><li>auditMan: CG碼承辦人</li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type tempPaymentDoc}\">暫付總表</span></li><li>url: <a href=\"http://url/download/doc/dc6a\">http://url/download/doc/dc6a</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseSummaryNotice}\">總表</span></li><li>url: <a href=\"http://url/download/doc/dc6adc6a\">http://url/download/doc/dc6adc6a</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseSvcList}\">清冊</span></li><li>url: <a href=\"http://url/download/doc/dc6afa306c\">http://url/download/doc/dc6afa306c</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseSvcListExcel}\">清冊EXCEL</span></li><li>url: <a href=\"http://url/download/doc/dc6a6c\">http://url/download/doc/dc6a6c</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseASvcList}\">A碼清冊</span></li><li>url: <a href=\"http://url/download/doc/dc6afa306cc554311c\">http://url/download/doc/dc6afa306cc554311c</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseASvcListExcel}\">A碼清冊EXCEL</span></li><li>url: <a href=\"http://url/download/doc9967-7bddc554311c\">http://url/download/doc9967-7bddc554311c</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseErrList}\">申請記錄不通過清冊</span></li><li>url: <a href=\"http://url/download/doc/dc6afa306cc-5ce29d30f843\">http://url/download/doc/dc6afa306cc-5ce29d30f843</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseErrListExcel}\">申請記錄不通過EXCEL清冊</span></li><li>url: <a href=\"http://url/download/doc/dc6afa306c-5ce29d30f843\">http://url/download/doc/dc6afa306c-5ce29d30f843</a></li></ul></blockquote><p><b>identifier</b>: <code>http://ltc-ig.fhir.tw/identifier/feeaudit/case-no</code>/201907C010163, <code>http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver</code>/006, <code>http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm</code>/201907</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-chen-ming-hui.html\">陳明慧 Female, DoB: 1945-03-15 ( National Person Identifier (TWN):\u00a0A123456789\u00a0(use:\u00a0official,\u00a0))</a></p><p><b>created</b>: 2019-07-23 15:43:51+0800</p><p><b>insurer</b>: <a href=\"Organization-ltc-organization-feeaudit-authority-example.html\">Organization 新北市政府衛生局</a></p><p><b>outcome</b>: Partial Processing</p><p><b>disposition</b>: 請長照機構於5日內將總表送至本局</p><blockquote><p><b>item</b></p><blockquote><p><b>長照支付審查－服務記錄識別資訊</b></p><ul><li>objid: 882601915</li><li>sourceSystem: TranCareCenter</li><li>transNo: A123456789</li></ul></blockquote><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication price}\">單價</span></p><h3>Amounts</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>400</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication copayment}\">自付額</span></p><h3>Amounts</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>85</td><td>New Taiwan dollar</td></tr></table></blockquote></blockquote><blockquote><p><b>addItem</b></p><blockquote><p><b>長照支付審查－服務記錄識別資訊</b></p><ul><li>objid: 882601915</li><li>sourceSystem: TranCareCenter</li></ul></blockquote><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-service-item AA05}\">照顧困難之服務加計</span></p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication price}\">單價</span></p><h3>Amounts</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>200</td><td>New Taiwan dollar</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication submitted}\">申請核銷金額</span></p><h3>Amounts</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>4500</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication approveFee}\">核定金額</span></p><h3>Amounts</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>1596</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication aSvcFee}\">政策鼓勵金額</span></p><h3>Amounts</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>400</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication tempPaymentFee}\">分案暫付金額</span></p><h3>Amounts</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>17500</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication incInAcc}\">核增金額</span></p><h3>Amounts</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>4000</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication decInAcc}\">核減金額</span></p><h3>Amounts</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>500</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>processNote</b></p><p><b>number</b>: 1</p><p><b>type</b>: Display</p><p><b>text</b>: 核增原因（inc_in_reason）：因個案身分異動</p></blockquote><blockquote><p><b>processNote</b></p><p><b>number</b>: 2</p><p><b>type</b>: Display</p><p><b>text</b>: 核減原因（dec_in_reason）：因個案CMS等級異動</p></blockquote></div>"
},
"extension" : [
{
"extension" : [
{
"url" : "records",
"valueInteger" : 3
},
{
"url" : "cases",
"valueInteger" : 2
},
{
"url" : "approveCaseNum",
"valueInteger" : 2
},
{
"url" : "approveRecordCount",
"valueInteger" : 1
},
{
"url" : "tempPaymentStatus",
"valueString" : "1: 等待暫付總表"
},
{
"url" : "transNo",
"valueString" : "00106"
},
{
"url" : "auditMan",
"valueString" : "CG碼承辦人"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary"
},
{
"extension" : [
{
"url" : "docType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type",
"code" : "tempPaymentDoc",
"display" : "暫付總表"
}
]
}
},
{
"url" : "url",
"valueUrl" : "http://url/download/doc/dc6a"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl"
},
{
"extension" : [
{
"url" : "docType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type",
"code" : "caseSummaryNotice",
"display" : "總表"
}
]
}
},
{
"url" : "url",
"valueUrl" : "http://url/download/doc/dc6adc6a"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl"
},
{
"extension" : [
{
"url" : "docType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type",
"code" : "caseSvcList",
"display" : "清冊"
}
]
}
},
{
"url" : "url",
"valueUrl" : "http://url/download/doc/dc6afa306c"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl"
},
{
"extension" : [
{
"url" : "docType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type",
"code" : "caseSvcListExcel",
"display" : "清冊EXCEL"
}
]
}
},
{
"url" : "url",
"valueUrl" : "http://url/download/doc/dc6a6c"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl"
},
{
"extension" : [
{
"url" : "docType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type",
"code" : "caseASvcList",
"display" : "A碼清冊"
}
]
}
},
{
"url" : "url",
"valueUrl" : "http://url/download/doc/dc6afa306cc554311c"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl"
},
{
"extension" : [
{
"url" : "docType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type",
"code" : "caseASvcListExcel",
"display" : "A碼清冊EXCEL"
}
]
}
},
{
"url" : "url",
"valueUrl" : "http://url/download/doc9967-7bddc554311c"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl"
},
{
"extension" : [
{
"url" : "docType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type",
"code" : "caseErrList",
"display" : "申請記錄不通過清冊"
}
]
}
},
{
"url" : "url",
"valueUrl" : "http://url/download/doc/dc6afa306cc-5ce29d30f843"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl"
},
{
"extension" : [
{
"url" : "docType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type",
"code" : "caseErrListExcel",
"display" : "申請記錄不通過EXCEL清冊"
}
]
}
},
{
"url" : "url",
"valueUrl" : "http://url/download/doc/dc6afa306c-5ce29d30f843"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl"
}
],
"identifier" : [
{
"system" : "http://ltc-ig.fhir.tw/identifier/feeaudit/case-no",
"value" : "201907C010163"
},
{
"system" : "http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver",
"value" : "006"
},
{
"system" : "http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm",
"value" : "201907"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional",
"display" : "Professional"
}
]
},
"use" : "claim",
"patient" : {
🔗 "reference" : "Patient/ltc-patient-chen-ming-hui"
},
"created" : "2019-07-23T15:43:51+08:00",
"insurer" : {
🔗 "reference" : "Organization/ltc-organization-feeaudit-authority-example"
},
"outcome" : "partial",
"disposition" : "請長照機構於5日內將總表送至本局",
"item" : [
{
"extension" : [
{
"extension" : [
{
"url" : "objid",
"valueString" : "882601915"
},
{
"url" : "sourceSystem",
"valueString" : "TranCareCenter"
},
{
"url" : "transNo",
"valueString" : "A123456789"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef"
}
],
"itemSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication",
"code" : "price",
"display" : "單價"
}
]
},
"amount" : {
"value" : 400,
"currency" : "TWD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication",
"code" : "copayment",
"display" : "自付額"
}
]
},
"amount" : {
"value" : 85,
"currency" : "TWD"
}
}
]
}
],
"addItem" : [
{
"extension" : [
{
"extension" : [
{
"url" : "objid",
"valueString" : "882601915"
},
{
"url" : "sourceSystem",
"valueString" : "TranCareCenter"
}
],
"url" : "http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef"
}
],
"itemSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-service-item",
"code" : "AA05",
"display" : "照顧困難之服務加計"
}
]
},
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication",
"code" : "price",
"display" : "單價"
}
]
},
"amount" : {
"value" : 200,
"currency" : "TWD"
}
}
]
}
],
"total" : [
{
"category" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication",
"code" : "submitted",
"display" : "申請核銷金額"
}
]
},
"amount" : {
"value" : 4500,
"currency" : "TWD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication",
"code" : "approveFee",
"display" : "核定金額"
}
]
},
"amount" : {
"value" : 1596,
"currency" : "TWD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication",
"code" : "aSvcFee",
"display" : "政策鼓勵金額"
}
]
},
"amount" : {
"value" : 400,
"currency" : "TWD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication",
"code" : "tempPaymentFee",
"display" : "分案暫付金額"
}
]
},
"amount" : {
"value" : 17500,
"currency" : "TWD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication",
"code" : "incInAcc",
"display" : "核增金額"
}
]
},
"amount" : {
"value" : 4000,
"currency" : "TWD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication",
"code" : "decInAcc",
"display" : "核減金額"
}
]
},
"amount" : {
"value" : 500,
"currency" : "TWD"
}
}
],
"processNote" : [
{
"number" : 1,
"type" : "display",
"text" : "核增原因（inc_in_reason）：因個案身分異動"
},
{
"number" : 2,
"type" : "display",
"text" : "核減原因（dec_in_reason）：因個案CMS等級異動"
}
]
}