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

## : 轉介單居家服務計畫範例 - TTL Representation

Raw ttl | Download

    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:CarePlan ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "ltc-careplan-referral-home-service-example"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://ltc-ig.fhir.tw/StructureDefinition/LTCCarePlanReferral"^^xsd:anyURI ;
    fhir:l <http://ltc-ig.fhir.tw/StructureDefinition/LTCCarePlanReferral>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CarePlan ltc-careplan-referral-home-service-example</b></p><a name=\"ltc-careplan-referral-home-service-example\"> </a><a name=\"hcltc-careplan-referral-home-service-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-LTCCarePlanReferral.html\">轉介單－服務種類</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Proposal</p><p><b>category</b>: <span title=\"Codes:{https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw assess-plan}\">Assessment and Plan of Treatment</span></p><p><b>subject</b>: <a href=\"Patient-ltc-patient-referral-chen-ming-hui-example.html\">陳明慧 Female, DoB: 1945-03-15 ( National Person Identifier (TWN): A123456789 (use: official, ))</a></p><p><b>period</b>: 2024-02-01 --&gt; 2024-08-01</p><p><b>author</b>: <a href=\"PractitionerRole-ltc-practitioner-role-nurse-example.html\">PractitionerRole Registered nurse</a></p><p><b>goal</b>: <a href=\"Goal-ltc-goal-mobility-improvement-example.html\">Goal: lifecycleStatus = active; description = Advancing mobility; start[x] = 2024-01-15; note = 住民目前需要部分協助才能行走，期望透過復健訓練達到獨立行走的目標</a></p><blockquote><p><b>activity</b></p><h3>Details</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Status</b></td><td><b>Performer</b></td><td><b>Description</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/ReferralCarePlanCS-TWLTC home-care}\">居家護理</span></td><td>Not Started</td><td><a href=\"Organization-ltc-organization-example.html\">Organization 新北市私立安康老人長期照顧中心（養護型）</a></td><td>提供居家護理服務，如換藥、傷口照護、健康評估等</td></tr></table></blockquote><blockquote><p><b>activity</b></p><h3>Details</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Status</b></td><td><b>Performer</b></td><td><b>Description</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://ltc-ig.fhir.tw/CodeSystem/ReferralCarePlanCS-TWLTC home-swallowing}\">居家吞嚥</span></td><td>Not Started</td><td><a href=\"Organization-ltc-organization-example.html\">Organization 新北市私立安康老人長期照顧中心（養護型）</a></td><td>提供居家吞嚥訓練與相關照護服務</td></tr></table></blockquote><p><b>note</b>: @2024-01-20</p><blockquote><div><p>個案需要居家照顧及復健服務，由照管中心評估後安排服務提供單位</p>\n</div></blockquote></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:intent [ fhir:v "proposal"] ; #
      fhir:category ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw"^^xsd:anyURI ;
    fhir:l <https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw>       ] ;
    fhir:code [ fhir:v "assess-plan" ]     ] )
      ] ) ; #
      fhir:subject [
    fhir:l fhir:Patient/ltc-patient-referral-chen-ming-hui-example ;
    fhir:reference [ fhir:v "Patient/ltc-patient-referral-chen-ming-hui-example" ]
      ] ; #
      fhir:period [
    fhir:start [ fhir:v "2024-02-01"^^xsd:date ] ;
    fhir:end [ fhir:v "2024-08-01"^^xsd:date ]
      ] ; #
      fhir:author [
    fhir:l fhir:PractitionerRole/ltc-practitioner-role-nurse-example ;
    fhir:reference [ fhir:v "PractitionerRole/ltc-practitioner-role-nurse-example" ]
      ] ; #
      fhir:goal ( [
    fhir:l fhir:Goal/ltc-goal-mobility-improvement-example ;
    fhir:reference [ fhir:v "Goal/ltc-goal-mobility-improvement-example" ]
      ] ) ; #
      fhir:activity ( [
    fhir:detail [
    fhir:code [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://ltc-ig.fhir.tw/CodeSystem/ReferralCarePlanCS-TWLTC"^^xsd:anyURI ;
    fhir:l <http://ltc-ig.fhir.tw/CodeSystem/ReferralCarePlanCS-TWLTC>           ] ;
    fhir:code [ fhir:v "home-care" ] ;
    fhir:display [ fhir:v "居家護理" ]         ] )       ] ;
    fhir:status [ fhir:v "not-started" ] ;
          ( fhir:performer [
    fhir:l fhir:Organization/ltc-organization-example ;
    fhir:reference [ fhir:v "Organization/ltc-organization-example" ]       ] ) ;
    fhir:description [ fhir:v "提供居家護理服務，如換藥、傷口照護、健康評估等" ]     ]
      ] [
    fhir:detail [
    fhir:code [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://ltc-ig.fhir.tw/CodeSystem/ReferralCarePlanCS-TWLTC"^^xsd:anyURI ;
    fhir:l <http://ltc-ig.fhir.tw/CodeSystem/ReferralCarePlanCS-TWLTC>           ] ;
    fhir:code [ fhir:v "home-swallowing" ] ;
    fhir:display [ fhir:v "居家吞嚥" ]         ] )       ] ;
    fhir:status [ fhir:v "not-started" ] ;
          ( fhir:performer [
    fhir:l fhir:Organization/ltc-organization-example ;
    fhir:reference [ fhir:v "Organization/ltc-organization-example" ]       ] ) ;
    fhir:description [ fhir:v "提供居家吞嚥訓練與相關照護服務" ]     ]
      ] ) ; #
      fhir:note ( [
    fhir:time [ fhir:v "2024-01-20"^^xsd:date ] ;
    fhir:text [ fhir:v "個案需要居家照顧及復健服務，由照管中心評估後安排服務提供單位" ]
      ] ) . #