Claims Form 1

NHDR Implementation Guide Release 1.0
0.1.0 - ci-build

NHDR Implementation Guide Release 1.0, published by NHDR. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/PROJ-PHILHEALTH-EA-NHDR/PhilHealth-NHDR-IG-Review/ and changes regularly. See the Directory of published versions

This is a sample representation of the Use Case implementation guide for Claims Form 1

This can be viewed as instances "Member is not the Patient" & "Member is the Patient" to also see downloadable XML, JSON, and TTL formats.

Implementation Rules

name.given is an array that captures the first name and middle name.
1. name.given[0] is used to capture a person's first name.
2. name.given[1] is used to capture a person's middle name.
For the field under Part I - Member Information, if Patient is the member? is true, you must add a Patient resource to the bundle and use Patient.link to reference this RelatedPerson resource. For example:

QuestionnaireResponse:

"resource": {
    "resourceType": "QuestionnaireResponse",
    "id": "QuestionnaireResponse-2",
    "meta": {
        "profile": [
            "https://nhdr.gov.ph/fhir/StructureDefinition/PH-QuestionnaireResponse"
        ]
    },
    "questionnaire": "Questionnaire/Questionnaire-2",
    "item": [
        {
            "linkId": "1",
            "text": "Patient is the member?",
            "answer": [
                {
                    "valueBoolean": true
                }
            ]
        }
    ],
    "status": "in-progress"
}

Patient:

"resource": {
    "resourceType": "Patient",
    "id": "Patient-2",
    "meta": {
        "profile": [
            "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient"
        ]
    },
    "link": [
        {
            "other": {
                "reference": "RelatedPerson/RelatedPerson-2"
            },
            "type": "refer"
        }
    ]
}

RelatedPerson:

"resource": {
    "resourceType": "RelatedPerson",
    "id": "RelatedPerson-2",
    "meta": {
        "profile": [
            "https://nhdr.gov.ph/fhir/StructureDefinition/PH-RelatedPerson"
        ]
    },
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "code": "NIIP"
                    }
                ],
                "text": "PhilHealth Identification Number"
            },
            "value": "PH54321"
        }
    ],
    "patient": {
        "reference": "Patient/Patient-2"
    }
    
    <!-- Rest of the resource -->

}