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

Mapping of Claims Form 2 to FHIR

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.
  • Encounter.reasonCode SHALL be supported if Patient Disposition is Transferred/Referred.

  • ICD 10 or RVS Code field will either be Condition.code or Procedure.code respectively. If the data fits in Procedure.code, you SHOULD use a separate resource as Procedure.code has a maximum cardinality of 1.

Form Field
FHIR Mapping (profile)
Data Type (profile)
Cardinality
Length
ValueSet
Series # Claim.identifier Identifier 0..1 15
Part I - Health Care Institution (HCI) Information          
PhilHealth Accreditation No. (PAN) - Institutional Health Care Provider Organization.identifier Identifier(OtherIDs) 0..1 #AN "Accreditation Number"
Name of Health Care Institution Organization.name string 0..1
Address (Building Number and Street Name) Organization.address.line string 0..*
Address (City/Municipality) Organization.address.extension:cityMunicipality Coding String 0..* City
Address (Province) Organization.address.extension:province Coding String 0..* Province
Part II - Patient Confinement Information          
Name of Patient (Last Name) Patient.name.family string 0..* 60
Name of Patient (First Name) Patient.name.given[0] string 0..* 60
Name of Patient (Name Extension) Patient.name.suffix string 0..* 5
Name of Patient (Middle Name) Patient.name.given[1] String 0..* 60
Was Patient referred by another HCI? [Yes/No] QuestionnaireResponse.item.answer.value[x] boolean 0..1 1
Name of referring Health Care Institution Encounter.hospitalization.origin string 0..1 12
Address of referring HCI (Building Number and Street Name) Organization.address.line string 0..*
Address of referring HCI (City/Municipality) Organization.address.extension:cityMunicipality Coding String 0..* City
Address of referring HCI (Province) Organization.address.extension:province Coding String 0..* Province
Address of referring HCI (ZIP Code) Organization.address.postalCode integer 0..*
Confinement Period (Date & Time Admitted) Encounter.period Period
Confinement Period (Date & Time Discharged) Encounter.period Period
Patient Disposition Condition.clinicalStatus CodeableConcept 0..1 1 ClinicalStatus
Patient Disposition: Expired Patient.deceased[x] dateTime 0..1
Patient Disposition: Transferred/Referred (Name of Referral Health Care Institution) Encounter.hospitalization.destination string 0..*
Patient Disposition: Transferred/Referred HCI Address (Building Number and Street Name) Organization.address.line string 0..*
Patient Disposition: Transferred/Referred HCI Address (City/Municipality) Organization.address.extension:province Coding String 0..* City
Patient Disposition: Transferred/Referred HCI Address (Province) Organization.address.extension:province Coding String 0..* Province
Patient Disposition: Transferred/Referred HCI Address (Postal Code) Organization.address.postalCode integer 0..*
Patient Disposition: Reason/s for referral/transfer Encounter.reasonCode CodeableConcept 0..1 ReasonCode
Type of Accomodation [Private/Non-Private] Encounter.location.physicalType CodeableConcept 0..1 4 Location Physical Type
Admission Diagnosis/es Encounter.diagnosis.condition string 0..1 500
Discharge Diagnosis/es: Diagnosis Encounter.diagnosis.condition string 0..* 0..1 500  
Discharge Diagnosis/es: ICD-10 Code/s Encounter.diagnosis.condition.code.coding CodeableConcept 15
Discharge Diagnosis/es: Related Procedure/s (if there's any) Procedure.code.text string 0..1 150
Discharge Diagnosis/es: RVS Code Procedure.code CodeableConcept 0..1 6 RVS Codes
Discharge Diagnosis/es: Date of Procedure Procedure.performed[x] dateTime 0..1 10
Discharge Diagnosis/es: Laterality (Left, Right, Both) Procedure.bodySite CodeableConcept 0..* 1 6 Procedure Body Site
Package Code Coverage.identifier CodeableConcept  
Package (Procedure) Procedure.extension:illnessClass CodeableConcept
Package (Session) Encounter.extension:illnessClass CodeableConcept
Date of Package Coverage.period Period
TB DOTS Phase Coverage.class.type CodeableConcept
Animal Bite Vaccination MedicalAdministrataion.medication[x] Reference(PH_Medication)
Animal Bite Vaccination Date MedicationAdministration.effective[x] dateTime
Newborn Care Screening Coverage.class.type CodeableConcept Coverage Class
Newborn Care Sub-screening Coverage.class.type CodeableConcept Coverage Class
Laboratory Number Coverage.identifier Identifier
ICD10 or RVS Code Condition.code / Procedure.code CodeableConcept ICD-10 / RVS Codes
Accreditation No. Practitioner.identifier Identifier(OtherIDs) 0..1 12 #AN "Accreditation Number"
Practitioner Name (Last Name) Practitioner.name.family string 0..1 60
Practitioner Name (First Name) Practitioner.name.given[0] string
Practitioner Name (Name Extension) Practitioner.name.suffix string
Practitioner Name (Middle Name) Practitioner.name.given[1] string
Practitioner Signature Practitioner.extension:signature.data base64Binary Signature
Date Signed (MM-DD-YYYY) Practitioner.extension:signature.when instant date
Co-Pay Details Coverage.costToBeneficiary.type CodeableConcept 0..1 14 1 Coverage Co-Pay Type
Co-Pay Amount Coverage.costToBeneficiary.value[x] Money 1..1 0..1 1
Part III - Certification of Consumption of Benefits and Consent to Access Patient Record/s          
Certification of Consumption of Benefits CoverageEligibilityRequest.identifier CodeableConcept 1
A0 Total Health Care Institution Fees (Total Actual Charges) Coverage.costToBeneficiary.value[x] Money 1..1 12
A0 Total Professional Fees (Total Actual Charges) Coverage.costToBeneficiary.value[x] Money 1..1 12
A0 Grand Total (Total Actual Charges) Coverage.costToBeneficiary.value[x] Money 1..1 12
B0 Total HCI Fees (Total Actual Charges) Coverage.costToBeneficiary.value[x] Money 1..1 12
B0 Total HCI Fees (Amount after Application of Discount) Coverage.costToBeneficiary.value[x] Money 1..1 12
B0 Total HCI Fees (Amount after PhilHealth Deduction) Coverage.costToBeneficiary.value[x] Money 1..1 12
B0 Total HCI Fees (Amount after PhilHealth Deduction) Paid By: Coverage.payor Reference(PH_Patient or PH_Organization) 1..* 1
B0 Total Professional Fees (Total Actual Charges) Coverage.costToBeneficiary.value[x] Money 1..1 12
B0 Total Professional Fees (Amount after Application of Discount) Coverage.costToBeneficiary.value[x] Money 1..1 12
B0 Total Professional Fees (PhilHealth Benefit) Coverage.costToBeneficiary.value[x] Money 1..1 12
B0 Total Professional Fees (Amount after PhilHealth Deduction) Coverage.costToBeneficiary.value[x] Money 1..1 12
B0 Total Professional Fees (Amount after PhilHealth Deduction) Paid By: Coverage.payor Reference(PH_Patient or PH_Organization) 1..* 1
B1 Total cost of purchase/s for drugs/medicines and/or medical supplies bought by the patient.member within/outside the HCI during confinement Claim.item.net Money 0..1 12
B1 Total cost of diagnostic/laboratory examinations paid by the patient/member done within/outside the HCI during confinement Claim.item.net Money 0..1 12
Signature Type Claim.extension:signature.type CodeableConcept Signature Type
Signature SubType Claim.extension:signature.extension:signatureSubType CodeableConcept
Date Signed Date Recevied Claim.extension:signature.when instant date 1..1
Signature Image Claim.extension:signature.data base64Binary Signature 1..1
Signature Name Claim.extension:signature.who Reference(PH_Patient or PH_Organization or PH_Practitioner or PH_PractitionerRole or or RelatedPerson or Device) HumanName 0..*
~~Designation Claim.extension:signature.extension:signaturePosition CodeableConcept String 0..* —~~
Relationship of the representative to the member/patient: extension:signature.who Claim.extension:signature.extension:relationship Reference CodeableConcept 0..*
Reason for signing on behalf of the member/patient: Claim.extension:signature.extension:signatureReason CodeableConcept 0..1
Thumbmark Validation (Patient or Representative?) Questionnaire.Response.item.answer.value[x] boolean? 0..1
Printed Thumbmark Claim.extension:signature.extension:signatureThumbmark base64Binary
Part IV - Certification of Consumption of Health Care Institution          
Signature Type Claim.extension:signature.type CodeableConcept Signature Type
Signature SubType Claim.extension:signature.extension:signatureSubType CodeableConcept
Date Signed Date Recevied Claim.extension:signature.when instant date 1..1
Signature Image Claim.extension:signature.data base64Binary Signature 1..1
Signature Name Claim.extension:signature.who Reference(PH_Patient or PH_Organization or PH_Practitioner or PH_PractitionerRole or or RelatedPerson or Device) HumanName 0..*
Designation Claim.extension:signature.extension:signaturePosition CodeableConcept String 0..*