# Mapping of Konsulta Registration Form to FHIR - NHDR Implementation Guide Release 1.0 v0.1.0

* [**Table of Contents**](toc.md)
* [**Konsulta Registration Form**](K1.md)
* **Mapping of Konsulta Registration Form to FHIR**

## Mapping of Konsulta Registration Form to FHIR

**View
Form**

<iframe src="K1.pdf" width="700" height="900"></iframe>

### Mapped Fields

| | | | | |
| :--- | :--- | :--- | :--- | :--- |
| Insurer | EnrollmentRequest.insurer | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) | 0..1 |   |
| ► | Organization.name | string | 0..1 |   |
| Konsulta Coverage | EnrollmentRequest.coverage | Reference([PH_Coverage](StructureDefinition-PH-Coverage.md)) | 0..1 |   |
| **To be filled out by Beneficiary** |   |   |   |   |
| Membership type | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.type | codeableConcept |   | ValueSet:[PatientType](ValueSet-PatientTypeVS.md) |
| PhilHealth Identification Number (PIN) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.identifier | identifier |   | PhilHealth ID |
| Date (MM-DD-YYYY) | EnrollmentRequest.created | dateTime | 0..1 |   |
| Name (Last Name) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.name.family | string |   |   |
| Name (First Name) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.name.given | string |   |   |
| Name (Middle Name) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.name.given | string |   |   |
| Address (BRGY/Town) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.address.barangay | coding |   | ValueSet:[BarangayCodes](ValueSet-BarangayVS.md) |
| Address (City/Municipality) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.address.cityMunicipality | coding |   | ValueSet:[CityCodes](ValueSet-CityVS.md) |
| Address (Province) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.address.province | coding |   | ValueSet:[ProviceCodes](ValueSet-ProvinceVS.md) |
| Date Of Birth (MM-DD-YYYY) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.birthDate | date |   |   |
| Contact Number | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.telecom.value | string |   |   |
| Register to a Konsulta Package Provider (KPP) (Checkbox) | Questionnaire.item.text | string | 0..1 |   |
| Register all my declared minor Dependents (please use additional for if necessary) (Checkbox) | Questionnaire.item.text | string | 0..1 | 0 = no 1 = yes |
| Name (Last Name) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.name.family | string |   |   |
| Name (First Name) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.name.given | string |   |   |
| Name (Middle Name) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.name.given | string |   |   |
| 1st Choice of Konsulta Package Provider | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.name | string |   |   |
| Address (BRGY/Town) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.barangay | coding |   | ValueSet:[BarangayCodes](ValueSet-BarangayVS.md) |
| Address (City/Municipality) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.cityMunicipality | coding |   | ValueSet:[CityCodes](ValueSet-CityVS.md) |
| Address (Province) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.province | coding |   | ValueSet:[ProviceCodes](ValueSet-ProvinceVS.md) |
| 2nd Choice of Konsulta Package Provider | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.name | string |   |   |
| Address (BRGY/Town) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.barangay | coding |   | ValueSet:[BarangayCodes](ValueSet-BarangayVS.md) |
| Address (City/Municipality) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.cityMunicipality | coding |   | ValueSet:[CityCodes](ValueSet-CityVS.md) |
| Address (Province) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.province | coding |   | ValueSet:[ProviceCodes](ValueSet-ProvinceVS.md) |
| Transfer (Checkbox) | Questionnaire.item.text | string | 0..1 |   |
| Previous KPP | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.name | string |   |   |
| 1st Choice of KPP | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.name | string |   |   |
| Address (BRGY/Town) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.barangay | coding |   | ValueSet:[BarangayCodes](ValueSet-BarangayVS.md) |
| Address (City/Municipality) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.cityMunicipality | coding |   | ValueSet:[CityCodes](ValueSet-CityVS.md) |
| Address (Province) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.province | coding |   | ValueSet:[ProviceCodes](ValueSet-ProvinceVS.md) |
| 2nd Choice of KPP | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.name | string |   |   |
| Address (BRGY/Town) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.barangay | coding |   | ValueSet:[BarangayCodes](ValueSet-BarangayVS.md) |
| Address (City/Municipality) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.cityMunicipality | coding |   | ValueSet:[CityCodes](ValueSet-CityVS.md) |
| Address (Province) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.province | coding |   | ValueSet:[ProviceCodes](ValueSet-ProvinceVS.md) |
| **Signature**over Printed Name | Provenance.signature.data | base64Binary | 0..1 |   |
| Signature over**Printed Name** | Provenance.signature.who | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 1..1 |   |
| ► | Patient.name | HumanName |   |   |
| **To be filled out by Philhealth Konsulta Personnel** |   |   |   |   |
| Registration Number | EnrollmentRequest.identifier | identifier | 0..* |   |
| Date Registered (MM-DD-YYYY) | EnrollmentRequest.created | dateTime | 0..1 |   |
| Name (Last Name) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.name.family | string |   |   |
| Name (First name) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.name.given | string |   |   |
| Name (Middle name) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.name.given | string |   |   |
| PhilHealth Identification Number (PIN) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.identifier | Identifier |   | PhilHealth ID |
| Date Of Birth (MM-DD-YYYY) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.birthDate | date |   |   |
| Konsulta Package Provider | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.name | string | 0..1 |   |
| Address (BRGY/Town) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.barangay | coding |   | ValueSet:[BarangayCodes](ValueSet-BarangayVS.md) |
| Address (City/Municipality) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.cityMunicipality | coding |   | ValueSet:[CityCodes](ValueSet-CityVS.md) |
| Address (Province) | EnrollmentRequest.candidate | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) | 0..1 |   |
| ► | Patient.generalPractitioner | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |   |
| ► | Organization.address.province | coding |   | ValueSet:[ProviceCodes](ValueSet-ProvinceVS.md) |
| **Signature**over Printed Name of**Authorized Personnel** | Provenance.signature.data | base64Binary | 0..1 |   |
| Signature over**Printed Name of Authorized Personnel** | Provenance.signature.who | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) | 1..1 |   |
| ► | Organization.contact.name | HumanName |   |   |

### Mandatory Elements Not in the Form

| | | |
| :--- | :--- | :--- |
| Provenance.target |   |   |
| Provenance.recorded | instant |   |
| Provenance.agent.who | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) |   |
| Organization.name | string |   |
| Provenance.signature.type | coding |   |
| Provenance.signature.when | instant |   |
| Questionnaire.status | code |   |
| Questionnaire.item.linkId | string |   |
| Questionnaire.item.type | code |   |
| Coverage.status | code |   |
| Coverage.beneficiary | Reference([PH_Patient](StructureDefinition-PH-Patient.md)) |   |
| Coverage.payor | Reference(Organization, Patient, RelatedPerson) |   |

