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/nhdr-fhir-ig-review-project-2/ and changes regularly. See the Directory of published versions

## Mapping of Claims Form 2 to FHIR

View
Form

### Mapped Fields

Form Field | Use-Case Mapping / Target Element | Data Type | Cardinality | Notes
--- | --- | --- | --- | ---
Series # | Claim.identifier | Identifier | 0..* |
Part I - Health Care Institution (HCI) Information |  |  |  |
PhilHealth Accreditation Number (PAN) of Health Care Institution | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.identifier | Identifier |  |
Name of Health Care Institution | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.name | string | 0..1 |
Address (Building Number and Street Name) | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.address.line | string | 0..* |
Address (City/Municipality) | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.address.extension:cityMunicipality | Coding | 0..1 | ValueSet: CityMunicipality
Address (Province) | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.address.extension:province | Coding | 0..1 | ValueSet: Province
Part II - Patient Confinement Information |  |  |  |
Name of Patient (Last Name) | Claim.patient | Reference(PH_Patient) | 1..1 |
► | Patient.name.family | string | 0..1 |
Name of Patient (First Name) | Claim.patient | Reference(PH_Patient) | 1..1 |
► | Patient.name.given[0] | string | 0..1 | Use first instance of `name.given`
Name of Patient (Name Extension) | Claim.patient | Reference(PH_Patient) | 1..1 |
► | Patient.name.suffix | string | 0..* |
Name of Patient (Middle Name) | Claim.patient | Reference(PH_Patient) | 1..1 |
► | Patient.name.given[1] | string | 0..1 | Use second instance of `name.given`
Was patient reffered by another HCI? (Yes/No) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.status | code | 0..1 |
Name of referring Health Care Institution | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.requester | ​Reference(PH_Organization) | 0..1 |
► | Organization.name | string | 0..1 |
Address of referring HCI (Building Number and Street Name) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.requester | ​Reference(PH_Organization) | 0..1 |
► | Organization.address.line | string | 0..* |
Address of referring HCI (City/Municipality) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.requester | ​Reference(PH_Organization) | 0..1 |
► | Organization.address.extension:cityMunicipality | Coding | 0..1 | ValueSet: CityMunicipality
Address of referring HCI (Province) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.requester | ​Reference(PH_Organization) | 0..1 |
► | Organization.address.extension:province | Coding | 0..1 | ValueSet: Province
Address of referring HCI (ZIP Code) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.requester | ​Reference(PH_Organization) | 0..1 |
► | Organization.address.postalCode | string | 0..1 |
Confinement Period (Date Admitted MM-DD-YYYY)(Time Admitted HH:MM)(AM/PM) | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.period.start | dateTime | 0..1 |
Confinement Period (Date Discharge MM-DD-YYY)(Time Discharge HH:MM)(AM/PM) | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.period.end | dateTime | 0..1 |
Patient Disposition (check notes for options: select only one) | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.hospitalization.dischargeDisposition | CodeableConcept | 0..1 | ValueSet: DischargeDisposition
e. Expired (Date Format MM-DD-YYYY)(Time Format HH-MM)(AM/PM) | Claim.patient | Reference(PH_Patient) | 1..1 |
► | Patient.deceasedDateTime | dateTime | 0..1 |
f. Transferred/Referred (Name of Referral Health Care Institution) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.performer | ​Reference(PH_Organization) | 0..* |
► | Organization.name | string | 0..1 |
f. Transferred/Referred HCI Address (Building Number and Street Name) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.performer | ​Reference(PH_Organization) | 0..* |
► | Organization.address.line | string | 0..* |
f. Transferred/Referred HCI Address (City/Municipality) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.performer | ​Reference(PH_Organization) | 0..* |
► | Organization.address.extension:cityMunicipality | Coding | 0..1 | ValueSet: CityMunicipality
f. Transferred/Referred HCI Address (Province) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.performer | ​Reference(PH_Organization) | 0..* |
► | Organization.address.extension:province | Coding | 0..1 | ValueSet: Province
f. Transferred/Referred HCI Address (Postal Code) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.performer | ​Reference(PH_Organization) | 0..* |
► | Organization.address.postalCode | string | 0..1 |
f. Reason/s for referral/transfer (text) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.reasonReference | ​Reference(PH_Observation) | 0..* |
► | Observation.valueString | string | 0..1 | ReasonCode
f. Reason/s for referral/transfer (code) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.reasonReference | ​Reference(PH_Observation) | 0..* |
► | Observation.valueString | string | 0..1 | ReasonCode
Type of Accomodation (Private/Non-Private) | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.location.physicalType | CodeableConcept | 0..1 | Location-PhysicalType Private/Non-Private?
Admission Diagnosis/es | Claim.diagnosis.diagnosisCodeableConcept | CodeableConcept | 1..1 | ICD-10
Discharge Diagnosis: Diagnosis - ICD-10 Code/s | Claim.diagnosis.diagnosisCodeableConcept | CodeableConcept | 1..1 | ICD-10
Discharge Diagnosis: Related Procedure/s (if there's any) - RVS Code | Claim.procedure.procedureCodeableConcept | CodeableConcept | 1..1 | RVS Codes
Discharge Diagnosis: Date of Procedure | Claim.procedure.date | dateTime | 0..1 |
Discharge Diagnosis: Laterality (Left, Right, Both) | Claim.procedure.procedureReference | Reference(PH_Procedure) | 1..1 |
► | Procedure.bodySite | CodeableConcept | 0..* | Body Site
8.a. For the following repetitive procedures, check box that applies and enumerate the procedure/sessions dates [mm-dd-yyyy]. For chemotherapy, see guidelines. | Claim.item.productOrService | CodeableConcept | 1..1 | no ValueSet yet
8.a. procedure/session dates | Claim.item.servicedDate | date | 0..1 |
8.b. For Z-Benefit Package Z-Benefit Package Code: | Claim.item.productOrService | CodeableConcept | 1..1 |
8.c. For MCP Package (enumerate four dates [mm-dd-year] of pre-natal check-ups) | Claim.item.servicedDate | date | 0..1 |
8.d. For TB-DOTS Package | Claim.item.detail.productOrService | CodeableConcept | 1..1 |
8.e. For Animal Bite Package: Day 0 ARV (Date) | Claim.item.servicedDate | date | 0..1 |
8.e. For Animal Bite Package: Day 3 ARV (Date) | Claim.item.servicedDate | date | 0..1 |
8.e. For Animal Bite Package: Day 7 ARV (Date) | Claim.item.servicedDate | date | 0..1 |
8.e. For Animal Bite Package: RIG (Date) | Claim.item.servicedDate | date | 0..1 |
8.e. For Animal Bite Package: Others (Specify) | Claim.item.productOrService | CodeableConcept | 1..1 |
8.e. For Animal Bite Package: Others (Specify) (Date) | Claim.item.servicedDate | date | 0..1 |
8.f. For Newborn Care Package | Claim.item.productOrService | CodeableConcept | 1..1 |
8.f. For Newborn Care Package: Essential Newborn Care | Claim.item.detail.productOrService | CodeableConcept | 1..1 |
8.g. For Outpatient HIV/AIDS Treatment Package: Laboratory Number: | Claim.item.encounter | Reference(PH_Encounter) | 0..* |
► | Encounter.serviceProvider | Reference(PH_Organization) | 0..1 |
► | Organization.identifier | Identifier | 0..* |
9. PhilHealth Benefits: First Case Rate: | Claim.item.productOrService | CodeableConcept | 1..1 |
9. PhilHealth Benefits: Second Case Rate: | Claim.item.productOrService | CodeableConcept | 1..1 |
10. Accreditation number of Accredited Health Care Professional | Claim.supportingInfo.valueReference | Reference(PH_Practitioner) | 0..1 |
► | Practitioner.identifier | Identifier | 0..* |
10. Name of Accredited Health Care Professional | Claim.supportingInfo.valueReference | Reference(PH_Provenance) | 0..1 |
► | Provenance.signature.who | (PH_Practitioner) | 1..1 |
► | Practitioner.name | HumanName | 0..1 |
10. Signature Over Printed Name (Name of Accredited Health Care Professional) | Claim.supportingInfo.valueReference | Reference(PH_Provenance) | 0..1 |
► | Provenance.signature.data | base64Binary | 0..1 |
10. Date Signed | Claim.supportingInfo.valueReference | Reference(PH_Provenance) | 0..1 |
► | Provenance.signature.when | instant | 0..1 |
Details: Co-Pay | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 |
► | Coverage.costToBeneficiary.type | CodeableConcept | 0..1 | Coverage Co-Pay Type
With co-pay on top of PhilHealth Benefit (Amount) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 |
► | Coverage.costToBeneficiary.valueMoney | Money | 1..1 |
Part III - Certification of Consumption of Benefits and Consent to Access Patient Record/s |  |  |  |
A. Certification of Consumption of Benefits | Questionnaire.item.text | string | 0..1 |
A. if Yes, Total Health Care Institution Fees : Total Actual Charges* | Claim.item.net | Money | 0..1 |
A. if Yes, Total Professional Fees : Total Actual Charges* | Claim.item.net | Money | 0..1 |
A. if Yes, Grand Total : Total Actual Charges* | Claim.total | Money | 0..1 |
A. if No, Total Health Care Institution Fees : Total Actual Charges* | Claim.item.net | Money | 0..1 |
A. if No, Total Health Care Institution Fees : Amount after Application of Discount (i.e., personal discount, Senior Citizen / PWD) | Claim.item.detail.net | Money | 0..1 |
A. if No, Total Health Care Institution Fees : PhilHealth Benefit | Claim.item.net | Money | 0..1 |
A. if No, Total Health Care Institution Fees : Amount after PhilHealth Deduction (Amount) | Claim.total | Money | 0..1 |
A. if No, Total Health Care Institution Fees : Amount after PhilHealth Deduction (Paid by (check all that applies)) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 |
► | Coverage.type | CodeableConcept | 0..1 | Coverage Type
A. if No, Total Professional Fees (for accredited and non-accredited professionals) : Total Actual Charges* | Claim.item.net | Money | 0..1 |
A. if No, Total Professional Fees (for accredited and non-accredited professionals) : Amount after Application of Discount (i.e., personal discount, Senior Citizen / PWD) | Claim.item.detail.net | Money | 0..1 |
A. if No, Total Professional Fees (for accredited and non-accredited professionals) : PhilHealth Benefit | Claim.item.net | Money | 0..1 |
A. if No, Total Professional Fees (for accredited and non-accredited professionals) : Amount after PhilHealth Deduction (Amount) | Claim.total | Money | 0..1 |
A. if No, Total Professional Fees (for accredited and non-accredited professionals) : Amount after PhilHealth Deduction (Paid by (check all that applies)) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 |
► | Coverage.type | CodeableConcept |  |
A. if No, Total cost of purchase/s for drugs/medicines and/or medical supplies bought by the patient/member within/outside the HCI during confinement | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 |
► | Coverage.costToBeneficiary.type | CodeableConcept |  |
A. if No, Total cost of purchase/s for drugs/medicines and/or medical supplies bought by the patient/member within/outside the HCI during confinement (Total Amount) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 |
► | Coverage.costToBeneficiary.valueMoney | Money |  |
A. if No, Total cost of diagnostic/laboratory examinations paid by the patient/member done within/outside the HCI during confinement | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 |
► | Coverage.costToBeneficiary.type | CodeableConcept |  |
A. if No, Total cost of diagnostic/laboratory examinations paid by the patient/member done within/outside the HCDI during confinement (Total Amount) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 |
► | Coverage.costToBeneficiary.valueMoney | Money |  |
Signature Type | Provenance.signature.type | Coding | 1..* |
B. Signature Over Printed Name of Member/Patient/Authorized Representative | Provenance.signature.who | Reference(PH_Patient) | 0..1 |
► | Patient.name | HumanName | 0..* |
B. Signature Over Printed Name of Member/Patient/Authorized Representative | Provenance.signature.data | base64Binary | 0..1 |
B. Signature Over Printed Name of Member/Patient/Authorized Representative | Provenance.signature.who | Reference(PH_RelatedPerson) | 0..1 |
► | RelatedPerson.name | HumanName | 0..* |
B. Signature Over Printed Name of Member/Patient/Authorized Representative | Provenance.signature.data | base64Binary | 0..1 |
B. Date Signed: | Provenance.signature.when | instant | 0..1 |
B. Relationship of the representative to the member/patient | Provenance.signature.who | Reference(PH_RelatedPerson) | 0..* |
► | RelatedPerson.relationship | CodeableConcept | 0..* | RelationshipType
B. Reason for signing on behalf of the member/patient | Provenance.signature.extension:reason | string | 0..1 |
B. If patient/representative is unable to write, put right thumbmark. Patient/Representative should be assisted by an HCI representative. | Provenance.signature.data | base64Binary | 0..1 |
Part IV - Certification of Consumption of Health Care Institution |  |  |  |
Signature Type | Provenance.signature.type | Coding | 1..* |
Signature Over Printed Name of Authorized HCI Representative | Provenance.signature.who | Reference(PH_Practitioner) | 0..1 |
► | Practitioner.name | HumanName | 0..1 |
Signature Over Printed Name of Authorized HCI Representative | Provenance.signature.data | base64Binary | 0..1 |
Official Capacity / Designation | Provenance.signature.extension:position | CodeableConcept | 0..* |
Date Signed: | Provenance.signature.when | instant | 0..1 |

### Mandatory Elements Not in the Form

Use-Case Mapping / Target Element | Data Type | Notes
--- | --- | ---
Provenance.target | Reference(PH_Claim) | Reference the intact Claim resource
Provenance.recorded | instant | Must be system-generated timestamp
Provenance.agent.who | Reference(PH_Organization) | Reference the intact Organization (Health Facility) resource
Organization.name | string | Derive from the referenced Organization resource
Claim.status | code | Use expected value 'submitted'
Claim.type | CodeableConcept | Use expected value '(custom ValueSet to be provided later)'
Claim.use | code | Use expected value 'claim'
Claim.created | dateTime | "Resource creation date", should be the `instant` that the resource was created.
Claim.priority | CodeableConcept | Use expected value 'normal'
Claim.supportingInfo.sequence | positiveInt | Expected incrementing value per object
Claim.supportingInfo.category | CodeableConcept | TBD
Claim.diagnosis.sequence | positiveInt | Expected incrementing value per object
Claim.procedure.sequence | positiveInt | Expected incrementing value per object
Claim.insurance.sequence | positiveInt | Expected incrementing value per object
Claim.insurance.focal | boolean | Flag that determines the coverage to be used for the adjudication of this claim.
Claim.item.sequence | positiveInt | Expected incrementing value per object
Claim.item.detail.sequence | positiveInt | Expected incrementing value per object
Questionnaire.status | code | Use expected value 'active'
Questionnaire.item.linkId | string | Expected incrementing value per questionnaire item.
Questionnaire.item.type | code | Indicates expected data type for the questionnaire item.