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 4 to FHIR

View
Form

### Mapped Fields

Form Field | Use-Case Mapping / Target Element | Data Type | Cardinality | ValueSet (if any)
--- | --- | --- | --- | ---
Series # | Claim.identifier | Identifier | 0..* |
Part I - Health Care Institution (HCI) Information |  |  |  |
Name of HCI | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.name | string | 0..1 |
Accreditation Number | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.identifier | Identifier |  |
Address of HCI (Bldg. No. and Name/Lot/Block/Street) | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.address.line | string | 0..* |
Address of HCI (Subdivision/Village) | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.address.line | string | 0..* |
Address of HCI (Barangay/City/Municipality) | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.address.extension:barangay | Coding | 0..1 | Barangay
Address of HCI (Barangay/City/Municipality) | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.address.extension:cityMunicipality | Coding | 0..1 | CityMunicipality
Address of HCI (Province) | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.address.extension:province | Coding | 0..1 | Province
Address of HCI (Zip Code) | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.address.postalCode | Coding | 0..1 |
Part II - Patient's Data |  |  |  |
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..* | Use first instance of `name.given`
Name of Patient (Middle Name) | Claim.patient | Reference(PH_Patient) | 1..1 |
► | Patient.name.given[1] | string | 0..* | Use second instance of `name.given`
PhilHealth Identification Number (PIN) | Claim.patient | Reference(PH_Patient) | 1..1 |
► | Patient.identifier | Identifier | 0..* |
Age | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.extension:ageYears | integer | 0..1 |
Sex | Claim.patient | Reference(PH_Patient) | 1..1 |
► | Patient.extension:sex | CodeableConcept | 0..1 |
Chief Complaint | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.reasonReference | Reference(PH_Observation) | 0..* |
► | Observation.valueString | string | 0..1 |
Admitting Diagnosis | Claim.diagnosis.diagnosisReference | Reference(PH_Condition) | 1..1 | Set `Claim.diagnosis.type` value as 'admitting'
► | Condition.code | CodeableConcept | 0..1 |
Discharge Diagnosis | Claim.diagnosis.diagnosisReference | Reference(PH_Condition) | 1..1 | Set `Claim.diagnosis.type` value as 'discharge'
► | Condition.code | CodeableConcept | 0..1 |
1st Case Rate Code | Claim.item.productOrService | CodeableConcept | 1..1 |
2nd Case Rate Code | Claim.item.productOrService | CodeableConcept | 1..1 |
Date Admitted (MM-DD-YYYY)(Time Admitted HH:MM)(AM/PM) | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.period.start | dateTime | 0..1 |
Date Discharged (MM-DD-YYYY)(Time Discharged HH:MM)(AM/PM) | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.period.end | dateTime | 0..1 |
Part III - Reason for Admission |  |  |  |
1. History of Present Illness | Claim.supportingInfo.valueReference | Reference(PH_Condition) | 0..1 |
► | Condition.note | Annotation | 0..* |
2. Pertinent Past Medical History | Claim.supportingInfo.valueReference | Reference(PH_Condition) | 0..1 |
► | Condition.note | Annotation | 0..* |
2. OB/GYN History (G) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. OB/GYN History (G) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. OB/GYN History (P) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. OB/GYN History (P) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. OB/GYN History (P)(T) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. OB/GYN History (P)(T) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. OB/GYN History (P)(P) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. OB/GYN History (P)(P) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. OB/GYN History (P)(A) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. OB/GYN History (P)(A) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. OB/GYN History (P)(L) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. OB/GYN History (P)(L) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. OB/GYN History LMP (MM-DD-YYYY) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. OB/GYN History LMP (MM-DD-YYYY) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueDateTime | dateTime | 0..1 |
2. OB/GYN History (Checkbox NA) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.dataAbsentReason | CodeableConcept | 0..1 | If checked, expected value `not-applicable` or `not-performed`
3. Pertinent Signs and Symptoms on Admission (tick applicable boxes) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.code | CodeableConcept | 1..1 |
4. Referred from another health care institution (HCI) [Yes/No] | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.status | code | 1..1 |
4. if Yes, Specify Reason | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.reasonReference | Reference(PH_Observation) | 0..* |
► | Observation.valueString | string | 0..1 |
4. Name of Originating HCI | Claim.referral | Reference(PH_ServiceRequest) | 0..1 |
► | ServiceRequest.requester | Reference(PH_Organization) | 0..1 |
► | Organization.name | string | 0..1 |
5. Physical Examination on Admission (Pertinent Findings per System) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.code | CodeableConcept | 1..1 |
5. Height (cm) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. Height (cm) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueQuantity | Quantity | 0..1 |
5. Weight (kg) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. Weight (kg) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueQuantity | Quantity | 0..1 |
5. General Survey | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. General Survey (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueCodeableConcept | CodeableConcept | 0..1 |
5. Vital Signs (BP) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. Vital Signs (BP) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
5. Vital Signs (HR) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. Vital Signs (HR) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
5. Vital Signs (RR) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. Vital Signs (RR) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
5. Vital Signs (Temp) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. Vital Signs (Temp) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
5. HEENT | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. HEENT (Check notes for options) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueCodeableConcept | CodeableConcept | 0..1 | Options: 1. Essentially normal 2. Icteric sclerae 3. Abnormal pupillary reaction 4. Pale conjunctivae 5. Cervical lymphadenopathy 6. Sunken eyeballs 7. Dry mucous membrane 8. Sunken fontanelle 9. Others
5. CHEST/LUNGS | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. CHEST/LUNGS (Check notes for options) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueCodeableConcept | CodeableConcept | 0..1 | Options: 1. Essentially normal 2. Lump/s over breast(s) 3. Asymmetrical chest expansion 4. Rales/crackles/rhonchi 5. Decreased breath sounds 6. Intercostal rib/clavicular retraction 7. Wheezes 8. Others
5. CVS | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. CVS (Check notes for options) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueCodeableConcept | CodeableConcept | 0..1 | Options: 1. Essentially normal 2. Irregular rhythm 3. Displaced apex beat 4. Muffled heart sound 5. Heaves and/or thrills 6. Murmur 7. Pericardial bulge 8. Others
5. ABDOMEN | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. ABDOMEN (Check notes for options) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueCodeableConcept | CodeableConcept | 0..1 | Options: 1. Essentially normal 2. Palpable mass(es) 3. Abdominal rigidity 4. Tympanitic/dull abdomen 5. Abdomen tenderness 6. Uterine contraction 7. Hyperactive bowel sounds 8. Others
5. GU (IE) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. GU (IE) (Check notes for options) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueCodeableConcept | CodeableConcept | 0..1 | Options: 1. Essentially normal 2. Blood stained in exam finger 3. Cervical dilatation 4. Presence of abnormal discharge 5. Others
5. SKIN/EXTREMITIES | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. SKIN/EXTREMITIES (Check notes for options) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueCodeableConcept | CodeableConcept | 0..1 | Options: 1. Essentially normal 2. Edema/swelling 3. Rashes/petechiae 4. Clubbing 5. Decreased mobility 6. Weak pulses 7. Cold clammy skin 8. Pale nailbeds 9. Cyanosis/mottled skin 10. Poor skin tungor 11. Others
5. NEURO-EXAM | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
5. NEURO-EXAM (Check notes for options) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueCodeableConcept | CodeableConcept | 0..1 | Options: 1. Essentially normal 2. Abnormal reflex(es) 3. Abnormal gait 4. Poor/altered memory 5. Abnormal position sense 6. Poor muscle tone/strength 7. Abnormal/decreased sensation 8. Poor coordination 9. Others
IV. COURSE IN THE WARD |  |  |  |
Date (MM-DD-YYYY) | Claim.supportingInfo.valueReference | Reference(PH_ClinicalImpression) | 0..1 |
► | ClinicalImpression.effectiveDateTime | dateTime | 0..1 |
DOCTOR'S ORDER/ACTION | Claim.supportingInfo.valueReference | Reference(PH_ClinicalImpression) | 0..1 |
► | ClinicalImpression.description | string | 0..1 |
SURGICAL PROCEDURE / RVS CODE (Attach photocopy of OR technique) | Claim.procedure.procedureCodeableConcept | CodeableConcept | 0..1 |
V. DRUGS / MEDICINES |  |  |  |
Generic Name | Claim.item.productOrService | CodeableConcept | 1..1 |
Quantity | Claim.item.quantity | SimpleQuantity | 0..1 |
Dosage | Claim.prescription | Reference(PH_MedicationRequest) | 0..1 |
► | MedicationRequest.dosageInstruction.doseAndRate.dose[x] | Range / SimpleQuantity | 0..1 |
Route | Claim.prescription | Reference(PH_MedicationRequest) | 0..1 |
► | MedicationRequest.dosageInstruction.route | CodeableConcept | 0..1 |
Frequency | Claim.prescription | Reference(PH_MedicationRequest) | 0..1 |
► | MedicatioNRequest.dosageInstruction.timing | Timing | 0..1 |
Total Cost | Claim.item.net | Money | 0..1 |
Part VI - OUTCOME OF TREATMENT |  |  |  |
OUTCOME OF TREATMENT (Check notes for options) | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.hospitalization.dischargeDisposition | CodeableConcept | 0..1 |
Part VII - CERTIFICATION OF HEALTH CARE PROFESSIONAL |  |  |  |
Signature Type | Provenance.signature.type | Coding | 1..* |
Signature over Printed Name of Attending Health Care Professional | Provenance.signature.who | Reference(PH_Practitioner) | 0..1 |
► | Practitioner.name | HumanName | 0..1 |
Signature over Printed Name of Attending Health Care Professional | Provenance.signature.data | base64Binary | 0..1 |
Date Signed | Provenance.signature.when | instant | 1..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.insurance.coverage | Reference(PH_Coverage) | To be resolved |
Claim.item.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. |
<!– | Encounter.status | code |
Encounter.class | coding |  |
Observation.status | code |  |
Condition.subject | Reference(PH_Patient) |  |
ClinicalImpression.status | code |  |
ClinicalImpression.subject | Reference(PH_Patient) |  |
DiagnosticReport.status | code |  | –>