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 3 to FHIR

View
Form

### Mapped Fields

Form Field | Use-Case Mapping / Target Element | Data Type | Cardinality | ValueSet (if any)
--- | --- | --- | --- | ---
Part I - Patient's Clinical Record |  |  |  |
PhilHealth Accreditation No. (PAN) - Institutional Health Care Provider | Claim.provider | Reference(PH_Organization) | 1..1 |
► | Organization.identifier | Identifier |  |
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`
Chief Complaint / Reason for Admission | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.reasonReference | Reference(PH_Observation) | 0..* |
► | Observation.valueString | string | 0..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 Discharge HH:MM)(AM/PM) | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.period.end | dateTime | 0..1 |
Brief History of Present Illness / OB History | Claim.diagnosis.diagnosisReference | Reference(PH_Condition) | 1..1 |
► | Condition.note | Annotation | 0..* |
General Survey | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Vital Signs (BP) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Vital Signs (CR) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Vital Signs (RR) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Vital Signs (Temperature) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Abdomen | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
HEENT | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
GU (IE) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Chest / Lungs | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Skin / Extremities | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
CVS | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Neuro Examination | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Course in the Wards (attach additional sheets if necessary) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | ClinicalImpression.description | string | 0..1 |
Pertinent Laboratory and Diagnostic Findings: (CBC, Urinalysis, Fecalysis, X-ray, Biopsy, etc.) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.code | CodeableConcept | 0..1 |
Pertinent Laboratory and Diagnostic Findings: (CBC, Urinalysis, Fecalysis, X-ray, Biopsy, etc.) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueString | string | 0..1 |
Pertinent Laboratory and Diagnostic Findings: (CBC Urinalysis, Fecalysis, X-ray, Biopsy, etc.) | Claim.supportingInfo.valueReference | Reference(PH_DiagnosticReport) | 0..1 |
► | DiagnosticReport.conclusion | string |  |
Disposition on Discharge (Check notes for options) | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.hospitalization.dischargeDisposition | CodeableConcept | 0..1 |
Part II - Maternity Care Package |  |  |  |
1. Initial Prenatal Consultation (MM-DD-YYYY) | Claim.item.servicedDate | date | 0..1 |
2. Clinical History and Physical Examination: a. Vital signs are normal | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.interpretation | CodeableConcept | 0..* |
2. Clinical History and Physical Examination: b. Ascertain the present Pregnancy is low-Risk | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueBoolean | boolean | 0..1 |
2. Clinical History and Physical Examination: c. Menstrual History LMP (MM-DD-YYYY) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. Clinical History and Physical Examination: c. Menstrual History LMP (MM-DD-YYYY) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueDateTime | dateTime | 0..1 |
2. Clinical History and Physical Examination: d. Menstrual History (Age of Menarche) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. Clinical History and Physical Examination: d. Menstrual History (Age of Menarche) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. Obstetric History (G) | ClaimsupportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. Obstetric History (G) (value) | ClaimsupportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. Obstetric History (P) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. Obstetric History (P) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. Obstetric History (P)[T] | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. Obstetric History (P)[T] (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. Obstetric History (P)[P] | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. Obstetric History (P)[P] (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. Obstetric History (P)[A] | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. Obstetric History (P)[A] (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
2. Obstetric History (P)[L] | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
2. Obstetric History (P)[L] (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueInteger | integer | 0..1 |
3. Obstetric risk factors (Check notes for options) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.code | CodeableConcept | 1..1 |
4. Medical / Surgical risk factors (Check notes for options) | Claim.diagnosis.diagnosisCodeableConcept | CodeableConcept | 1..1 |
5. Admitting Diagnosis | Claim.diagnosis.diagnosisReference | Reference(PH_Condition) | 1..1 |
6. Orientation to MCP / Availment of Benefits (Yes / No) | Questionnaire.item.text | string | 0..1 |
6. Expected date of delivery (MM-DD-YYYY) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.effectiveDateTime | dateTime | 0..1 |
7a. Prenatal Consultation No. | Claim.item.sequence | positiveInt | 1..1 |
7b. Date of visit (MM-DD-YYYY) | Claim.item.servicedDate | date | 0..1 |
7c. AOG in weeks | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valueInteger | integer | 0..1 |
7d. Weight and Vital Signs | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.valcodeueInteger | CodeableConcept | 1..1 |
7d.1 Weight | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
7d.1 Weight (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueQuantity | Quantity | 0..1 |
7d.2 Cardiac Rate | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
7d.2 Cardiac Rate (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
7d.3 Respiratory Rate | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
7d.3 Respiratory Rate (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
7d.4 Blood Pressure | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
7d.4 Blood Pressure (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
7d.5 Temperature | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
7d.5 Temperature (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueQuantity | Quantity | 0..1 |
Part II - Maternity Care Package (Delivery Outcome) |  |  |  |
8. Date of Delivery (MM-DD-YYYY)(AM/PM)[HH:MM] | Claim.item.servicedDate | date | 0..1 |
9. Maternal Outcome (Obstetric Index) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
9. Maternal Outcome (Obstetric Index) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
9. Pregnancy Uterine (AOG by LMP) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
9. Pregnancy Uterine (AOG by LMP) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
9. Pregnancy Uterine (Manner of Delivery) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
9. Pregnancy Uterine (Manner of Delivery) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
9. Pregnancy Uterine (Presentation) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
9. Pregnancy Uterine (Presentation) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
10. Birth Outcome | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.code | CodeableConcept | 1..1 |
10. Birth Outcome (Fetal Outcome) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
10. Birth Outcome (Fetal Outcome) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
10. Birth Outcome (Sex) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
10. Birth Outcome (Sex) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
10. Birth Outcome (Birth Weight (grm)) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
10. Birth Outcome (Birth Weight (grm)) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
10. Birth Outcome (APGAR Score) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.code | CodeableConcept | 1..1 |
10. Birth Outcome (APGAR Score) (value) | Claim.supportingInfo.valueReference | Reference(PH_Observation) | 0..1 |
► | Observation.component.valueString | string | 0..1 |
11. Scheduled Postpartum follow-up consultation 1 week after delivery | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.period.start | dateTime |  |
12. Date of Discharge | Claim.extension:encounter | Reference(PH_Encounter) |  |
► | Encounter.period.end | dateTime |  |
Part II - Maternity Care Package (Postpartum Care) |  |  |  |
13. Perineal wound care (checkbox) | Questionnaire.item.text | string | 0..1 |
13. Perineal wound care (Remarks) | Questionnaire.item.text | string | 0..1 |
14. Signs of Maternal Postpartum Complications (checkbox) | Questionnaire.item.text | string | 0..1 |
14. Signs of Maternal Postpartum Complications (Remarks) | Questionnaire.item.text | string | 0..1 |
15a. Counselling and Education (Breastfeeding and Nutrition) (checkbox) | Questionnaire.item.text | string | 0..1 |
15a. Counselling and Education (Breastfeeding and Nutrition) (Remarks) | Questionnaire.item.text | string | 0..1 |
15b. Counselling and Education (Family Planning) (checkbox) | Questionnaire.item.text | string | 0..1 |
15b. Counselling and Education (Family Planning) (Remarks) | Questionnaire.item.text | string | 0..1 |
16. Provided family planning service to patient (as requested by patient) (checkbox) | Questionnaire.item.text | string | 0..1 |
16. Provided family planning service to patient (as requested by patient) (Remarks) | Questionnaire.item.text | string | 0..1 |
17. Referred to partner physician for Voluntary Surgical Sterilization (as requested by pt.) (checkbox) | Questionnaire.item.text | string | 0..1 |
17. Refereed to partner physician for Voluntary Surgical Sterilization (as requested by pt.) (Remarks) | Questionnaire.item.text | string | 0..1 |
18. Schedule the next postpartum follow-up (checkbox) | Questionnaire.item.text | string | 0..1 |
18. Schedule the next postpartum follow-up (Remarks) | Questionnaire.item.text | string | 0..1 |
19. Signature Type | Provenance.signature.type | 1..* | Coding |
19. Signature Over Printed Name of Attending Physician / Midwife | Provenance.signature.who | Reference(PH_Practitioner) | 1..1 |
► | Practitioner.name | HumanName |  |
19. Signature Over Printed Name of Attending Physician / Midwife | Provenance.signature.data | base64Binary | 0..1 |
19. 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.