# Mapping of Konsulta Availment Slip to FHIR - NHDR Implementation Guide Release 1.0 v0.1.0

* [**Table of Contents**](toc.md)
* [**Konsulta Availment Slip Form**](K3.md)
* **Mapping of Konsulta Availment Slip to FHIR**

## Mapping of Konsulta Availment Slip to FHIR

**View
Form**

<iframe src="K3.pdf" width="700" height="900"></iframe>

### Mapped Fields

| | | | | |
| :--- | :--- | :--- | :--- | :--- |
| **To be filled out by the facility** |   |   |   |   |
| Consent Confirmation | Questionnaire.item.text | string | 0..1 |   |
| HCI Name | Claim.provider | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) | 1..1 |   |
| ► | Organization.name | string |   |   |
| Case Number | Claim.encounter | Reference([PH_Encounter](StructureDefinition-PH-Encounter.md)) | 0..* |   |
| ► | Encounter.identifier | identifier |   |   |
| HCI Accreditation Number | Claim.provider | Reference([PH_Organization](StructureDefinition-PH-Organization.md)) | 1..1 |   |
| ► | Organization.Identifier | identifier |   | DOH fhudcode |
| Transaction Number | Claim.identifier | identifier | 0..1 |   |
| PhilHealth Identification Number (PIN) | Claim.patient | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.identifier | identifier |   | PhilHealth ID |
| Membership Category | Claim.patient | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.MemberType | codeableConcept |   | ValueSet:[MemberType](ValueSet-MemberTypeVS.md) |
| Patient Name (Last Name) | Claim.patient | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.name.family | string |   |   |
| Patient Name (First Name) | Claim.patient | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.name.given | string |   |   |
| Patient Name (Name Extension) | Claim.patient | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.name.suffix | string |   |   |
| Patient Name (Middle Name) | Claim.patient | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.name.given | string |   |   |
| Age | Claim.encounter | Reference([PH_Encounter](StructureDefinition-PH-Encounter.md)) | 0..1 |   |
| ► | Encounter.ageYears | integer |   |   |
| Contact Number | Claim.patient | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.telecom.value | string |   |   |
| Membership Type | Claim.patient | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.type | codeableConcept |   | ValueSet:[PatientType](ValueSet-PatientTypeVS.md) |
| Authorization Transaction Code | Claim.encounter | Reference([PH_Encounter](StructureDefinition-PH-Encounter.md)) | 0..1 |   |
| ► | Encounter.appointment | Reference([PH_Appointment](StructureDefinition-PH-Appointment.md)) |   |   |
| ► | Appointment.identifier | identifier |   |   |
| Konsulta Services | Claim.item.productOrService | codeableConcept |   |   |
| Performed? [check - x] | Questionnaire.item.text | string | 0..1 |   |
| Date Performed | Claim.item.serviced[x] | date | 0..1 |   |
| Performed by (Last Name) | Claim.careTeam.provider | Reference([PH_Practitioner](StructureDefinition-PH_Practitioner.md)) | 1..1 |   |
| ► | Practitioner.name.family | string |   |   |
| Performed by (First Name) | Claim.careTeam.provider | Reference([PH_Practitioner](StructureDefinition-PH_Practitioner.md)) | 1..1 |   |
| ► | Practitioner.name.given | string |   |   |
| Performed by (Name Extension) | Claim.careTeam.provider | Reference([PH_Practitioner](StructureDefinition-PH_Practitioner.md)) | 1..1 |   |
| ► | Practitioner.name.suffix | string |   |   |
| Performed by (Middle Name) | Claim.careTeam.provider | Reference([PH_Practitioner](StructureDefinition-PH_Practitioner.md)) | 1..1 |   |
| ► | Practitioner.name.given | string |   |   |
| **To be filled out by the patient** |   |   |   |   |
| Have you received the above-mentioned essential service? [Y or N] | Questionnaire.item.text | string | 0..1 |   |
| How satisfied are you with the services provided? | Questionnaire.item.text | string | 0..1 |   |
| For your comment, suggestion or complaint | Questionnaire.item.text | string | 0..1 |   |
| PhilHealth Identification Number of Patient | Claim.patient | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.identifier | identifier |   | PhilHealth ID |
| **Patient Name**over Signature | Provenance.signature.who | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) | 1..1 |   |
| ► | Patient.name | HumanName |   |   |
| Patient Name over**Signature** | Provenance.signature.data | base64Binary | 0..1 |   |
| Thumbmark Print | Provenance.signature.data | base64Binary | 0..1 |   |

### Mandatory Elements Not in the Form

| | | |
| :--- | :--- | :--- |
| Claim.status | code |   |
| Claim.type | CodeableConcept |   |
| Claim.use | code |   |
| Claim.created | dateTime |   |
| Claim.priority | CodeableConcept |   |
| Claim.careTeam.sequence | positiveInt |   |
| Claim.insurance |   |   |
| Claim.insurance.sequence | positiveInt |   |
| Claim.insurance.focal | boolean |   |
| Claim.insurance.coverage | Reference([PH_Coverage](StructureDefinition-PH_Coverage.md)) |   |
| Claim.item.sequence | positiveInt |   |
| Provenance.signature.type | coding |   |
| Provenance.target | Reference(Any) |   |
| Provenance.recorded | instant |   |
| Provenance.agent |   |   |
| Provenance.agent.who | Reference([PH_Organization](StructureDefinition-PH_Organization.md)) |   |
| Organization.name | string |   |
| Provenance.signature.when | instant |   |
| Questionnaire.status | code |   |
| Questionnaire.item.linkId | string |   |
| Questionnaire.item.type | code |   |
| Encounter.status | code |   |
| Encounter.class | coding |   |
| Appointment.status | code |   |
| Appointment.participant.status | code |   |
| Coverage.status | code |   |
| Coverage.beneficiary | Reference([PH_Patient](StructureDefinition-PH_Patient.md)) |   |
| Coverage.payor | Reference([PH_RelatedPerson](StructureDefinition-PH_RelatedPerson.md)) |   |
| Coverage.costToBeneficiary.value[x] | SimpleQuantity, Money |   |

