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 Konsulta Request for Authorization Transaction Code Form to FHIR

View
Form

### Mapped Fields

Form Field | Use-Case Mapping / Target Element | Data Type | Cardinality | Notes
--- | --- | --- | --- | ---
To be filled out by Beneficiary |  |  |  |
Date of Appointment | Appointment.created | dateTime | 0..1 |
Membership Type | Appointment.participant.actor | Reference(PH_Patient) | 0..1 |
► | Patient.type | codeableConcept |  | ValueSet: PatientType
PhilHealth Identification Number (PIN) | Appointment.participant.actor | Reference(PH_Patient) | 0..1 |
► | Patient.identifier | Identifier |  | PhilHealth ID
Date of Birth (MM-DD-YYYY) | Appointment.participant.actor | Reference(PH_Patient) | 0..1 |
► | Patient.birthDate | date |  |
Name (Last Name) | Appointment.participant.actor | Reference(PH_Patient) | 0..1 |
► | Patient.name.family | string |  |
Name (First Name) | Appointment.participant.actor | Reference(PH_Patient) | 0..1 |
► | Patient.name.given | string |  |
Name (Middle Name) | Appointment.participant.actor | Reference(PH_Patient) | 0..1 |
► | Patient.name.given | string |  |
Address (BRGY/Town) | Appointment.participant.actor | Reference(PH_Patient) | 0..1 |
► | Patient.address.barangay | coding |  | ValueSet: BarangayCodes
Address (City/Municipality) | Appointment.participant.actor | Reference(PH_Patient) | 0..1 |
► | Patient.address.cityMunicipality | coding |  | ValueSet: CityCodes
Address (Province) | Appointment.participant.actor | Reference(PH_Patient) | 0..1 |
► | Patient.address.province | coding |  | ValueSet: ProvinceCodes
Signature Over Printed Name | Provenance.signature.data | base64Binary | 0..1 |
Signature Over Printed Name | Provenance.signature.who | Reference(PH_Patient) | 1..1 |
► | Patient.name | HumanName |  |
To be filled out by Philhealth Konsulta Personnel |  |  |  |
ATC | Appointment.identifier | identifier | 0..* | Then referenced in a later claim
Signature Over Printed Name of Authored PhilHealth Personnel | Provenance.signature.data | base64Binary | 0..1 |
Signature Over Printed Name of Authored PhilHealth Personnel | Provenance.signature.who | Reference(PH_Organization) | 1..1 |
► | Organization.contact.name | HumanName |  |

### Mandatory Elements Not in the Form

Use-Case Mapping / Target Element | Data Type | Notes
--- | --- | ---
Appointment.status | code |
Appointment.participant.status | code |
Provenance.target | Reference(Any) |
Provenance.recorded | instant |
Provenance.signature.type | coding |
Provenance.agent.who | Reference(PH_Organization) |
Organization.name | string |
Provenance.signature.when | instant |