臺灣健保事前審查實作指引
1.1.0 - ci-build
臺灣健保事前審查實作指引
1.1.0 - ci-build
臺灣健保事前審查實作指引, published by 衛生福利部中央健康保險署. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/TWNHIFHIR/pas/ and changes regularly. See the Directory of published versions
Bundle bun-imm of type collection
Entry 1 - fullUrl = https://nhicore.nhi.gov.tw/pas/Claim/cla-imm
Resource Claim:
ClaimEncounter: Encounter: status = planned; class = ambulatory (ActCode#AMB); serviceType = 胸腔暨重症加護
status: Active
type: Institutional
subType: 送核
use: Preauthorization
patient: 王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))
created: 2024-05-30
provider: Organization 臺北市立聯合醫院
priority: 一般事前審查申請
supportingInfo
sequence: 1
category: 病人體重
value: 59.65 kg (Details: UCUM codekg = 'kg')
supportingInfo
sequence: 2
category: 病人身高
value: 170 cm (Details: UCUM codecm = 'cm')
supportingInfo
sequence: 3
category: 病人血型
supportingInfo
sequence: 4
category: 影像報告
supportingInfo
sequence: 6
category: 檢查報告
supportingInfo
sequence: 8
category: 檢驗(查)
value: Observation Platelets [#/volume] in Blood by Automated count
supportingInfo
sequence: 9
category: 檢驗(查)
supportingInfo
sequence: 10
category: 病人狀態評估
supportingInfo
sequence: 11
category: 用藥品項
supportingInfo
sequence: 12
category: 放射/照光治療
value: Procedure 骨髓高溫療法
supportingInfo
sequence: 13
category: 治療計畫文件
value: DocumentReference: status = current; category = 治療計畫文件
supportingInfo
sequence: 14
category: 病歷資料
supportingInfo
sequence: 15
category: 結果資訊
value: Observation International Working Group(IWG) Consensus Criteria
supportingInfo
sequence: 16
category: 門診病歷
supportingInfo
sequence: 17
category: 診斷
value: Condition 右側膝部原發性骨關節炎，單側性
supportingInfo
sequence: 18
category: 過敏史
value: AllergyIntolerance
supportingInfo
sequence: 19
category: 主觀描述
supportingInfo
sequence: 20
category: 客觀描述
supportingInfo
sequence: 21
category: 評估
value: ClinicalImpression: status = completed; summary = Right knee . arthritis . active
supportingInfo
sequence: 22
category: 計畫
Diagnoses
Extension Sequence Diagnosis[x] Type 1 慢性右心臟衰竭 Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI Procedures
Sequence Date Procedure[x] 1 2024-01-01 經自然開口或人工造口心包腔液態近接放射性同位素抗腫瘤藥劑輸入 Insurances
Sequence Focal Coverage 1 true Coverage: status = active item
RequestedService: MedicationRequest: status = on-hold; intent = plan; medication[x] = Alunbrig film-coated tablets 30mg
sequence: 1
productOrService: 藥品
modifier: 初次使用, 第一線治療
programCode: ALK陽性的晚期非小細胞肺癌第一線治療
quantity: 52 {tbl} (Details: UCUM code{tbl} = '{tbl}')
item
RequestedService: MedicationRequest: status = on-hold; intent = plan; medication[x] = Herzuma Inj. 440mg, Lyophilized powder for injection
sequence: 2
productOrService: 藥品
modifier: 初次使用, 第一線治療
programCode: 早期乳癌-未發生腋下淋巴結轉移
quantity: 70 {tbl} (Details: UCUM code{tbl} = '{tbl}')
Entry 2 - fullUrl = https://nhicore.nhi.gov.tw/pas/Encounter/enc-opd
Resource Encounter:
Profile: 門診病歷-Encounter OPD TWPAS
status: completed
class: ambulatory
serviceType: No display for Encounter.serviceType (concept: Family practice (qualifier value))
serviceProvider: Organization 臺北市立聯合醫院
participant
Entry 3 - fullUrl = https://nhicore.nhi.gov.tw/pas/Encounter/enc-min
Resource Encounter:
Profile: 就醫科別-Encounter TWPAS
就醫現況：Planned (EncounterStatus#planned)
就醫分類：ambulatory (ActEncounterCode CT#AMB)
就醫科別：胸腔暨重症加護 (臺灣健保署就醫科別#AJ)
Entry 4 - fullUrl = https://nhicore.nhi.gov.tw/pas/Patient/pat-min
Resource Patient:
Profile: 病人資訊-Patient TWPAS
識別碼型別：National Person Identifier （ Identifier Type Codes#NNxxx）
身分證字號（official）：A123456789 （http://www.moi.gov.tw）識別碼型別：Medical record number （ Identifier Type Codes#MR）
病歷號（official）：123456 （https://tpech.gov.taipei）姓名（usual）：王大明
性別：男
出生日期：2001-01-01
Entry 5 - fullUrl = https://nhicore.nhi.gov.tw/pas/Practitioner/pra-min
Resource Practitioner:
Profile: 醫事人員-Practitioner TWPAS
識別碼型別：National Person Identifier （ Identifier Type Codes#NNxxx）
身分證字號（official）：F123456789 （http://www.moi.gov.tw）
識別碼型別：Medical License number （ Identifier Type Codes#MD）
醫師證號：KP00017 （https://dep.mohw.gov.tw/DOMA）
Entry 6 - fullUrl = https://nhicore.nhi.gov.tw/pas/Organization/org-hosp-example
Resource Organization:
醫事機構
Profile: 機構-Organization TWPAS
機構名稱：臺北市立聯合醫院
識別碼型別：Provider number（ IdentifierType#PRN）
機構代碼（official）：0101090517 (https://nhicore.nhi.gov.tw/pas/CodeSystem/organization-identifier-tw)機構種類：Healthcare Provider ( OrganizationType#prov)
Entry 7 - fullUrl = https://nhicore.nhi.gov.tw/pas/Condition/con-diagnosis
Resource Condition:
Profile: 診斷-Condition TWPAS
clinicalStatus: Active
category: Diagnosis Narrative
code: 右側膝部原發性骨關節炎，單側性
subject: 王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))
Entry 8 - fullUrl = https://nhicore.nhi.gov.tw/pas/Observation/obs-blood-group
Resource Observation:
Profile: 血型-Observation Blood Group TWPAS
status: Final
category: 病人血型
code: ABO and Rh group [Type] in Blood
subject: 王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))
effective: 2024-05-07
value: Blood group A
Entry 9 - fullUrl = https://nhicore.nhi.gov.tw/pas/AllergyIntolerance/all-min
Resource AllergyIntolerance:
Profile: 過敏史-AllergyIntolerance TWPAS
clinicalStatus: Active
code: 對 A 藥物過敏，過敏反應為全身性皮疹、呼吸喘，約在服用後15分鐘發生。曾於2023年5月因感冒服用過 A 藥，出現上述過敏反應，故此後避免使用。
patient: 王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))
Entry 10 - fullUrl = https://nhicore.nhi.gov.tw/pas/Observation/obs-subjective
Resource Observation:
Profile: 主觀描述-Observation Subjective TWPAS
status: Final
category: Survey
code: Subjective Narrative
subject: 王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))
effective: 2025-11-11
value: Pain and tenderness of Right knee since yesterday.
Entry 11 - fullUrl = https://nhicore.nhi.gov.tw/pas/Observation/obs-objective
Resource Observation:
Profile: 客觀描述-Observation Objective TWPAS
status: Final
category: Survey
code: Objective Narrative
subject: 王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))
effective: 2025-11-11
value: BP 110/70 mmHg PR 80/min BT 38.50C
Entry 12 - fullUrl = https://nhicore.nhi.gov.tw/pas/ClinicalImpression/cliImp-min
Resource ClinicalImpression:
Profile: 評估-ClinicalImpression TWPAS
status: Completed
subject: 王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))
summary: Right knee . arthritis . active
Entry 13 - fullUrl = https://nhicore.nhi.gov.tw/pas/CarePlan/careplan-min
Resource CarePlan:
Profile: 計畫-CarePlan TWPAS
status: Completed
intent: Plan
category: Assessment and Plan of Treatment
description: 1.Arrenge Arthrocentesis of Right knee and synovial fluid analysis (routine, culture and crystal analysis) after patient consent. 2.Analgesics. 3.Bed rest with ice packing if necessary.
subject: 王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))
Entry 14 - fullUrl = https://nhicore.nhi.gov.tw/pas/DiagnosticReport/diaRep-ima-min
Resource DiagnosticReport:
Profile: 影像報告-DiagnosticReport Image TWPAS
狀態：final
病人：Patient/pat-min "王大明"
影像報告：左上肢動脈血管內超音波 (臺灣健保署2023年中文版ICD-10-PCS值集#B34JZZ3)
影像報告日期：2024-05-07
簽發影像報告醫師：Practitioner/pra-min
影像檢查的身體部位／DICOM影像：ImagingStudy/imaStu-min
影像報告結果：影像報告結果
影像報告名稱：影像報告01
影像報告：file://ImagingDiagnosticReport01.pdf
影像報告名稱：影像報告02
影像報告：file://ImagingDiagnosticReport02.pdf
Entry 15 - fullUrl = https://nhicore.nhi.gov.tw/pas/ImagingStudy/imaStu-min
Resource ImagingStudy:
Profile：DICOM影像-ImagingStudy TWPAS
狀態：registered
病人：Patient/pat-min "王大明"
Study UID：urn:oid:2.16.886.2102.54.4546465747.465465465
Series Instance UID：2.16.886.2102.54.4546465747.465465466
SOP Instance UIDs：2.25.88017001449189502323411118737039844241, 2.25.88017001449189502323411118737039844242
影像檢查的身體部位：Head and neck structure (SNOMED CT#774007)
儀器：CT Image Storage (DICOM#CT)
Entry 16 - fullUrl = https://nhicore.nhi.gov.tw/pas/Media/med-min
Resource DocumentReference:
Profile: 非DICOM影像-Media TWPAS
狀態：completed
病人：Patient/pat-min "王大明"
影像檢查的身體部位：Head and neck structure (SNOMED CT#774007)
非DICOM影像：file://US01.jpg（#image/jpeg）
Entry 17 - fullUrl = https://nhicore.nhi.gov.tw/pas/DiagnosticReport/diaRep-min
Resource DiagnosticReport:
Profile: 檢查報告-DiagnosticReport TWPAS
狀態：final
報告類型：Prostate Pathology biopsy report (EncounterStatus#66117-3)
檢體種類：Prostate
病人：Patient/pat-min "王大明"
報告日期：2024-05-07
檢查報告醫師：Practitioner/pra-min
報告結果-文數字：細胞檢查報告結果
檢查報告名稱：PathologyReport01
檢查報告：file://PathologyReport01.pdf
檢查報告名稱：PathologyReport02
檢查報告：file://PathologyReport02.pdf
Entry 18 - fullUrl = https://nhicore.nhi.gov.tw/pas/Observation/obs-lab-min
Resource Observation:
狀態：final
類型：檢驗(查) (NHI-補充資訊類別值集#tests)
檢驗(查)名稱：Platelets [#/volume] in Blood by Automated count (LOINCCodes#777-3)
檢驗(查)報告日期：2024-01-01
簽發檢驗(查)報告醫事人員身分證號：Practitioner/pra-min
檢驗(查)結果：5.1 mmol/l
檢驗(查)結果判讀：高，High (ObservationInterpretationCodes #H)
檢驗(查)結果之參考範圍下限：2.9 mmol/L
檢驗(查)結果之參考範圍上限：4.9 mmol/L
檢驗(查)附件：DocumentReference/doc-test-min
Entry 19 - fullUrl = https://nhicore.nhi.gov.tw/pas/Observation/obs-lab-cbc
Resource Observation:
狀態：final
類型：檢驗(查) (NHI-補充資訊類別值集#tests)
套組代碼：CBC panel - Blood by Automated count (LOINCCodes#58410-2)
檢驗(查)報告日期：2024-01-01
簽發檢驗(查)報告醫事人員身分證號：Practitioner/pra-min
檢驗(查)附件：DocumentReference/doc-test-min
檢驗(查)名稱：Leukocytes [#/volume] in Blood by Automated count (LOINCCodes#6690-2)
檢驗(查)結果：3.6 × 10^3/μL
檢驗(查)結果之參考範圍下限：3.9 × 10^3/μL
檢驗(查)結果之參考範圍上限：10.6 × 10^3/μL檢驗(查)名稱：Erythrocytes [#/volume] in Blood by Automated count (LOINCCodes#789-8)
檢驗(查)結果：4.7 × 10^6/μL
檢驗(查)結果之參考範圍下限：4.5 × 10^3/μL
檢驗(查)結果之參考範圍上限：5.9 × 10^3/μL檢驗(查)名稱：Hemoglobin [Mass/volume] in Blood (LOINCCodes#718-7)
檢驗(查)結果：14 g/dL
檢驗(查)結果之參考範圍下限：13.5 g/dL
檢驗(查)結果之參考範圍上限：17.5 g/dL檢驗(查)名稱：Hematocrit [Volume Fraction] of Blood by Automated count (LOINCCodes#4544-3)
檢驗(查)結果：45 %
檢驗(查)結果之參考範圍下限：41 %
檢驗(查)結果之參考範圍上限：53 %檢驗(查)名稱：Platelets [#/volume] in Blood by Automated count (LOINCCodes#777-3)
檢驗(查)結果：101 × 10^3/μL
檢驗(查)結果之參考範圍下限：150 × 10^3/μL
檢驗(查)結果之參考範圍上限：400 × 10^3/μL
Entry 20 - fullUrl = https://nhicore.nhi.gov.tw/pas/DocumentReference/doc-test-min
Resource DocumentReference:
Profile: 文件參照-DocumentReference TWPAS
狀態：current
報告類型：檢驗(查)附件 (NHI-文件類型#test)
病人：Patient/pat-min "王大明"
檢驗(查)附件 (application/pdf)：file://TestReport01.pdf
檢驗(查)附件名稱：TestReport01
檢驗(查)附件 (application/pdf)：file://TestReport02.pdf
檢驗(查)附件名稱：TestReport02
Entry 21 - fullUrl = https://nhicore.nhi.gov.tw/pas/Observation/obs-pat-nyha
Resource Observation:
狀態：final
病人狀態評估項目代碼：Functional capacity NYHA (LOINC + SCT + NHI-健保事前審查-病人狀態評估項目值集 #88020-3)
病人狀態評估日期：2024-01-01
評估項目醫事人員身分證號：Practitioner/pra-min
病人狀態評估結果：class1
Entry 22 - fullUrl = https://nhicore.nhi.gov.tw/pas/MedicationRequest/medReq-treat
Resource MedicationRequest:
藥物使用狀態：completed
藥物處方終止原因：Try another treatment first (MedicationRequest Status Reason Codes#altchoice)
意圖：Order ( medicationRequest Intent#order)
自費註記：健保 (NHI-藥物類型#nhi)
藥品代碼：ANTI-CUGH SYRUP 60ML (NHI-健保事前審查-用藥品項值集#A000755151)
病人：Patient/pat-min ""
藥品使用頻率及服用時間：1W3D
藥物每次處方劑量(單位)：4 (tablets (Common UCUM units#{tbl}))
藥物處方起始日期：2024-05-01
藥物處方終止日期：2024-05-07
給藥途徑／作用部位：Oral use (SNOMED CT + 臺灣健保署給藥途徑值集#26643006)
Entry 23 - fullUrl = https://nhicore.nhi.gov.tw/pas/Procedure/pro-min
Resource Procedure:
Profile: 放射/照光治療-Procedure TWPAS
放射/照光治療狀態：completed
放射/照光治療項目：骨髓高溫療法 (臺灣2023年中文版ICD-10-PCS#D7Y08ZZ)
病人：Patient/pat-min "王大明"
放射/照光治療日期：2024-05-06 09:00:00+0000
放射/照光治療總劑量：Substance/sub-min 5000 mg
Entry 24 - fullUrl = https://nhicore.nhi.gov.tw/pas/Substance/sub-min
Resource Substance:
Profile: 放射/照光治療總劑量-Substance TWPAS
放射/照光治療項目：骨髓高溫療法 (臺灣2023年中文版ICD-10-PCS#D7Y08ZZ)
放射/照光治療總劑量(單位)：5000 (/mg)
Entry 25 - fullUrl = https://nhicore.nhi.gov.tw/pas/DocumentReference/doc-careplan-min
Resource DocumentReference:
Profile: 文件參照-DocumentReference TWPAS
狀態：current
報告類型：治療計畫文件 (NHI-文件類型#careplan)
病人：Patient/pat-min "王大明"
治療計畫文件名稱：免疫檢查點抑制劑治療計畫
治療計畫文件 (application/pdf)：file://CarePlanReport01.pdf
Entry 26 - fullUrl = https://nhicore.nhi.gov.tw/pas/Observation/obs-tx-min
Resource Observation:
狀態：final
治療後疾病狀態評估項目：International Working Group(IWG) Consensus Criteria (NHI-治療後疾病狀態評估項目值集#IWGC)
治療後疾病狀態評估日期：2024-01-01
治療後疾病狀態評估結果：Partial remission (PR)
Entry 27 - fullUrl = https://nhicore.nhi.gov.tw/pas/MedicationRequest/medReq-apply
Resource MedicationRequest:
Profile: 事前審查品項-MedicationRequest Apply TWPAS
狀態：On Hold
目的：Plan
事前審查品項代碼：Alunbrig film-coated tablets 30mgL (NHI-健保事前審查-用藥品項值集#BC27730100)
病人：Patient/pat-min "王大明"
事前審查藥物預定處方起始日期：2024-01-01
事前審查藥物預定處方終止日期：2024-02-11
事前審查藥品使用頻率及服用時間：Every day at institution specified times.、飯前1小時使用 (HL7 TimingAbbreviation + 臺灣健保署藥品使用頻率值集#BIW、#AC1H)
事前審查藥品每次處方劑量：75 mg/m2
事前審查藥品療程／週期數：42
給藥途徑／作用部位：Oral use (SNOMED CT + 臺灣健保署給藥途徑值集#26643006)
事前審查藥物預定處方起始日期：2024-02-12
事前審查藥物預定處方終止日期：2024-03-10
事前審查藥品使用頻率及服用時間：每4週的第1天、每4週的第2天、每4週的第3天、每4週的第4天、每4週的第5天、飯前1小時使用 (HL7 TimingAbbreviation + 臺灣健保署藥品使用頻率值集#Q4WD1、#Q4WD2、#Q4WD3、#Q4WD4、#Q4WD5、#AC1H)
事前審查藥品每次處方劑量：150 mg/m2
事前審查藥品療程／週期數：1
給藥途徑／作用部位：Oral use (SNOMED CT + 臺灣健保署給藥途徑值集#26643006)
Entry 28 - fullUrl = https://nhicore.nhi.gov.tw/pas/MedicationRequest/medReq-apply-2
Resource MedicationRequest:
Profile: 事前審查品項-MedicationRequest Apply TWPAS
狀態：On Hold
目的：Plan
事前審查品項代碼：Herzuma Inj. 440mg (NHI-健保事前審查-用藥品項值集#KC011162B5)
病人：Patient/pat-min "王大明"
事前審查藥物預定處方起始日期：2024-03-11
事前審查藥物預定處方終止日期：2024-07-28
事前審查藥品使用頻率及服用時間：每4週的第1天、每4週的第2天、每4週的第3天、每4週的第4天、每4週的第5天、飯前1小時使用 (HL7 TimingAbbreviation + 臺灣健保署藥品使用頻率值集#Q4WD1、#Q4WD2、#Q4WD3、#Q4WD4、#Q4WD5、#AC1H)
事前審查藥品每次處方劑量：200 mg/m2
事前審查藥品療程／週期數：1
給藥途徑／作用部位：Oral use (SNOMED CT + 臺灣健保署給藥途徑值集#26643006)
Entry 29 - fullUrl = https://nhicore.nhi.gov.tw/pas/Coverage/cov-min
Resource Coverage:
Profile：健保事前審查計畫-Coverage TWPAS
狀態：active
受益人：Patient/pat-min "王大明"
保險人：Organization/org-nhi "衛生福利部中央健康保險署"
Entry 30 - fullUrl = https://nhicore.nhi.gov.tw/pas/Organization/org-nhi
Resource Organization:
機構名稱：衛生福利部中央健康保險署
識別碼型別：Government Organization Identifier（ 臺灣識別碼類型值集#GOI）
機關代號（official）：A21030000I (https://oid.nat.gov.tw/)機構種類：Government ( OrganizationType#govt)
Entry 31 - fullUrl = https://nhicore.nhi.gov.tw/pas/DocumentReference/doc-medicalRecord-min
Resource DocumentReference:
Profile: 文件參照-DocumentReference TWPAS
狀態：current
報告類型：病歷資料 (NHI-文件類型#medrec)
病人：Patient/pat-min "王大明"
病歷資料 (application/pdf)：file://王大明病歷.pdf
病歷資料名稱：王大明病歷
Entry 32 - fullUrl = https://nhicore.nhi.gov.tw/pas/DocumentReference/doc-patientAssessment-min
Resource DocumentReference:
Profile: 文件參照-DocumentReference TWPAS
狀態：current
報告類型：病人狀態評估報告 (NHI-文件類型#patientAssessment)
病人：Patient/pat-min "王大明"
病人狀態評估報告 (application/pdf)：file://病人狀態評估報告.pdf
病人狀態評估報告名稱：病人狀態評估報告名稱