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
{
"resourceType" : "Claim",
"id" : "cla-imm",
"meta" : {
"profile" : [
🔗 "https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-immunologic-agent-twpas"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim cla-imm</b></p><a name=\"cla-imm\"> </a><a name=\"hccla-imm\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Claim-immunologic-agent-twpas.html\">免疫製劑事前審查-Claim Immunologic Aagent TWPAS</a></p></div><p><b>ClaimEncounter</b>: <a href=\"Encounter-enc-min.html\">Encounter: status = planned; class = ambulatory (ActCode#AMB); serviceType = 胸腔暨重症加護</a></p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>subType</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-type 1}\">送核</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-pat-min.html\">王大明 Male, DoB: 2001-01-01 ( Medical record number\u00a0(use:\u00a0official,\u00a0))</a></p><p><b>created</b>: 2024-05-30</p><p><b>enterer</b>: <a href=\"Practitioner-pra-min.html\">Practitioner: identifier = National Person Identifier where the xxx is the ISO table 3166 3-character (alphabetic) country code,Medical License number</a></p><p><b>provider</b>: <a href=\"Organization-org-hosp-example.html\">Organization 臺北市立聯合醫院</a></p><p><b>priority</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-tmhb-type 1}\">一般事前審查申請</span></p><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type weight}\">病人體重</span></p><p><b>value</b>: 59.65 kg<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM codekg = 'kg')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type height}\">病人身高</span></p><p><b>value</b>: 170 cm<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM codecm = 'cm')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type bloodgroup}\">病人血型</span></p><p><b>value</b>: <a href=\"Observation-obs-blood-group.html\">Observation ABO and Rh group [Type] in Blood</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 4</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type imagingReport}\">影像報告</span></p><p><b>value</b>: <a href=\"DiagnosticReport-diaRep-ima-min.html\">Diagnostic Report for '左上肢動脈血管內超音波' for '->王大明 Male, DoB: 2001-01-01 ( Medical record number\u00a0(use:\u00a0official,\u00a0))'</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 6</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type examinationReport}\">檢查報告</span></p><p><b>value</b>: <a href=\"DiagnosticReport-diaRep-min.html\">Diagnostic Report for 'Prostate Pathology biopsy report' for '->王大明 Male, DoB: 2001-01-01 ( Medical record number\u00a0(use:\u00a0official,\u00a0))'</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 8</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type tests}\">檢驗(查)</span></p><p><b>value</b>: <a href=\"Observation-obs-lab-min.html\">Observation Platelets [#/volume] in Blood by Automated count</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 9</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type tests}\">檢驗(查)</span></p><p><b>value</b>: <a href=\"Observation-obs-lab-cbc.html\">Observation CBC panel - Blood by Automated count</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 10</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type patientAssessment}\">病人狀態評估</span></p><p><b>value</b>: <a href=\"Observation-obs-pat-nyha.html\">Observation Functional capacity NYHA</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 11</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type medicationRequest}\">用藥品項</span></p><p><b>value</b>: <a href=\"MedicationRequest-medReq-treat.html\">MedicationRequest: status = completed; statusReason = Try another treatment first; intent = order; category = 健保; medication[x] = ANTI-COUGH SYRUP "WASHINGTON"</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 12</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type radiotherapy}\">放射/照光治療</span></p><p><b>value</b>: <a href=\"Procedure-pro-min.html\">Procedure 骨髓高溫療法</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 13</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type carePlanDocument}\">治療計畫文件</span></p><p><b>value</b>: <a href=\"DocumentReference-doc-careplan-min.html\">DocumentReference: status = current; category = 治療計畫文件</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 14</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type medicalRecord}\">病歷資料</span></p><p><b>value</b>: <a href=\"DocumentReference-doc-medicalRecord-min.html\">DocumentReference: status = current; category = 病歷資料</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 15</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type treatmentAssessment}\">結果資訊</span></p><p><b>value</b>: <a href=\"Observation-obs-tx-min.html\">Observation International Working Group(IWG) Consensus Criteria</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 16</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type opd}\">門診病歷</span></p><p><b>value</b>: <a href=\"Encounter-enc-opd.html\">Encounter: status = finished; class = ambulatory (ActCode#AMB); serviceType = Family practice (qualifier value); period = 2025-11-11 --> (ongoing)</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 17</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type diagnosis}\">診斷</span></p><p><b>value</b>: <a href=\"Condition-con-diagnosis.html\">Condition 右側膝部原發性骨關節炎，單側性</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 18</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type allergy}\">過敏史</span></p><p><b>value</b>: <a href=\"AllergyIntolerance-all-min.html\">AllergyIntolerance </a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 19</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type subjective}\">主觀描述</span></p><p><b>value</b>: <a href=\"Observation-obs-subjective.html\">Observation Subjective Narrative</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 20</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type objective}\">客觀描述</span></p><p><b>value</b>: <a href=\"Observation-obs-objective.html\">Observation Objective Narrative</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 21</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type assessment}\">評估</span></p><p><b>value</b>: <a href=\"ClinicalImpression-cliImp-min.html\">ClinicalImpression: status = completed; summary = Right knee . arthritis . active</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 22</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type plan}\">計畫</span></p><p><b>value</b>: <a href=\"CarePlan-careplan-min.html\">CarePlan: 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.</a></p></blockquote><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><span title=\"Codes:{https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw I50.812}\">慢性右心臟衰竭</span></td><td><span title=\"Codes:\">Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI</span></td></tr></table><h3>Procedures</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Date</b></td><td><b>Procedure[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>2024-01-01</td><td><span title=\"Codes:{https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-pcs-2023-tw 3E0Y704}\">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</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-cov-min.html\">Coverage: status = active</a></td></tr></table><blockquote><p><b>item</b></p><p><b>RequestedService</b>: <a href=\"MedicationRequest-medReq-apply.html\">MedicationRequest: status = on-hold; intent = plan; medication[x] = Alunbrig film-coated tablets 30mg</a></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-order-type 1}\">藥品</span></p><p><b>modifier</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-continuation-status 1}\">初次使用</span>, <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-line-of-therapy 1}\">第一線治療</span></p><p><b>programCode</b>: <span title=\"Codes:\">ALK陽性的晚期非小細胞肺癌第一線治療</span></p><p><b>quantity</b>: 52 {tbl}<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM code{tbl} = '{tbl}')</span></p></blockquote><blockquote><p><b>item</b></p><p><b>RequestedService</b>: <a href=\"MedicationRequest-medReq-apply-2.html\">MedicationRequest: status = on-hold; intent = plan; medication[x] = Herzuma Inj. 440mg, Lyophilized powder for injection</a></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-order-type 1}\">藥品</span></p><p><b>modifier</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-continuation-status 1}\">初次使用</span>, <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-line-of-therapy 1}\">第一線治療</span></p><p><b>programCode</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-reason C50P1}\">早期乳癌-未發生腋下淋巴結轉移</span></p><p><b>quantity</b>: 70 {tbl}<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM code{tbl} = '{tbl}')</span></p></blockquote></div>"
},
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{
"url" : "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-claim-encounter",
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🔗 "reference" : "Encounter/enc-min"
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🔗 "reference" : "Patient/pat-min"
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🔗 "reference" : "Practitioner/pra-min"
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🔗 "reference" : "Organization/org-hosp-example"
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{
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"code" : "weight"
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🔗 "reference" : "Observation/obs-blood-group"
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🔗 "reference" : "DiagnosticReport/diaRep-ima-min"
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🔗 "reference" : "DiagnosticReport/diaRep-min"
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"category" : {
"coding" : [
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🔗 "reference" : "Observation/obs-lab-min"
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🔗 "reference" : "Observation/obs-lab-cbc"
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"coding" : [
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🔗 "reference" : "Observation/obs-pat-nyha"
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{
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"category" : {
"coding" : [
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"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
"code" : "medicationRequest"
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"valueReference" : {
🔗 "reference" : "MedicationRequest/medReq-treat"
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{
"sequence" : 12,
"category" : {
"coding" : [
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"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
"code" : "radiotherapy"
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"valueReference" : {
🔗 "reference" : "Procedure/pro-min"
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{
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"category" : {
"coding" : [
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"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
"code" : "carePlanDocument"
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🔗 "reference" : "DocumentReference/doc-careplan-min"
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{
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"coding" : [
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"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
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🔗 "reference" : "DocumentReference/doc-medicalRecord-min"
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{
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"category" : {
"coding" : [
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"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
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"valueReference" : {
🔗 "reference" : "Observation/obs-tx-min"
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},
{
"sequence" : 16,
"category" : {
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
"code" : "opd"
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},
"valueReference" : {
🔗 "reference" : "Encounter/enc-opd"
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},
{
"sequence" : 17,
"category" : {
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
"code" : "diagnosis"
}
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},
"valueReference" : {
🔗 "reference" : "Condition/con-diagnosis"
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},
{
"sequence" : 18,
"category" : {
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
"code" : "allergy"
}
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},
"valueReference" : {
🔗 "reference" : "AllergyIntolerance/all-min"
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},
{
"sequence" : 19,
"category" : {
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
"code" : "subjective"
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"valueReference" : {
🔗 "reference" : "Observation/obs-subjective"
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"category" : {
"coding" : [
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"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
"code" : "objective"
}
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"valueReference" : {
🔗 "reference" : "Observation/obs-objective"
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"category" : {
"coding" : [
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"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
"code" : "assessment"
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"valueReference" : {
🔗 "reference" : "ClinicalImpression/cliImp-min"
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"category" : {
"coding" : [
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"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
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"valueReference" : {
🔗 "reference" : "CarePlan/careplan-min"
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"coding" : [
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"system" : "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw",
"code" : "I50.812"
}
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"text" : "Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI"
}
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"sequence" : 1,
"date" : "2024-01-01",
"procedureCodeableConcept" : {
"coding" : [
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"system" : "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-pcs-2023-tw",
"code" : "3E0Y704"
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"focal" : true,
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🔗 "reference" : "Coverage/cov-min"
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"extension" : [
{
"url" : "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-requestedService",
"valueReference" : {
🔗 "reference" : "MedicationRequest/medReq-apply"
}
}
],
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-order-type",
"code" : "1",
"display" : "藥品"
}
]
},
"modifier" : [
{
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-continuation-status",
"code" : "1",
"display" : "初次使用"
}
]
},
{
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-line-of-therapy",
"code" : "1",
"display" : "第一線治療"
}
]
}
],
"programCode" : [
{
"text" : "ALK陽性的晚期非小細胞肺癌第一線治療"
}
],
"quantity" : {
"value" : 52,
"system" : "http://unitsofmeasure.org",
"code" : "{tbl}"
}
},
{
"extension" : [
{
"url" : "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-requestedService",
"valueReference" : {
🔗 "reference" : "MedicationRequest/medReq-apply-2"
}
}
],
"sequence" : 2,
"productOrService" : {
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-order-type",
"code" : "1",
"display" : "藥品"
}
]
},
"modifier" : [
{
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-continuation-status",
"code" : "1",
"display" : "初次使用"
}
]
},
{
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-line-of-therapy",
"code" : "1",
"display" : "第一線治療"
}
]
}
],
"programCode" : [
{
"coding" : [
{
"system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-reason",
"code" : "C50P1"
}
]
}
],
"quantity" : {
"value" : 70,
"system" : "http://unitsofmeasure.org",
"code" : "{tbl}"
}
}
]
}