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

## : 免疫製劑事前審查 - XML Representation

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    <Claim xmlns="http://hl7.org/fhir">
      <id value="cla-imm"/>
      <meta>
        <profile
                 value="https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-immunologic-agent-twpas"/>
      </meta>
      <text>
        <status value="extensions"/>
        <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 (use: official, ))</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 'B34JZZ3' for '-&gt;王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))'</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 '-&gt;王大明 Male, DoB: 2001-01-01 ( Medical record number (use: official, ))'</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 &quot;WASHINGTON&quot;</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 D7Y08ZZ</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="Composition-opd.html">Composition 門診病歷</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 allergy}">過敏史</span></p><p><b>value</b>: <a href="AllergyIntolerance-all-min.html">AllergyIntolerance </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}">I50.812</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}">3E0Y704</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>
      </text>
      <extension
                 url="https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-claim-encounter">
        <valueReference>🔗
          <reference value="Encounter/enc-min"/>
        </valueReference>
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      <status value="active"/>
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        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
          <code value="institutional"/>
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      <use value="preauthorization"/>
      <patient>🔗
        <reference value="Patient/pat-min"/>
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      <created value="2024-05-30"/>
      <enterer>🔗
        <reference value="Practitioner/pra-min"/>
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      <provider>🔗
        <reference value="Organization/org-hosp-example"/>
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      <priority>
        <coding>
          <system
                  value="https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-tmhb-type"/>
          <code value="1"/>
          <display value="一般事前審查申請"/>
        </coding>
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            <code value="bloodgroup"/>
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        <valueReference>🔗
          <reference value="Observation/obs-blood-group"/>
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        <valueReference>🔗
          <reference value="DiagnosticReport/diaRep-ima-min"/>
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        <category>
          <coding>
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            <code value="examinationReport"/>
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        <valueReference>🔗
          <reference value="Observation/obs-pat-nyha"/>
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        <valueReference>🔗
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            <code value="radiotherapy"/>
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        <valueReference>🔗
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        <valueReference>🔗
          <reference value="Observation/obs-tx-min"/>
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        <valueReference>🔗
          <reference value="Composition/opd"/>
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            <code value="allergy"/>
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        <valueReference>🔗
          <reference value="AllergyIntolerance/all-min"/>
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      </supportingInfo>
      <diagnosis>
        <extension
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          <valueDate value="2024-01-01"/>
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        <sequence value="1"/>
        <diagnosisCodeableConcept>
          <coding>
            <system
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            <code value="I50.812"/>
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        </diagnosisCodeableConcept>
        <type>
          <text
                value="Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI"/>
        </type>
      </diagnosis>
      <procedure>
        <sequence value="1"/>
        <date value="2024-01-01"/>
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          <coding>
            <system
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        </procedureCodeableConcept>
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      <insurance>
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        <focal value="true"/>
        <coverage>🔗
          <reference value="Coverage/cov-min"/>
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          <valueReference>🔗
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        <quantity>
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          <system value="http://unitsofmeasure.org"/>
          <code value="{tbl}"/>
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          <valueReference>🔗
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          <system value="http://unitsofmeasure.org"/>
          <code value="{tbl}"/>
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