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/UP-Manila-SILab/PhilHealth-NHDR-IG-Review/ and changes regularly. See the Directory of published versions
/ Target Element |
(if any) |
|||
|---|---|---|---|---|
| Series # | Claim.identifier | Identifier | 0..* | — |
| Part I - Health Care Institution (HCI) Information | ||||
| PhilHealth Accreditation Number (PAN) of Health Care Institution | Claim.provider | Reference(PH_Organization) | 1..1 | — |
| Organization.identifier | Identifier | 1..1 | — | |
| Name of Health Care Institution | Claim.provider | Reference(PH_Organization) | 1..1 | — |
| Organization.name | string | 1..1 | — | |
| Address (Building Number and Street Name) | Claim.provider | Reference(PH_Organization) | 1..1 | — |
| Organization.address.line | string | 1..1 | — | |
| Address (City/Municipality) | Claim.provider | Reference(PH_Organization) | 1..1 | — |
| Organization.address.extension:cityMunicipality | Coding | 1..1 | CityMunicipality | |
| Address (Province) | Claim.provider | Reference(PH_Organization) | 1..1 | — |
| Organization.address.extension:province | Coding | 1..1 | Province | |
| Part II - Patient Confinement Information | ||||
| Name of Patient (Last Name) | Claim.patient | Reference(PH_Patient) | 1..1 | — |
| Patient.name.family | string | 0..1 | — | |
| Name of Patient (First Name) | Claim.patient | Reference(PH_Patient) | 1..1 | — |
| Patient.name.given[0] | string | 0..1 | — | |
| Name of Patient (Name Extension) | Claim.patient | Reference(PH_Patient) | 1..1 | — |
| Patient.name.suffix | string | 0..* | — | |
| Name of Patient (Middle Name) | Claim.patient | Reference(PH_Patient) | 1..1 | — |
| Patient.name.given[1] | string | 0..1 | — | |
| Was Patient reffered by another HCI? (Yes/No) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.status | code | 0..1 | — | |
| Name of referring Health Care Institution | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.requester | Reference(PH_Organization) | 0..1 | — | |
Organization.name |
string | 0..1 | — | |
| Address of referring HCI (Building Number and Street Name) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.requester | Reference(PH_Organization) | 0..1 | — | |
| Organization.address.line | string | 0..1 | — | |
| Address of referring HCI (City/Municipality) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.requester | Reference(PH_Organization) | 0..1 | — | |
| Organization.address.extension:cityMunicipality | Coding | 0..1 | — | |
| Address of referring HCI (Province) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.requester | Reference(PH_Organization) | 0..1 | — | |
| Organization.address.extension:province | Coding | 0..1 | — | |
| Address of referring HCI (ZIP Code) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.requester | Reference(PH_Organization) | 0..1 | — | |
| Organization.address.postalCode | Coding | 0..1 | — | |
| Confinement Period (Date Admitted MM-DD-YYYY)(Time Admitted HH:MM)(AM/PM) | Claim.extension:claimEncounter | Reference(PH_Encounter) | 0..1 | — |
| Encounter.period.start | dateTime | — | — | |
| Confinement Period (Date Discharge MM-DD-YYY)(Time Discharge HH:MM)(AM/PM) | Claim.extension:claimEncounter | Reference(PH_Encounter) | 0..1 | — |
| Encounter.period.end | dateTime | — | — | |
| Patient Disposition (check notes for options: select only one) | Claim.extension:claimEncounter | Reference(PH_Encounter) | 0..1 | — |
| Encounter.hospitalization.dischargeDisposition | CodeableConcept | — | — | |
| e. Expired (Date Format MM-DD-YYYY)(Time Format HH-MM)(AM/PM) | Claim.patient | Reference(PH_Patient) | 1..1 | — |
| Patient.deceasedDateTime | dateTime | 0..1 | — | |
| f. Transferred/Referred (Name of Referral Health Care Institution) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.performer | Reference(PH_Organization) | 0..1 | — | |
| Organization.name | string | 0..1 | — | |
| f. Transferred/Referred HCI Address (Building Number and Street Name) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.performer | Reference(PH_Organization) | 0..1 | — | |
| Organization.address.line | string | 0..1 | — | |
| f. Transferred/Referred HCI Address (City/Municipality) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.performer | Reference(PH_Organization) | 0..1 | — | |
| Organization.address.extension:cityMunicipality | Coding | 0..1 | CityMunicipality | |
| f. Transferred/Referred HCI Address (Province) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.performer | Reference(PH_Organization) | 0..1 | — | |
| Organization.address.extension:province | Coding | 0..1 | Province | |
| f. Transferred/Referred HCI Address (Postal Code) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.performer | Reference(PH_Organization) | 0..1 | — | |
| Organization.address.postalCode | Coding | 0..1 | ||
| f. Reason/s for referral/transfer (text) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.reasonReference | Reference(PH_Observation) | 0..1 | — | |
| Observation.valueString | string | 0..1 | ReasonCode | |
| f. Reason/s for referral/transfer (code) | Claim.referral | Reference(PH_ServiceRequest) | 0..1 | — |
| ServiceRequest.reasonReference | Reference(PH_Observation) | 0..1 | — | |
| Observation.valueString | string | 0..1 | ReasonCode | |
| Type of Accomodation (Private/Non-Private) | Claim.extension:claimEncounter | Reference(PH_Encounter) | 0..1 | — |
| Encounter.location.physicalType | CodeableConcept | — | Location-PhysicalType | |
| Admission Diagnosis/es | Claim.diagnosis.diagnosisCodeableConcept | CodeableConcept | 1..1 | — |
| Discharge Diagnosis: Diagnosis - ICD-10 Code/s | Claim.diagnosis.diagnosisCodeableConcept | CodeableConcept | 1..1 | — |
| Discharge Diagnosis: Related Procedure/s (if there's any) - RVS Code | Claim.procedure.procedureCodeableConcept | CodeableConcept | 1..1 | — |
| Discharge Diagnosis: Date of Procedure | Claim.procedure.date | dateTime | 0..1 | — |
| Discharge Diagnosis: Laterality (Left, Right, Both) | Claim.procedure.procedureReference | Reference(PH_Procedure) | 0..1 | — |
| Procedure.bodySite | CodeableConcept | 1..1 | — | |
| 8.a. For the following repetitive procedures, check box that applies and enumerate the procedure/sessions dates [mm-dd-yyyy]. For chemotherapy, see guidelines. | Claim.item.productOrService | CodeableConcept | 1..1 | — |
| 8.a. procedure/session dates | Claim.item.servicedDate | date | 0..1 | — |
| 8.b. For Z-Benefit Package Z-Benefit Package Code: | Claim.item.productOrService | CodeableConcept | 1..1 | — |
| 8.c. For MCP Package (enumerate four dates [mm-dd-year] of pre-natal check-ups) | Claim.item.servicedDate | date | 0..1 | — |
| 8.d. For TB-DOTS Package | Claim.item.detail.productOrService | CodeableConcept | 1..1 | — |
| 8.e. For Animal Bite Package: Day 0 ARV (Date) | Claim.item.servicedDate | date | 0..1 | — |
| 8.e. For Animal Bite Package: Day 3 ARV (Date) | Claim.item.servicedDate | date | 0..1 | — |
| 8.e. For Animal Bite Package: Day 7 ARV (Date) | Claim.item.servicedDate | date | 0..1 | — |
| 8.e. For Animal Bite Package: RIG (Date) | Claim.item.servicedDate | date | 0..1 | — |
| 8.e. For Animal Bite Package: Others (Specify) | Claim.item.productOrService | CodeableConcept | 1..1 | — |
| 8.e. For Animal Bite Package: Others (Specify) (Date) | Claim.item.servicedDate | date | 0..1 | — |
| 8.f. For Newborn Care Package | Claim.item.productOrService | CodeableConcept | 1..1 | — |
| 8.f. For Newborn Care Package: Essential Newborn Care | Claim.item.detail.productOrService | CodeableConcept | 1..1 | — |
| 8.g. For Outpatient HIV/AIDS Treatment Package: Laboratory Number: | Claim.item.encounter | Reference(PH_Encounter) | 0..1 | — |
| Encounter.serviceProvider | Reference(PH_Organization) | 0..1 | — | |
| Organization.identifier | Identifier | 0..* | — | |
| 9. PhilHealth Benefits: First Case Rate: | Claim.item.productOrService | CodeableConcept | 1..1 | — |
| 9. PhilHealth Benefits: Second Case Rate: | Claim.item.productOrService | CodeableConcept | 1..1 | — |
| 10. Accreditation number of Accredited Health Care Professional | Claim.supportingInfo.valueReference | Reference(PH_Practitioner) | 0..1 | — |
| Practitioner.identifier | Identifier | 0..1 | — | |
| 10. Name of Accredited Health Care Professional | Claim.supportingInfo.valueReference | Reference(PH_Provenance) | 0..1 | — |
| Provenance.signature.who | (PH_Practitioner) | 1..1 | — | |
| Practitioner.name | HumanName |
0..1 | — | |
| 10. Signature Over Printed Name (Name of Accredited Health Care Professional) | Claim.supportingInfo.valueReference | Reference(PH_Provenance) | 0..1 | — |
| Provenance.signature.data | base64Binary | 0..1 | — | |
| 10. Date Signed | Claim.supportingInfo.valueReference | Reference(PH_Provenance) | 0..1 | — |
| Provenance.signature.when | instant | 0..1 | — | |
| Details: Co-Pay | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 | — |
| Coverage.costToBeneficiary.type | CodeableConcept | 0..1 | — | |
| With co-pay on top of PhilHealth Benefit (Amount) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 | — |
| Coverage.costToBeneficiary.valueMoney | Money | — | — | |
| Part III - Certification of Consumption of Benefits and Consent to Access Patient Record/s | ||||
| A. Certification of Consumption of Benefits | Questionnaire.item.text | string | 0..1 | — |
| A. if Yes, Total Health Care Institution Fees : Total Actual Charges* | Claim.item.net | Money | 0..1 | — |
| A. if Yes, Total Professional Fees : Total Actual Charges* | Claim.item.net | Money | 0..1 | — |
| A. if Yes, Grand Total : Total Actual Charges* | Claim.total | Money | 0..1 | — |
| A. if No, Total Health Care Institution Fees : Total Actual Charges* | Claim.item.net | Money | 0..1 | — |
| A. if No, Total Health Care Institution Fees : Amount after Application of Discount (i.e., personal discount, Senior Citizen / PWD) | Claim.item.detail.net | Money | 0..1 | — |
| A. if No, Total Health Care Institution Fees : PhilHealth Benefit | Claim.item.net | Money | 0..1 | — |
| A. if No, Total Health Care Institution Fees : Amount after PhilHealth Deduction (Amount) | Claim.total | Money | 0..1 | — |
| A. if No, Total Health Care Institution Fees : Amount after PhilHealth Deduction (Paid by (check all that applies)) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 | — |
| Coverage.type | CodeableConcept | — | — | |
| A. if No, Total Professional Fees (for accredited and non-accredited professionals) : Total Actual Charges* | Claim.item.net | Money | 0..1 | — |
| A. if No, Total Professional Fees (for accredited and non-accredited professionals) : Amount after Application of Discount (i.e., personal discount, Senior Citizen / PWD) | Claim.item.detail.net | Money | 0..1 | — |
| A. if No, Total Professional Fees (for accredited and non-accredited professionals) : PhilHealth Benefit | Claim.item.net | Money | 0..1 | — |
| A. if No, Total Professional Fees (for accredited and non-accredited professionals) : Amount after PhilHealth Deduction (Amount) | Claim.total | Money | 0..1 | — |
| A. if No, Total Professional Fees (for accredited and non-accredited professionals) : Amount after PhilHealth Deduction (Paid by (check all that applies)) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 | — |
| Coverage.type | CodeableConcept | — | — | |
| A. if No, Total cost of purchase/s for drugs/medicines and/or medical supplies bought by the patient/member within/outside the HCI during confinement | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 | — |
| Coverage.costToBeneficiary.type | CodeableConcept | — | — | |
| A. if No, Total cost of purchase/s for drugs/medicines and/or medical supplies bought by the patient/member within/outside the HCI during confinement (Total Amount) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 | — |
| Coverage.costToBeneficiary.valueMoney | Money | — | — | |
| A. if No, Total cost of diagnostic/laboratory examinations paid by the patient/member done within/outside the HCI during confinement | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 | — |
| Coverage.costToBeneficiary.type | CodeableConcept | — | — | |
| A. if No, Total cost of diagnostic/laboratory examinations paid by the patient/member done within/outside the HCDI during confinement (Total Amount) | Claim.insurance.coverage | Reference(PH_Coverage) | 1..1 | — |
| Coverage.costToBeneficiary.valueMoney | Money | — | — | |
| B. Signature Over Printed Name of Member/Patient/Authorized Representative | Provenance.signature.who | Reference(PH_Patient) | 0..1 | — |
| Patient.name | HumanName | 0..1 | — | |
| B. Signature Over Printed Name of Member/Patient/Authorized Representative | Provenance.signature.data | base64Binary | 0..1 | — |
| B. Signature Over Printed Name of Member/Patient/Authorized Representative | Provenance.signature.who | Reference(PH_RelatedPerson) | 1..1 | — |
| RelatedPerson.name | HumanName | 0..1 | — | |
| B. Signature Over Printed Name of Member/Patient/Authorized Representative | Provenance.signature.data | base64Binary | 0..1 | — |
| B. Date Signed: | Provenance.signature.when | instant | 0..1 | — |
| B. Relationship of the representative to the member/patient | Provenance.signature.who | Reference(PH_RelatedPerson) | 1..1 | — |
| RelatedPerson.relationship | CodeableConcept | — | — | |
| B. Reason for signing on behalf of the member/patient | Provenance.signature.extension:signatureReason | string | 0..1 | — |
| B. If patient/representative is unable to write, put right thumbmark. Patient/Representative should be assisted by an HCI representative. | Provenance.signature.data | base64Binary | 0..1 | — |
| Part IV - Certification of Consumption of Health Care Institution | ||||
| Signature Over Printed Name of Authorized HCI Representative | Provenance.signature.who | Reference(PH_Practitioner) | 0..1 | — |
| Practitioner.name | HumanName | 0..1 | — | |
| Signature Over Printed Name of Authorized HCI Representative | Provenance.signature.data | base64Binary | 0..1 | — |
| Official Capacity / Designation | Provenance.signature.extension:signaturePosition | CodeableConcept | 0..* | — |
| Date Signed: | Provenance.signature.when | instant | 0..1 | — |