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

Mapping of Claims Form 3 to FHIR

Form Field
Use-Case Mapping
/ Target Element
Data Type
Cardinality
ValueSet
(if any)
Part I - Patient's Clinical Record        
PhilHealth Accreditation No. (PAN) - Institutional Health Care Provider Claim.provider Reference(PH_Organization) 1..1
Organization.identifier Identifier 0..*  
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..*
Name of Patient (Middle Name) Claim.patient Reference(PH_Patient) 1..1
Patient.name.given[1] string 0..*
Chief Complaint / Reason for Admission Claim.extension:claimEncounter Reference(PH_Encounter) 0..*  
Encounter.reasonReference Reference(PH_Observation) 0..*
Observation.valueString string 0..1
Date Admitted (MM-DD-YYYY)(Time Admitted HH:MM(AM/PM)) Claim.extension:claimEncounter Reference(PH_Encounter) 0..*  
Encounter.period.start dateTime 0..1
Date Discharged (MM-DD-YYYY)(Time Discharge HH:MM)(AM/PM) Claim.extension:claimEncounter Reference(PH_Encounter) 0..*  
Encounter.period.end dateTime 0..1
Brief History of Present Illness / OB History Claim.diagnosis.diagnosisReference Reference(PH_Condition) 1..1  
Condition.note Annotation 0..*
General Survey Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
Vital Signs (BP) Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
Vital Signs (CR) Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
Vital Signs (RR) Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
Vital Signs (Temperature) Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
Abdomen Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
HEENT Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
GU (IE) Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
Chest / Lungs Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
Skin / Extremities Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
CVS Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
Neuro Examination Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string 0..1
Course in the Wards (attach additional sheets if necessary) Claim.supportingInfo.valueReference Reference(PH_ClinicalImpression) 1..1  
ClinicalImpression.description string
Pertinent Laboratory and Diagnostic Findings: (CBC, Urinalysis, Fecalysis, X-ray, Biopsy, etc.) Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.code CodeableConcept
Pertinent Laboratory and Diagnostic Findings: (CBC, Urinalysis, Fecalysis, X-ray, Biopsy, etc.) Claim.supportingInfo.valueReference Reference(PH_Observation) 1..1  
Observation.valueString string
Pertinent Laboratory and Diagnostic Findings: (CBC Urinalysis, Fecalysis, X-ray, Biopsy, etc.) Claim.supportingInfo.valueReference Reference(PH_DiagnosticReport) 1..1  
DiagnosticReport.conclusion string
Disposition on Discharge (Check notes for options) Claim.extension:claimEncounter Reference(PH_Encounter) 0..*  
Encounter.hospitalization.dischargeDisposition CodeableConcept
Part II - Maternity Care Package        
1. Initial Prenatal Consultation (MM-DD-YYYY) Claim.item.servicedDate date
2. Clinical History and Physical Examination: a. Vital signs are normal Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.interpretation CodeableConcept
2. Clinical History and Physical Examination: b. Ascertain the present Pregnancy is low-Risk Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueBoolean
valueCodeableConcept
boolean
2. Clinical History and Physical Examination: c. Menstrual History LMP (MM-DD-YYYY) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueDateTime dateTime
2. Clinical History and Physical Examination: d. Menstrual History (Age of Menarche) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueInteger integer
2. Obstetric History (G) ClaimsupportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueInteger integer
2. Obstetric History (P) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueInteger integer
2. Obstetric History (P)[T] Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueInteger integer
2. Obstetric History (P)[P] Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueInteger integer
2. Obstetric History (P)[A] Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueInteger integer
2. Obstetric History (P)[L] Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueInteger integer
3. Obstetric risk factors (Check notes for options) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueCodeableConcept CodeableConcept  
4. Medical / Surgical risk factors (Check notes for options) Claim.diagnosis.diagnosisCodeableConcept CodeableConcept 1..1  
5. Admitting Diagnosis Claim.diagnosis.diagnosisReference Reference(PH_Condition) 1..1
Observation    
6. Orientation to MCP / Availment of Benefits (Yes / No) Questionnaire.item.text string 0..1
6. Expected date of delivery (MM-DD-YYYY) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.effectiveDateTime dateTime 0..1
7. Prenatal Consultation No. Claim.item.sequence positiveInt 1..1
7. Date of visit (MM-DD-YYYY) Claim.item.servicedDate date 0..1
7. AOG in weeks Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueInteger integer
7.1 Weight Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueString string
7.2 Cardiac Rate Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueString string
7.3 Respiratory Rate Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueString string
7.4 Blood Pressure Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueString string
7.5 Temperature Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueString string
Part II - Maternity Care Package (Delivery Outcome)        
8. Date of Delivery (MM-DD-YYYY)(AM/PM)[HH:MM] Claim.item.servicedDate date 0..1
9. Maternal Outcome (Obstetric Index) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueString string
9. Pregnancy Uterine (AOG by LMP) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueString string
9. Pregnancy Uterine (Manner of Delivery) Claim.item.productOrService CodeableConcept 1..1  
9. Pregnancy Uterine (Presentation) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueCodeableConcept CodeableConcept  
10. Birth Outcome (Fetal Outcome) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueString string
10. Birth Outcome (Sex) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1
Observation.valueCodeableConcept CodeableConcept  
10. Birth Outcome (Birth Weight (grm)) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueInteger integer    
10. Birth Outcome (APGAR Score) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueInteger integer    
11. Scheduled Postpartum follow-up consultation 1 week after delivery Claim.extension:claimEncounter Reference(PH_Encounter)    
Encounter.period.start dateTime    
12. Date of Discharge Claim.extension:claimEncounter Reference(PH_Encounter)    
Encounter.period.end dateTime    
Part II - Maternity Care Package (Postpartum Care)        
13. Perineal wound care (checkbox) Questionnaire.item.text string 0..1
13. Perineal wound care (Remarks) Questionnaire.item.text string 0..1
14. Signs of Maternal Postpartum Complications (checkbox) Questionnaire.item.text string 0..1
14. Signs of Maternal Postpartum Complications (Remarks) Questionnaire.item.text string 0..1
15a. Counselling and Education (Breastfeeding and Nutrition) (checkbox) Questionnaire.item.text string 0..1
15a. Counselling and Education (Breastfeeding and Nutrition) (Remarks) Questionnaire.item.text string 0..1
15b. Counselling and Education (Family Planning) (checkbox) Questionnaire.item.text string 0..1
15b. Counselling and Education (Family Planning) (Remarks) Questionnaire.item.text string 0..1
16. Provided family planning service to patient (as requested by patient) (checkbox) Questionnaire.item.text string 0..1
16. Provided family planning service to patient (as requested by patient) (Remarks) Questionnaire.item.text string 0..1
17. Referred to partner physician for Voluntary Surgical Sterilization (as requested by pt.) (checkbox) Questionnaire.item.text string 0..1
17. Refereed to partner physician for Voluntary Surgical Sterilization (as requested by pt.) (Remarks) Questionnaire.item.text string 0..1
18. Schedule the next postpartum follow-up (checkbox) Questionnaire.item.text string 0..1
18. Schedule the next postpartum follow-up (Remarks) Questionnaire.item.text string 0..1
19. Signature Type Provenance.signature.type 1..* Coding
19. Signature Over Printed Name of Attending Physician / Midwife Provenance.signature.who Reference(PH_Practitioner) 1..1
Practitioner.name HumanName
19. Signature Over Printed Name of Attending Physician / Midwife Provenance.signature.data 0..1  
19. Date Signed Provenance.signature.when instant 1..1