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

Mapped Fields

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    
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..* Use first instance of name.given
Name of Patient (Middle Name) Claim.patient Reference(PH_Patient) 1..1  
Patient.name.given[1] string 0..* Use second instance of name.given
Chief Complaint / Reason for Admission Claim.extension:encounter Reference(PH_Encounter)    
Encounter.reasonReference Reference(PH_Observation) 0..*  
Observation.valueString string 0..1  
Date Admitted (MM-DD-YYYY)(Time Admitted HH:MM(AM/PM)) Claim.extension:encounter Reference(PH_Encounter)    
Encounter.period.start dateTime 0..1  
Date Discharged (MM-DD-YYYY)(Time Discharge HH:MM)(AM/PM) Claim.extension:encounter Reference(PH_Encounter)    
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) 0..1  
Observation.valueString string 0..1  
Vital Signs (BP) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
Vital Signs (CR) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
Vital Signs (RR) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
Vital Signs (Temperature) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
Abdomen Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
HEENT Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
GU (IE) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
Chest / Lungs Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
Skin / Extremities Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
CVS Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
Neuro Examination Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
Course in the Wards (attach additional sheets if necessary) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
ClinicalImpression.description string 0..1  
Pertinent Laboratory and Diagnostic Findings: (CBC, Urinalysis, Fecalysis, X-ray, Biopsy, etc.) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.code CodeableConcept 0..1  
Pertinent Laboratory and Diagnostic Findings: (CBC, Urinalysis, Fecalysis, X-ray, Biopsy, etc.) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueString string 0..1  
Pertinent Laboratory and Diagnostic Findings: (CBC Urinalysis, Fecalysis, X-ray, Biopsy, etc.) Claim.supportingInfo.valueReference Reference(PH_DiagnosticReport) 0..1  
DiagnosticReport.conclusion string    
Disposition on Discharge (Check notes for options) Claim.extension:encounter Reference(PH_Encounter)    
Encounter.hospitalization.dischargeDisposition CodeableConcept 0..1  
Part II - Maternity Care Package        
1. Initial Prenatal Consultation (MM-DD-YYYY) Claim.item.servicedDate date 0..1  
2. Clinical History and Physical Examination: a. Vital signs are normal Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.interpretation CodeableConcept 0..*  
2. Clinical History and Physical Examination: b. Ascertain the present Pregnancy is low-Risk Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueBoolean boolean 0..1  
2. Clinical History and Physical Examination: c. Menstrual History LMP (MM-DD-YYYY) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. Clinical History and Physical Examination: c. Menstrual History LMP (MM-DD-YYYY) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueDateTime dateTime 0..1  
2. Clinical History and Physical Examination: d. Menstrual History (Age of Menarche) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. Clinical History and Physical Examination: d. Menstrual History (Age of Menarche) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. Obstetric History (G) ClaimsupportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. Obstetric History (G) (value) ClaimsupportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. Obstetric History (P) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. Obstetric History (P) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. Obstetric History (P)[T] Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. Obstetric History (P)[T] (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. Obstetric History (P)[P] Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. Obstetric History (P)[P] (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. Obstetric History (P)[A] Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. Obstetric History (P)[A] (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. Obstetric History (P)[L] Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. Obstetric History (P)[L] (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
3. Obstetric risk factors (Check notes for options) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.code CodeableConcept 1..1  
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  
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  
7a. Prenatal Consultation No. Claim.item.sequence positiveInt 1..1  
7b. Date of visit (MM-DD-YYYY) Claim.item.servicedDate date 0..1  
7c. AOG in weeks Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valueInteger integer 0..1  
7d. Weight and Vital Signs Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.valcodeueInteger CodeableConcept 1..1  
7d.1 Weight Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
7d.1 Weight (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueQuantity Quantity 0..1  
7d.2 Cardiac Rate Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
7d.2 Cardiac Rate (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
7d.3 Respiratory Rate Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
7d.3 Respiratory Rate (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
7d.4 Blood Pressure Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
7d.4 Blood Pressure (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
7d.5 Temperature Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
7d.5 Temperature (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueQuantity Quantity 0..1  
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.component.code CodeableConcept 1..1  
9. Maternal Outcome (Obstetric Index) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
9. Pregnancy Uterine (AOG by LMP) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
9. Pregnancy Uterine (AOG by LMP) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
9. Pregnancy Uterine (Manner of Delivery) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
9. Pregnancy Uterine (Manner of Delivery) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
9. Pregnancy Uterine (Presentation) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
9. Pregnancy Uterine (Presentation) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
10. Birth Outcome Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.code CodeableConcept 1..1  
10. Birth Outcome (Fetal Outcome) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
10. Birth Outcome (Fetal Outcome) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
10. Birth Outcome (Sex) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
10. Birth Outcome (Sex) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
10. Birth Outcome (Birth Weight (grm)) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
10. Birth Outcome (Birth Weight (grm)) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
10. Birth Outcome (APGAR Score) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
10. Birth Outcome (APGAR Score) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
11. Scheduled Postpartum follow-up consultation 1 week after delivery Claim.extension:encounter Reference(PH_Encounter)    
Encounter.period.start dateTime    
12. Date of Discharge Claim.extension:encounter 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 base64Binary 0..1  
19. Date Signed Provenance.signature.when instant 1..1  

Mandatory Elements Not in the Form

Use-Case Mapping / Target Element
Data Type
Notes
Provenance.target Reference(PH_Claim) Reference the intact Claim resource
Provenance.recorded instant Must be system-generated timestamp
Provenance.agent.who Reference(PH_Organization) Reference the intact Organization (Health Facility) resource
Organization.name string Derive from the referenced Organization resource
Claim.status code Use expected value 'submitted'
Claim.type CodeableConcept Use expected value '(custom ValueSet to be provided later)'
Claim.use code Use expected value 'claim'
Claim.created dateTime "Resource creation date", should be the instant that the resource was created.
Claim.priority CodeableConcept Use expected value 'normal'
Claim.supportingInfo.sequence positiveInt Expected incrementing value per object
Claim.supportingInfo.category CodeableConcept TBD
Claim.diagnosis.sequence positiveInt Expected incrementing value per object
Claim.procedure.sequence positiveInt Expected incrementing value per object
Claim.insurance.sequence positiveInt Expected incrementing value per object
Claim.insurance.focal boolean Flag that determines the coverage to be used for the adjudication of this claim.
Claim.insurance.coverage Reference(PH_Coverage) To be resolved
Claim.item.sequence positiveInt Expected incrementing value per object
Questionnaire.status code Use expected value 'active'
Questionnaire.item.linkId string Expected incrementing value per questionnaire item.
Questionnaire.item.type code Indicates expected data type for the questionnaire item.