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 4 to FHIR

Mapped Fields

Form Field
Use-Case Mapping
/ Target Element
Data Type
Cardinality
ValueSet
(if any)
Series # Claim.identifier Identifier 0..*  
Part I - Health Care Institution (HCI) Information        
Name of HCI Claim.provider Reference(PH_Organization) 1..1  
Organization.name string 0..1  
Accreditation Number Claim.provider Reference(PH_Organization) 1..1  
Organization.identifier Identifier    
Address of HCI (Bldg. No. and Name/Lot/Block/Street) Claim.provider Reference(PH_Organization) 1..1  
Organization.address.line string 0..*  
Address of HCI (Subdivision/Village) Claim.provider Reference(PH_Organization) 1..1  
Organization.address.line string 0..*  
Address of HCI (Barangay/City/Municipality) Claim.provider Reference(PH_Organization) 1..1  
Organization.address.extension:barangay Coding 0..1 Barangay
Address of HCI (Barangay/City/Municipality) Claim.provider Reference(PH_Organization) 1..1  
Organization.address.extension:cityMunicipality Coding 0..1 CityMunicipality
Address of HCI (Province) Claim.provider Reference(PH_Organization) 1..1  
Organization.address.extension:province Coding 0..1 Province
Address of HCI (Zip Code) Claim.provider Reference(PH_Organization) 1..1  
Organization.address.postalCode Coding 0..1  
Part II - Patient's Data        
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
PhilHealth Identification Number (PIN) Claim.patient Reference(PH_Patient) 1..1  
Patient.identifier Identifier 0..*  
Age Claim.extension:encounter Reference(PH_Encounter)    
Encounter.extension:ageYears integer 0..1  
Sex Claim.patient Reference(PH_Patient) 1..1  
Patient.extension:sex CodeableConcept 0..1  
Chief Complaint Claim.extension:encounter Reference(PH_Encounter)    
Encounter.reasonReference Reference(PH_Observation) 0..*  
Observation.valueString string 0..1  
Admitting Diagnosis Claim.diagnosis.diagnosisReference Reference(PH_Condition) 1..1 Set Claim.diagnosis.type value as 'admitting'
Condition.code CodeableConcept 0..1  
Discharge Diagnosis Claim.diagnosis.diagnosisReference Reference(PH_Condition) 1..1 Set Claim.diagnosis.type value as 'discharge'
Condition.code CodeableConcept 0..1  
1st Case Rate Code Claim.item.productOrService CodeableConcept 1..1  
2nd Case Rate Code Claim.item.productOrService CodeableConcept 1..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 Discharged HH:MM)(AM/PM) Claim.extension:encounter Reference(PH_Encounter)    
Encounter.period.end dateTime 0..1  
Part III - Reason for Admission        
1. History of Present Illness Claim.supportingInfo.valueReference Reference(PH_Condition) 0..1  
Condition.note Annotation 0..*  
2. Pertinent Past Medical History Claim.supportingInfo.valueReference Reference(PH_Condition) 0..1  
Condition.note Annotation 0..*  
2. OB/GYN History (G) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. OB/GYN History (G) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. OB/GYN History (P) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. OB/GYN History (P) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. OB/GYN History (P)(T) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. OB/GYN History (P)(T) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. OB/GYN History (P)(P) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. OB/GYN History (P)(P) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. OB/GYN History (P)(A) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. OB/GYN History (P)(A) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. OB/GYN History (P)(L) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. OB/GYN History (P)(L) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueInteger integer 0..1  
2. OB/GYN History LMP (MM-DD-YYYY) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
2. OB/GYN History LMP (MM-DD-YYYY) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueDateTime dateTime 0..1  
2. OB/GYN History (Checkbox NA) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.dataAbsentReason CodeableConcept 0..1 If checked, expected value not-applicable or not-performed
3. Pertinent Signs and Symptoms on Admission (tick applicable boxes) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.code CodeableConcept 1..1  
4. Referred from another health care institution (HCI) [Yes/No] Claim.referral Reference(PH_ServiceRequest) 0..1  
ServiceRequest.status code 1..1  
4. if Yes, Specify Reason Claim.referral Reference(PH_ServiceRequest) 0..1  
ServiceRequest.reasonReference Reference(PH_Observation) 0..*  
Observation.valueString string 0..1  
4. Name of Originating HCI Claim.referral Reference(PH_ServiceRequest) 0..1  
ServiceRequest.requester Reference(PH_Organization) 0..1  
Organization.name string 0..1  
5. Physical Examination on Admission (Pertinent Findings per System) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.code CodeableConcept 1..1  
5. Height (cm) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. Height (cm) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueQuantity Quantity 0..1  
5. Weight (kg) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. Weight (kg) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueQuantity Quantity 0..1  
5. General Survey Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. General Survey (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueCodeableConcept CodeableConcept 0..1  
5. Vital Signs (BP) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. Vital Signs (BP) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
5. Vital Signs (HR) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. Vital Signs (HR) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
5. Vital Signs (RR) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. Vital Signs (RR) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
5. Vital Signs (Temp) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. Vital Signs (Temp) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueString string 0..1  
5. HEENT Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. HEENT (Check notes for options) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueCodeableConcept CodeableConcept 0..1 Options:
1. Essentially normal
2. Icteric sclerae
3. Abnormal pupillary reaction
4. Pale conjunctivae
5. Cervical lymphadenopathy
6. Sunken eyeballs
7. Dry mucous membrane
8. Sunken fontanelle
9. Others
5. CHEST/LUNGS Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. CHEST/LUNGS (Check notes for options) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueCodeableConcept CodeableConcept 0..1 Options:
1. Essentially normal
2. Lump/s over breast(s)
3. Asymmetrical chest expansion
4. Rales/crackles/rhonchi
5. Decreased breath sounds
6. Intercostal rib/clavicular retraction
7. Wheezes
8. Others
5. CVS Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. CVS (Check notes for options) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueCodeableConcept CodeableConcept 0..1 Options:
1. Essentially normal
2. Irregular rhythm
3. Displaced apex beat
4. Muffled heart sound
5. Heaves and/or thrills
6. Murmur
7. Pericardial bulge
8. Others
5. ABDOMEN Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. ABDOMEN (Check notes for options) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueCodeableConcept CodeableConcept 0..1 Options:
1. Essentially normal
2. Palpable mass(es)
3. Abdominal rigidity
4. Tympanitic/dull abdomen
5. Abdomen tenderness
6. Uterine contraction
7. Hyperactive bowel sounds
8. Others
5. GU (IE) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. GU (IE) (Check notes for options) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueCodeableConcept CodeableConcept 0..1 Options:
1. Essentially normal
2. Blood stained in exam finger
3. Cervical dilatation
4. Presence of abnormal discharge
5. Others
5. SKIN/EXTREMITIES Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. SKIN/EXTREMITIES (Check notes for options) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueCodeableConcept CodeableConcept 0..1 Options:
1. Essentially normal
2. Edema/swelling
3. Rashes/petechiae
4. Clubbing
5. Decreased mobility
6. Weak pulses
7. Cold clammy skin
8. Pale nailbeds
9. Cyanosis/mottled skin
10. Poor skin tungor
11. Others
5. NEURO-EXAM Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.code CodeableConcept 1..1  
5. NEURO-EXAM (Check notes for options) (value) Claim.supportingInfo.valueReference Reference(PH_Observation) 0..1  
Observation.component.valueCodeableConcept CodeableConcept 0..1 Options:
1. Essentially normal
2. Abnormal reflex(es)
3. Abnormal gait
4. Poor/altered memory
5. Abnormal position sense
6. Poor muscle tone/strength
7. Abnormal/decreased sensation
8. Poor coordination
9. Others
IV. COURSE IN THE WARD        
Date (MM-DD-YYYY) Claim.supportingInfo.valueReference Reference(PH_ClinicalImpression) 0..1  
ClinicalImpression.effectiveDateTime dateTime 0..1  
DOCTOR'S ORDER/ACTION Claim.supportingInfo.valueReference Reference(PH_ClinicalImpression) 0..1  
ClinicalImpression.description string 0..1  
SURGICAL PROCEDURE / RVS CODE (Attach photocopy of OR technique) Claim.procedure.procedureCodeableConcept CodeableConcept 0..1  
V. DRUGS / MEDICINES        
Generic Name Claim.item.productOrService CodeableConcept 1..1  
Quantity Claim.item.quantity SimpleQuantity 0..1  
Dosage Claim.prescription Reference(PH_MedicationRequest) 0..1  
MedicationRequest.dosageInstruction.doseAndRate.dose[x] Range / SimpleQuantity 0..1  
Route Claim.prescription Reference(PH_MedicationRequest) 0..1  
MedicationRequest.dosageInstruction.route CodeableConcept 0..1  
Frequency Claim.prescription Reference(PH_MedicationRequest) 0..1  
MedicatioNRequest.dosageInstruction.timing Timing 0..1  
Total Cost Claim.item.net Money 0..1  
Part VI - OUTCOME OF TREATMENT        
OUTCOME OF TREATMENT (Check notes for options) Claim.extension:encounter Reference(PH_Encounter)    
Encounter.hospitalization.dischargeDisposition CodeableConcept 0..1  
Part VII - CERTIFICATION OF HEALTH CARE PROFESSIONAL        
Signature Type Provenance.signature.type Coding 1..*  
Signature over Printed Name of Attending Health Care Professional Provenance.signature.who Reference(PH_Practitioner) 0..1  
Practitioner.name HumanName 0..1  
Signature over Printed Name of Attending Health Care Professional Provenance.signature.data base64Binary 0..1  
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.