ID
25625
Description
Muster 63 - Verordnung spezialisierter ambulanter Palliativversorgung (SAPV) (Freigabe 01.09.2014). Formulare für die vertragsärztliche Versorgung - Freigabe durch Dezernat 4 - Ärztliche Leistungen und Versorgungsstruktur Geschäftsbereich Sicherstellung und Versorgungsstruktur Abteilung Sicherstellung Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Quelle: http://www.kbv.de/html/formulare.php --- Template 85 - Prescription of specialized outpatient palliative care (Released 09-01-2014). Released by Department 4 - Medical treatment and structure of supply, division ensurance and structure of supply, department ensurance Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Source: http://www.kbv.de/html/formulare.php
Link
Keywords
Versions (4)
- 1/4/17 1/4/17 -
- 1/5/17 1/5/17 -
- 1/28/17 1/28/17 -
- 9/7/17 9/7/17 -
Copyright Holder
KBV
Uploaded on
September 7, 2017
DOI
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License
Creative Commons BY-NC 3.0
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KBV Prescription of specialized outpatient palliative care Template 63
KBV Prescription of specialized outpatient palliative care Template 63a
- StudyEvent: ODM
Description
Verordnungsrelevante Diagnosen (ICD-10; ggf. Organmanifestation)
Description
Komplexes Symptomgeschehen
Description
urogenital symptoms
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0042066
Description
ulcers or
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0041582
- UMLS CUI [1,2]
- C0043251
- UMLS CUI [2,1]
- C0041582
- UMLS CUI [2,2]
- C0027651
Description
heavy pain
Data type
boolean
Alias
- UMLS CUI [1]
- C0458256
Description
cardiac or respiratory symptoms
Data type
boolean
Alias
- UMLS CUI [1]
- C0741933
- UMLS CUI [2]
- C0037090
Description
neurologic, psychiatric or mental symptoms
Data type
boolean
Alias
- UMLS CUI [1]
- C0235031
- UMLS CUI [2]
- C0233401
- UMLS CUI [3]
- C0586405
Description
gastrointestinal symptom
Data type
boolean
Alias
- UMLS CUI [1]
- C0426576
Description
other symptoms
Data type
boolean
Alias
- UMLS CUI [1]
- C0037088
Description
Nähere Beschreibung des komplexen Symptomgeschehens und des besonderen Versorgungsbedarfs zur Begründung, warum spezialisierte ambulante Palliativversorgung notwendig ist (z.B. therapierefraktäre Schmerzen, Ruhedyspnoe/Erstickungsanfälle, nicht beherrschbares Erbrechen/Durchfälle)
Data type
text
Alias
- UMLS CUI [1]
- C0037088
- UMLS CUI [2]
- C1719237
Description
Aktuelle Medikation
Description
Maßnahmen
Description
consultation
Data type
boolean
Alias
- UMLS CUI [1]
- C0009818
Description
consultation of physician
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0009818
- UMLS CUI [1,2]
- C1710470
Description
consultation of nurse
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0009818
- UMLS CUI [1,2]
- C0028661
Description
consultation of patient or relatives
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0009818
- UMLS CUI [1,2]
- C0030705
- UMLS CUI [2,1]
- C0009818
- UMLS CUI [2,2]
- C0080103
Description
coordination of palliative treatment
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0001554
- UMLS CUI [1,2]
- C0030231
Description
consultation topic
Data type
text
Alias
- UMLS CUI [1,1]
- C1706203
- UMLS CUI [1,2]
- C0009818
Description
supportive care
Data type
boolean
Alias
- UMLS CUI [1]
- C0344211
Description
complete care
Data type
boolean
Alias
- UMLS CUI [1]
- C0033137
Description
further details for specialized outpatient palliative care
Data type
text
Alias
- UMLS CUI [1]
- C0030231
Description
Antrag des Versicherten
Description
Die spezialisierte ambulante Palliativversorgung wird wie vom behandelnden Arzt verordnet beantragt. Datenschutzhinweis (§67a Abs. 3 SGB X): Damit wir Ihren Antrag auf SAPV-Leistungen bearbeiten können, ist Ihr Mitwiren nach § 60 SGB I erforderlich. Ihre Daten sin im vorliegenden Falle aufgrund § 37 SGB V i.V.m. § 92 Abs. 1 SGB V zu erheben.
Data type
date
Alias
- UMLS CUI [1,1]
- C0185125
- UMLS CUI [1,2]
- C1551367
- UMLS CUI [1,3]
- C0011008
Description
Angaben des Leistungserbringers für die SAPV
Alias
- UMLS CUI-1
- C0199168
Description
Treatment start date
Data type
date
Alias
- UMLS CUI [1,1]
- C3173309
- UMLS CUI [1,2]
- C0030231
Description
Treatment End Date
Data type
date
Alias
- UMLS CUI [1,1]
- C1531784
- UMLS CUI [1,2]
- C0030231
Description
medical service name
Data type
text
Alias
- UMLS CUI [1]
- C0021682
Description
address
Data type
text
Alias
- UMLS CUI [1]
- C1442065
Description
Institution number
Data type
text
Alias
- UMLS CUI [1]
- C0489558
Description
contact person
Data type
text
Alias
- UMLS CUI [1,1]
- C0027365
- UMLS CUI [1,2]
- C0337611
Description
telephone number
Data type
integer
Alias
- UMLS CUI [1]
- C1515258
Description
Fax number
Data type
integer
Alias
- UMLS CUI [1,1]
- C1710470
- UMLS CUI [1,2]
- C1549619
Description
Data type
text
Alias
- UMLS CUI [1]
- C1705961
Description
Signature date
Data type
date
Measurement units
- TT-MM-JJ
Alias
- UMLS CUI [1]
- C0807937
Description
Genehmigung der Krankenkasse
Description
Die Genehmigung der Krankenkasse ist der Abrechnung beizufügen. Endet die Notwendigkeit vor Ablauf des angegebenen Zeitraums, so erlischt damit auch die Kostenverpflichtung. Sollte die SAPV über den letzten Bewilligungstag hinaus erforderlich sein, so ist rechtzeitig vor Ablauf des genehmigten Zeitraums eine erneute Verordnung bei der Krankenkasse einzureichen.
Data type
integer
Alias
- UMLS CUI [1]
- C0262703
Description
insurance coverage
Data type
text
Alias
- UMLS CUI [1]
- C0376629
Description
Signature date
Data type
text
Measurement units
- YYYY-MM-DD
Alias
- UMLS CUI [1]
- C0807937
Description
Patient
Description
Patient Name
Data type
text
Alias
- UMLS CUI [1]
- C1299487
Description
Patient address
Data type
text
Alias
- UMLS CUI [1]
- C0421449
Description
Patient ID
Data type
integer
Alias
- UMLS CUI [1]
- C2348585
Description
Date of birth
Data type
date
Alias
- UMLS CUI [1]
- C0421451
Similar models
KBV Prescription of specialized outpatient palliative care Template 63a
- StudyEvent: ODM
C1522577 (UMLS CUI [1,2])
C0000924 (UMLS CUI [1,2])
C0042066 (UMLS CUI [1,2])
C0043251 (UMLS CUI [1,2])
C0041582 (UMLS CUI [2,1])
C0027651 (UMLS CUI [2,2])
C0037090 (UMLS CUI [2])
C0233401 (UMLS CUI [2])
C0586405 (UMLS CUI [3])
C1719237 (UMLS CUI [2])
C1710470 (UMLS CUI [1,2])
C0028661 (UMLS CUI [1,2])
C0030705 (UMLS CUI [1,2])
C0009818 (UMLS CUI [2,1])
C0080103 (UMLS CUI [2,2])
C0030231 (UMLS CUI [1,2])
C0009818 (UMLS CUI [1,2])
C1551367 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C0030231 (UMLS CUI [1,2])
C0030231 (UMLS CUI [1,2])
C0337611 (UMLS CUI [1,2])
C1549619 (UMLS CUI [1,2])