German English

KBV Transfer Form Preventive cytologic Examination Template 39

1 forms  
Heading
Description

Heading

Health Insurance name
Description

Health Insurance name

Data type

text

Alias
UMLS CUI [1]
C0021682
Patient surname
Description

Patient surname

Data type

text

Alias
UMLS CUI [1]
C0421448
Patient Name
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Patient address
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
Patient Birth Date
Description

Patient Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Insurance ID
Description

Insurance ID

Data type

integer

Alias
UMLS CUI [1]
C1547687
Insurance number
Description

Insurance number

Data type

integer

Alias
UMLS CUI [1]
C1549712
Status
Description

Status

Data type

integer

Alias
UMLS CUI [1]
C0449438
Facility number
Description

Facility number

Data type

integer

Alias
UMLS CUI [1]
C1549700
Physician ID number
Description

Physician ID number

Data type

integer

Alias
UMLS CUI [1]
C1548646
Date
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Cytologic Examination
Description

Cytologic Examination

Examination number
Description

Examination number

Data type

integer

Alias
UMLS CUI [1]
C2826946
Date of Receipt
Description

Date of Receipt

Data type

date

Alias
UMLS CUI [1]
C2985846
Consecutive number
Description

Consecutive number

Data type

integer

Alias
UMLS CUI [1]
C0750480
date of procedure
Description

date of procedure

Data type

date

Alias
UMLS CUI [1,1]
C2584899
UMLS CUI [1,2]
C0010799
Royalty statement
Description

Royalty statement

Uniform rating scale
Description

Uniform rating scale

Data type

integer

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0205375
cost refund according to BMÄ/E-GO-Nr.
Description

cost refund according to BMÄ/E-GO-Nr.

Data type

integer

Signature
Description

Signature

Signature date
Description

Signature date

Data type

date

Alias
UMLS CUI [1]
C0807937
Back to the top of the page

Similar models

KBV Transfer Form Preventive cytologic Examination Template 39

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Health Insurance name
Item
text
C0021682 (UMLS CUI [1])
Patient surname
Item
text
C0421448 (UMLS CUI [1])
Patient Name
Item
text
C1299487 (UMLS CUI [1])
Patient address
Item
text
C0421449 (UMLS CUI [1])
Patient Birth Date
Item
date
C0421451 (UMLS CUI [1])
Insurance ID
Item
integer
C1547687 (UMLS CUI [1])
Insurance number
Item
integer
C1549712 (UMLS CUI [1])
Status
Item
integer
C0449438 (UMLS CUI [1])
Facility number
Item
integer
C1549700 (UMLS CUI [1])
Physician ID number
Item
integer
C1548646 (UMLS CUI [1])
Date
Item
date
C0011008 (UMLS CUI [1])
Examination number
Item
integer
C2826946 (UMLS CUI [1])
Date of Receipt
Item
date
C2985846 (UMLS CUI [1])
Consecutive number
Item
integer
C0750480 (UMLS CUI [1])
date of procedure
Item
date
C2584899 (UMLS CUI [1,1])
C0010799 (UMLS CUI [1,2])
Uniform rating scale
Item
integer
C0681889 (UMLS CUI [1,1])
C0205375 (UMLS CUI [1,2])
cost refund according to BMÄ/E-GO-Nr.
Item
integer
Item Group
Signature
Signature date
Item
Signature date
date
C0807937 (UMLS CUI [1])
Back to the top of the page