KBV Transfer Form Preventive cytologic Examination Template 39

Briefkopf
Description

Briefkopf

Name der Krankenversicherung
Description

Health Insurance name

Data type

text

Alias
UMLS CUI [1]
C0021682
Nachname
Description

Patient surname

Data type

text

Alias
UMLS CUI [1]
C0421448
Patientenname
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Adresse des Patienten
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
Patient Geburtsdatum
Description

Patient Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Kostenträgerkennung
Description

Insurance ID

Data type

integer

Alias
UMLS CUI [1]
C1547687
Versichertennummer
Description

Insurance number

Data type

integer

Alias
UMLS CUI [1]
C1549712
Status
Description

Status

Data type

integer

Alias
UMLS CUI [1]
C0449438
Betriebsstättennummer
Description

Facility number

Data type

integer

Alias
UMLS CUI [1]
C1549700
Arzt- Nr.
Description

Physician ID number

Data type

integer

Alias
UMLS CUI [1]
C1548646
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Zytologische Untersuchung
Description

Zytologische Untersuchung

Unters.- Nummer
Description

Examination number

Data type

integer

Alias
UMLS CUI [1]
C2826946
Eingangsdatum
Description

Date of Receipt

Data type

date

Alias
UMLS CUI [1]
C2985846
Lfd.-Nr.
Description

Consecutive number

Data type

integer

Alias
UMLS CUI [1]
C0750480
Die Untersuchung wurde durchgeführt am
Description

date of procedure

Data type

date

Alias
UMLS CUI [1,1]
C2584899
UMLS CUI [1,2]
C0010799
Honorarabrechnung
Description

Honorarabrechnung

Untersuchung gemäß EBM-Nr.
Description

Uniform rating scale

Data type

integer

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0205375
Kostenerstattung für den Versand gemäß BMÄ/E-GO-Nr.
Description

cost refund according to BMÄ/E-GO-Nr.

Data type

integer

Unterschrift
Description

Unterschrift

Datum
Description

Signature date

Data type

date

Alias
UMLS CUI [1]
C0807937

Similar models

KBV Transfer Form Preventive cytologic Examination Template 39

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Briefkopf
Health Insurance name
Item
Name der Krankenversicherung
text
C0021682 (UMLS CUI [1])
Patient surname
Item
Nachname
text
C0421448 (UMLS CUI [1])
Patient Name
Item
Patientenname
text
C1299487 (UMLS CUI [1])
Patient address
Item
Adresse des Patienten
text
C0421449 (UMLS CUI [1])
Patient Birth Date
Item
Patient Geburtsdatum
date
C0421451 (UMLS CUI [1])
Insurance ID
Item
Kostenträgerkennung
integer
C1547687 (UMLS CUI [1])
Insurance number
Item
Versichertennummer
integer
C1549712 (UMLS CUI [1])
Status
Item
Status
integer
C0449438 (UMLS CUI [1])
Facility number
Item
Betriebsstättennummer
integer
C1549700 (UMLS CUI [1])
Physician ID number
Item
Arzt- Nr.
integer
C1548646 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Item Group
Zytologische Untersuchung
Examination number
Item
Unters.- Nummer
integer
C2826946 (UMLS CUI [1])
Date of Receipt
Item
Eingangsdatum
date
C2985846 (UMLS CUI [1])
Consecutive number
Item
Lfd.-Nr.
integer
C0750480 (UMLS CUI [1])
date of procedure
Item
Die Untersuchung wurde durchgeführt am
date
C2584899 (UMLS CUI [1,1])
C0010799 (UMLS CUI [1,2])
Item Group
Honorarabrechnung
Uniform rating scale
Item
Untersuchung gemäß EBM-Nr.
integer
C0681889 (UMLS CUI [1,1])
C0205375 (UMLS CUI [1,2])
cost refund according to BMÄ/E-GO-Nr.
Item
Kostenerstattung für den Versand gemäß BMÄ/E-GO-Nr.
integer
Item Group
Unterschrift
Signature date
Item
Datum
date
C0807937 (UMLS CUI [1])