ID

25584

Beschrijving

Muster 10A - Anforderungsschein für Laboratoriumsuntersuchungen bei Laborgemeinschaften Freigabe: 01.09.2014) - 10.2014, 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 Forms for contract medical care 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

www.kbv.de

Trefwoorden

Versies (2)
  1. 21-12-16 21-12-16 -
  2. 06-09-17 06-09-17 -
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KBV Request form laboratory services Template 10A

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KBV Request form laboratory services Template 10A

1 Formulieren  
Briefkopf
Beschrijving

Briefkopf

Krankenkasse bzw. Kostenträger
Beschrijving

Health Insurance name

Datatype

text

Alias
UMLS CUI [1]
C0021682
Name, Vorname des Versicherten
Beschrijving

Patient Name

Datatype

text

Alias
UMLS CUI [1]
C1299487
Adresse des Versicherten
Beschrijving

Patient address

Datatype

text

Alias
UMLS CUI [1]
C0421449
geb. am
Beschrijving

Patient Birth Date

Datatype

date

Alias
UMLS CUI [1]
C0421451
Kostenträgerkennung
Beschrijving

Insurance Company ID

Datatype

integer

Alias
UMLS CUI [1]
C1547687
Versicherten-Nr.
Beschrijving

Insurance number

Datatype

integer

Alias
UMLS CUI [1]
C1549712
Status
Beschrijving

Status

Datatype

integer

Alias
UMLS CUI [1]
C0449438
Betriebsstätten-Nr.
Beschrijving

Facility ID

Datatype

integer

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

Physician ID

Datatype

integer

Alias
UMLS CUI [1]
C1548646
Datum
Beschrijving

Date

Datatype

date

Alias
UMLS CUI [1]
C0011008
Anforderungsschein für Laboratoriumsuntersuchungen bei Laborgemeinschaften
Beschrijving

Anforderungsschein für Laboratoriumsuntersuchungen bei Laborgemeinschaften

Datum
Beschrijving

Date

Datatype

date

Alias
UMLS CUI [1]
C0011008
Kurativ
Beschrijving

Curative

Datatype

boolean

Alias
UMLS CUI [1]
C1276305
Präventiv
Beschrijving

Preventive

Datatype

boolean

Alias
UMLS CUI [1]
C0199176
Bei Belegärztlicher Behandlung
Beschrijving

Treatment by affiliate physician

Datatype

boolean

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C1510825
UMLS CUI [1,3]
C0031831
Unfall und Unfallfolgen
Beschrijving

Accident

Datatype

boolean

Alias
UMLS CUI [1]
C0000924
Barcode
Beschrijving

Barcode

Datatype

text

Alias
UMLS CUI [1]
C0004738
Kennziffer
Beschrijving

Code number

Datatype

text

Alias
UMLS CUI [1]
C0600091
Geschlecht
Beschrijving

Gender

Datatype

text

Alias
UMLS CUI [1]
C0079399
Abnahmedatum
Beschrijving

Date of blood collection

Datatype

date

Maateenheden
  • TTMMJJ
Alias
UMLS CUI [1]
C1302413
TTMMJJ
Abnahmezeit
Beschrijving

Time of blood collection

Datatype

time

Maateenheden
  • hhmm
Alias
UMLS CUI [1]
C0944745
hhmm
Diagnose
Beschrijving

Diagnosis

Datatype

text

Alias
UMLS CUI [1]
C0011900
Befundübermittlung eilt
Beschrijving

Urgent procedure

Datatype

boolean

Alias
UMLS CUI [1]
C3272275
EDTA Blut
Beschrijving

EDTA Blut

Großes Blutbild
Beschrijving

Blood count

Datatype

boolean

Alias
UMLS CUI [1]
C0005771
Kleines Blutbild
Beschrijving

Blood count

Datatype

boolean

Alias
UMLS CUI [1]
C0005771
HbA1c
Beschrijving

HbA1C

Datatype

boolean

Alias
UMLS CUI [1]
C0019018
Retikulozyten
Beschrijving

Reticulocytes

Datatype

boolean

Alias
UMLS CUI [1]
C0206161
Blutsenkung
Beschrijving

ESR

Datatype

boolean

Alias
UMLS CUI [1]
C1176468
Diff. Blutbild/Ausstrich
Beschrijving

Differential blood count

Datatype

boolean

Alias
UMLS CUI [1]
C0162401
Citrat
Beschrijving

Citrat

Quick
Beschrijving

Quick

Datatype

boolean

Alias
UMLS CUI [1]
C0086890
Quick unter Marcumar-Therapie
Beschrijving

Quick during marcoumar treatment

Datatype

boolean

Alias
UMLS CUI [1,1]
C0086890
UMLS CUI [1,2]
C0918269
Thrombinzeit
Beschrijving

Thrombin time

Datatype

boolean

Alias
UMLS CUI [1]
C0677634
PTT
Beschrijving

PTT value

Datatype

boolean

Alias
UMLS CUI [1]
C0030605
Fibrinogen
Beschrijving

Fibrinogen

Datatype

boolean

Alias
UMLS CUI [1]
C0337428
Serum Vollblut
Beschrijving

Serum Vollblut

Alkalische Phosphatase
Beschrijving

Alkaline Phosphatase

Datatype

boolean

Alias
UMLS CUI [1]
C0484638
Amylase
Beschrijving

Amylase measurement

Datatype

boolean

Alias
UMLS CUI [1]
C0201883
ASL
Beschrijving

Antistreptolysin

Datatype

boolean

Alias
UMLS CUI [1]
C1318462
Bilirubin direkt
Beschrijving

Direct Bilirubin

Datatype

boolean

Alias
UMLS CUI [1]
C0201916
Gesamtbilirubin
Beschrijving

total bilirubin

Datatype

boolean

Alias
UMLS CUI [1]
C0201913
Calcium
Beschrijving

Calcium

Datatype

boolean

Alias
UMLS CUI [1]
C0201925
Cholesterin
Beschrijving

Cholesterin

Datatype

boolean

Alias
UMLS CUI [1]
C1445957
Cholinesterase
Beschrijving

Cholinesterase

Datatype

boolean

Alias
UMLS CUI [1]
C0202207
CK
Beschrijving

Creatin kinase

Datatype

boolean

Alias
UMLS CUI [1]
C0201973
CK-MB
Beschrijving

Creatine Kinase MB Measurement

Datatype

boolean

Alias
UMLS CUI [1]
C0523584
CRP
Beschrijving

CRP

Datatype

boolean

Alias
UMLS CUI [1]
C0006560
Eisen
Beschrijving

Iron

Datatype

boolean

Alias
UMLS CUI [1]
C0337439
Eiweiß Elektrophorese
Beschrijving

Protein electrophoresis

Datatype

boolean

Alias
UMLS CUI [1]
C0201720
Gesamteiweiß
Beschrijving

Total protein

Datatype

boolean

Alias
UMLS CUI [1]
C0555903
y-GT
Beschrijving

gamma GT

Datatype

boolean

Alias
UMLS CUI [1]
C0202035
Glukose
Beschrijving

Glucose

Datatype

boolean

Alias
UMLS CUI [1]
C0337438
GOT
Beschrijving

GOT

Datatype

boolean

Alias
UMLS CUI [1]
C0004002
GPT
Beschrijving

GPT

Datatype

boolean

Alias
UMLS CUI [1]
C0201836
Harnsäure
Beschrijving

Uric acid

Datatype

boolean

Alias
UMLS CUI [1]
C0202239
Harnstoff
Beschrijving

Urea measurement

Datatype

boolean

Alias
UMLS CUI [1]
C0523961
HBDH
Beschrijving

HBDH

Datatype

boolean

Alias
UMLS CUI [1]
C1278046
HDL-Cholesterin
Beschrijving

HDL-Cholesterol

Datatype

boolean

Alias
UMLS CUI [1]
C0023822
IgA
Beschrijving

IgA

Datatype

boolean

Alias
UMLS CUI [1]
C0202083
IgG
Beschrijving

IgG

Datatype

boolean

Alias
UMLS CUI [1]
C0202087
IgM
Beschrijving

IgM

Datatype

boolean

Alias
UMLS CUI [1]
C0202084
Kalium
Beschrijving

Potassium

Datatype

boolean

Alias
UMLS CUI [1]
C0202194
Kreatinin
Beschrijving

Creatinine

Datatype

boolean

Alias
UMLS CUI [1]
C0201976
Kreatinin Clearance
Beschrijving

Creatinine clearance

Datatype

boolean

Alias
UMLS CUI [1]
C0373595
LDH
Beschrijving

LDH

Datatype

boolean

Alias
UMLS CUI [1]
C0202113
LDL-Cholesterin
Beschrijving

LDL-Cholesterol

Datatype

boolean

Alias
UMLS CUI [1]
C0202117
Lipase
Beschrijving

Lipase measurement

Datatype

boolean

Alias
UMLS CUI [1]
C0373670
Natrium
Beschrijving

Sodium

Datatype

boolean

Alias
UMLS CUI [1]
C0337443
OP-Vorbereitung
Beschrijving

OP-Prep

Datatype

boolean

Alias
UMLS CUI [1,1]
C0543467
UMLS CUI [1,2]
C1521827
Phosphat, anorganisches
Beschrijving

Phosphate inorganic

Datatype

boolean

Alias
UMLS CUI [1]
C0031603
Transferrin
Beschrijving

Transferrin

Datatype

boolean

Alias
UMLS CUI [1]
C0202105
Triglyceride
Beschrijving

Triglycerides

Datatype

boolean

Alias
UMLS CUI [1]
C0202236
TSH basal
Beschrijving

TSH

Datatype

boolean

Alias
UMLS CUI [1]
C0202230
TSH nach TRH
Beschrijving

TSH post TRH

Datatype

boolean

Alias
UMLS CUI [1]
C0800893
Glukose
Beschrijving

Glukose

Glukose 1
Beschrijving

Glucose

Datatype

boolean

Alias
UMLS CUI [1]
C0337438
Glukose 2
Beschrijving

Glucose

Datatype

boolean

Alias
UMLS CUI [1]
C0337438
Glukose 3
Beschrijving

Glucose

Datatype

boolean

Alias
UMLS CUI [1]
C0337438
Glukose 4
Beschrijving

Glucose

Datatype

boolean

Alias
UMLS CUI [1]
C0337438
Urin
Beschrijving

Urin

Urin Status
Beschrijving

Urine status

Datatype

boolean

Alias
UMLS CUI [1]
C0421368
Mikroalbumin
Beschrijving

Microalbumin measurement

Datatype

boolean

Alias
UMLS CUI [1]
C0740086
Schwangerschaftstest
Beschrijving

Pregnancy test

Datatype

boolean

Alias
UMLS CUI [1]
C0032976
Glucose
Beschrijving

Glucose measurement, urine

Datatype

boolean

Alias
UMLS CUI [1]
C0004076
Amylase
Beschrijving

Amylase measurement urine

Datatype

boolean

Alias
UMLS CUI [1]
C0201886
Sediment
Beschrijving

Urine Sediment Analysis Measurement

Datatype

boolean

Alias
UMLS CUI [1]
C2700128
Sonstiges
Beschrijving

Sonstiges

Sonstiges
Beschrijving

Other

Datatype

text

Alias
UMLS CUI [1]
C0205394
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Similar models

KBV Request form laboratory services Template 10A

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Briefkopf
Health Insurance name
Item
Krankenkasse bzw. Kostenträger
text
C0021682 (UMLS CUI [1])
Patient Name
Item
Name, Vorname des Versicherten
text
C1299487 (UMLS CUI [1])
Patient address
Item
Adresse des Versicherten
text
C0421449 (UMLS CUI [1])
Patient Birth Date
Item
geb. am
date
C0421451 (UMLS CUI [1])
Insurance Company ID
Item
Kostenträgerkennung
integer
C1547687 (UMLS CUI [1])
Insurance number
Item
Versicherten-Nr.
integer
C1549712 (UMLS CUI [1])
Status
Item
Status
integer
C0449438 (UMLS CUI [1])
Facility ID
Item
Betriebsstätten-Nr.
integer
C1549700 (UMLS CUI [1])
Physician ID
Item
Arzt-Nr.
integer
C1548646 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Item Group
Anforderungsschein für Laboratoriumsuntersuchungen bei Laborgemeinschaften
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Curative
Item
Kurativ
boolean
C1276305 (UMLS CUI [1])
Preventive
Item
Präventiv
boolean
C0199176 (UMLS CUI [1])
Treatment by affiliate physician
Item
Bei Belegärztlicher Behandlung
boolean
C0087111 (UMLS CUI [1,1])
C1510825 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,3])
Accident
Item
Unfall und Unfallfolgen
boolean
C0000924 (UMLS CUI [1])
Barcode
Item
Barcode
text
C0004738 (UMLS CUI [1])
Code number
Item
Kennziffer
text
C0600091 (UMLS CUI [1])
Item
Geschlecht
text
C0079399 (UMLS CUI [1])
Gender
Code List
Geschlecht
CL Item
W (W)
CL Item
M (M)
Date of blood collection
Item
Abnahmedatum
date
C1302413 (UMLS CUI [1])
Time of blood collection
Item
Abnahmezeit
time
C0944745 (UMLS CUI [1])
Diagnosis
Item
Diagnose
text
C0011900 (UMLS CUI [1])
Urgent procedure
Item
Befundübermittlung eilt
boolean
C3272275 (UMLS CUI [1])
Item Group
EDTA Blut
Blood count
Item
Großes Blutbild
boolean
C0005771 (UMLS CUI [1])
Blood count
Item
Kleines Blutbild
boolean
C0005771 (UMLS CUI [1])
HbA1C
Item
HbA1c
boolean
C0019018 (UMLS CUI [1])
Reticulocytes
Item
Retikulozyten
boolean
C0206161 (UMLS CUI [1])
ESR
Item
Blutsenkung
boolean
C1176468 (UMLS CUI [1])
Differential blood count
Item
Diff. Blutbild/Ausstrich
boolean
C0162401 (UMLS CUI [1])
Item Group
Citrat
Quick
Item
Quick
boolean
C0086890 (UMLS CUI [1])
Quick during marcoumar treatment
Item
Quick unter Marcumar-Therapie
boolean
C0086890 (UMLS CUI [1,1])
C0918269 (UMLS CUI [1,2])
Thrombin time
Item
Thrombinzeit
boolean
C0677634 (UMLS CUI [1])
PTT value
Item
PTT
boolean
C0030605 (UMLS CUI [1])
Fibrinogen
Item
Fibrinogen
boolean
C0337428 (UMLS CUI [1])
Item Group
Serum Vollblut
Alkaline Phosphatase
Item
Alkalische Phosphatase
boolean
C0484638 (UMLS CUI [1])
Amylase measurement
Item
Amylase
boolean
C0201883 (UMLS CUI [1])
Antistreptolysin
Item
ASL
boolean
C1318462 (UMLS CUI [1])
Direct Bilirubin
Item
Bilirubin direkt
boolean
C0201916 (UMLS CUI [1])
total bilirubin
Item
Gesamtbilirubin
boolean
C0201913 (UMLS CUI [1])
Calcium
Item
Calcium
boolean
C0201925 (UMLS CUI [1])
Cholesterin
Item
Cholesterin
boolean
C1445957 (UMLS CUI [1])
Cholinesterase
Item
Cholinesterase
boolean
C0202207 (UMLS CUI [1])
Creatin kinase
Item
CK
boolean
C0201973 (UMLS CUI [1])
Creatine Kinase MB Measurement
Item
CK-MB
boolean
C0523584 (UMLS CUI [1])
CRP
Item
CRP
boolean
C0006560 (UMLS CUI [1])
Iron
Item
Eisen
boolean
C0337439 (UMLS CUI [1])
Protein electrophoresis
Item
Eiweiß Elektrophorese
boolean
C0201720 (UMLS CUI [1])
Total protein
Item
Gesamteiweiß
boolean
C0555903 (UMLS CUI [1])
gamma GT
Item
y-GT
boolean
C0202035 (UMLS CUI [1])
Glucose
Item
Glukose
boolean
C0337438 (UMLS CUI [1])
GOT
Item
GOT
boolean
C0004002 (UMLS CUI [1])
GPT
Item
GPT
boolean
C0201836 (UMLS CUI [1])
Uric acid
Item
Harnsäure
boolean
C0202239 (UMLS CUI [1])
Urea measurement
Item
Harnstoff
boolean
C0523961 (UMLS CUI [1])
HBDH
Item
HBDH
boolean
C1278046 (UMLS CUI [1])
HDL-Cholesterol
Item
HDL-Cholesterin
boolean
C0023822 (UMLS CUI [1])
IgA
Item
IgA
boolean
C0202083 (UMLS CUI [1])
IgG
Item
IgG
boolean
C0202087 (UMLS CUI [1])
IgM
Item
IgM
boolean
C0202084 (UMLS CUI [1])
Potassium
Item
Kalium
boolean
C0202194 (UMLS CUI [1])
Creatinine
Item
Kreatinin
boolean
C0201976 (UMLS CUI [1])
Creatinine clearance
Item
Kreatinin Clearance
boolean
C0373595 (UMLS CUI [1])
LDH
Item
LDH
boolean
C0202113 (UMLS CUI [1])
LDL-Cholesterol
Item
LDL-Cholesterin
boolean
C0202117 (UMLS CUI [1])
Lipase measurement
Item
Lipase
boolean
C0373670 (UMLS CUI [1])
Sodium
Item
Natrium
boolean
C0337443 (UMLS CUI [1])
OP-Prep
Item
OP-Vorbereitung
boolean
C0543467 (UMLS CUI [1,1])
C1521827 (UMLS CUI [1,2])
Phosphate inorganic
Item
Phosphat, anorganisches
boolean
C0031603 (UMLS CUI [1])
Transferrin
Item
Transferrin
boolean
C0202105 (UMLS CUI [1])
Triglycerides
Item
Triglyceride
boolean
C0202236 (UMLS CUI [1])
TSH
Item
TSH basal
boolean
C0202230 (UMLS CUI [1])
TSH post TRH
Item
TSH nach TRH
boolean
C0800893 (UMLS CUI [1])
Item Group
Glukose
Glucose
Item
Glukose 1
boolean
C0337438 (UMLS CUI [1])
Glucose
Item
Glukose 2
boolean
C0337438 (UMLS CUI [1])
Glucose
Item
Glukose 3
boolean
C0337438 (UMLS CUI [1])
Glucose
Item
Glukose 4
boolean
C0337438 (UMLS CUI [1])
Item Group
Urin
Urine status
Item
Urin Status
boolean
C0421368 (UMLS CUI [1])
Microalbumin measurement
Item
Mikroalbumin
boolean
C0740086 (UMLS CUI [1])
Pregnancy test
Item
Schwangerschaftstest
boolean
C0032976 (UMLS CUI [1])
Glucose measurement, urine
Item
Glucose
boolean
C0004076 (UMLS CUI [1])
Amylase measurement urine
Item
Amylase
boolean
C0201886 (UMLS CUI [1])
Urine Sediment Analysis Measurement
Item
Sediment
boolean
C2700128 (UMLS CUI [1])
Item Group
Sonstiges
Other
Item
Sonstiges
text
C0205394 (UMLS CUI [1])
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