ID

20238

Description

Muster 15 - Ohrenärztliche Verordnung einer Hörhilfe (Freigabe 01.09.2014). 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 15 - Prescription of Hearing Aids (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

www.kbv.de

Keywords

Versions (6)
  1. 2/15/17 2/15/17 -
  2. 2/23/17 2/23/17 -
  3. 2/25/17 2/25/17 -
  4. 2/25/17 2/25/17 -
  5. 3/3/17 3/3/17 -
  6. 9/7/17 9/7/17 -
Uploaded on

February 15, 2017

DOI

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License

Creative Commons BY-NC 3.0
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KBV Prescription of Hearing Aids Template 15

German

KBV Prescription of Hearing Aids Template 15

1 forms  
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
Ohrenärztliche Verordnung einer Hörhilfe
Description

Ohrenärztliche Verordnung einer Hörhilfe

IK des Leistungserbringers
Description

Institution number

Data type

text

Alias
UMLS CUI [1]
C0489558
Rechnungsnummer
Description

Account number

Data type

text

Alias
UMLS CUI [1]
C1549676
Belegnummer
Description

Billing code

Data type

text

Alias
UMLS CUI [1]
C1547149
Der Anspruchsberechtigte war schon Träger eines Gerätes
Description

hearing aids

Data type

boolean

Alias
UMLS CUI [1]
C0018768
Falls ja, warum entspricht das bisher getragene Gerät nicht mehr den Anforderungen?
Description

hearing aids indication

Data type

text

Alias
UMLS CUI [1,1]
C0018768
UMLS CUI [1,2]
C0392360
Ohrbefund
Description

Ohrbefund

Gehörgang
Description

ear canal

Data type

integer

Alias
UMLS CUI [1,1]
C0013444
UMLS CUI [1,2]
C0205090
Trommelfell
Description

ear drums

Data type

integer

Alias
UMLS CUI [1]
C0206504
Hörverlust in dB
Description

hearing loss

Data type

integer

Alias
UMLS CUI [1,1]
C3887873
UMLS CUI [1,2]
C0205090
Unbehaglichkeitsschwelle
Description

threshold of discomfort

Data type

integer

Measurement units
  • dB
Alias
UMLS CUI [1,1]
C0004312
UMLS CUI [1,2]
C0234215
UMLS CUI [1,3]
C0205090
dB
Diagnose
Description

Diagnose

Diagnose
Description

Diagnosis

Data type

text

Alias
UMLS CUI [1]
C0011900
Hörhilfe ist notwendig
Description

hearing aids

Data type

integer

Alias
UMLS CUI [1,1]
C0018768
UMLS CUI [1,2]
C0392360
rechts
Description

tinnitus masker

Data type

integer

Measurement units
  • kHz
Alias
UMLS CUI [1,1]
C0492828
UMLS CUI [1,2]
C3887873
UMLS CUI [1,3]
C0205090
kHz
verdeckbar dB
Description

tinnitus masker sensational level

Data type

integer

Alias
UMLS CUI [1,1]
C0492828
UMLS CUI [1,2]
C0430655
UMLS CUI [1,3]
C0205090
links
Description

tinnitus masker

Data type

integer

Measurement units
  • kHz
Alias
UMLS CUI [1,1]
C0492828
UMLS CUI [1,2]
C3887873
UMLS CUI [1,3]
C0205091
kHz
verdeckbar dB
Description

tinnitus masker sensational level

Data type

integer

Alias
UMLS CUI [1,1]
C0492828
UMLS CUI [1,2]
C0430655
UMLS CUI [1,3]
C0205091
Die Schwerhörigkeit ist Folge von
Description

Die audiometrischen Untersuchungen wurden von mir bzw. unter meiner Verantwortung vorgenommen

Data type

integer

Alias
UMLS CUI [1,1]
C3887873
UMLS CUI [1,2]
C1314792
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Similar models

KBV Prescription of Hearing Aids Template 15

1 forms
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
Ohrenärztliche Verordnung einer Hörhilfe
Institution number
Item
IK des Leistungserbringers
text
C0489558 (UMLS CUI [1])
Account number
Item
Rechnungsnummer
text
C1549676 (UMLS CUI [1])
Billing code
Item
Belegnummer
text
C1547149 (UMLS CUI [1])
hearing aids
Item
Der Anspruchsberechtigte war schon Träger eines Gerätes
boolean
C0018768 (UMLS CUI [1])
hearing aids indication
Item
Falls ja, warum entspricht das bisher getragene Gerät nicht mehr den Anforderungen?
text
C0018768 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Item Group
Ohrbefund
Item
Gehörgang
integer
C0013444 (UMLS CUI [1,1])
C0205090 (UMLS CUI [1,2])
ear canal
Code List
Gehörgang
CL Item
normal (1)
CL Item
operativ erweitert (2)
CL Item
eng (3)
Item
Trommelfell
integer
C0206504 (UMLS CUI [1])
ear drums
Code List
Trommelfell
CL Item
intakt (1)
CL Item
durchlöchert (2)
CL Item
feucht (3)
hearing loss
Item
Hörverlust in dB
integer
C3887873 (UMLS CUI [1,1])
C0205090 (UMLS CUI [1,2])
threshold of discomfort
Item
Unbehaglichkeitsschwelle
integer
C0004312 (UMLS CUI [1,1])
C0234215 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
Item Group
Diagnose
Diagnosis
Item
Diagnose
text
C0011900 (UMLS CUI [1])
Item
Hörhilfe ist notwendig
integer
C0018768 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
hearing aids
Code List
Hörhilfe ist notwendig
CL Item
rechts (1)
CL Item
links  (2)
CL Item
beiderseits (3)
tinnitus masker
Item
rechts
integer
C0492828 (UMLS CUI [1,1])
C3887873 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
tinnitus masker sensational level
Item
verdeckbar dB
integer
C0492828 (UMLS CUI [1,1])
C0430655 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
tinnitus masker
Item
links
integer
C0492828 (UMLS CUI [1,1])
C3887873 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
tinnitus masker sensational level
Item
verdeckbar dB
integer
C0492828 (UMLS CUI [1,1])
C0430655 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
Item
Die Schwerhörigkeit ist Folge von
integer
C3887873 (UMLS CUI [1,1])
C1314792 (UMLS CUI [1,2])
hearing loss cause
Code List
Die Schwerhörigkeit ist Folge von
CL Item
Unfall, Unfallfolgen (1)
CL Item
Versorgunsleiden (BVG) (2)
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