ID

20487

Description

Muster 16 - Rezept(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 16 - Drug Prescription (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 (3)
  1. 2/19/17 2/19/17 -
  2. 2/25/17 2/25/17 -
  3. 9/7/17 9/7/17 -
Copyright Holder

Kassenärztliche Bundesvereinigung

Uploaded on

February 25, 2017

DOI

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License

Creative Commons BY-NC 3.0
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KBV Drug Prescription Template 16

German

KBV Drug Prescription Template 16

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
Arzneimittel
Description

Arzneimittel

BVG
Description

court

Data type

integer

Alias
UMLS CUI [1]
C0178572
Hilfsmittel
Description

aid

Data type

integer

Alias
UMLS CUI [1]
C0036605
Impfstoff
Description

vaccine

Data type

integer

Alias
UMLS CUI [1]
C0042210
Spr.-St. Bedarf
Description

consultation needs

Data type

integer

Alias
UMLS CUI [1,1]
C0199298
UMLS CUI [1,2]
C0010186
Begr.-Pflicht
Description

dentristy

Data type

boolean

Alias
UMLS CUI [1]
C0011438
Apotheken-Nummer / IK
Description

Institution number

Data type

text

Alias
UMLS CUI [1]
C0489558
Zuzahlung
Description

additional payment

Data type

float

Alias
UMLS CUI [1]
C2734948
Gesamt-Brutto
Description

total costs

Data type

float

Alias
UMLS CUI [1]
C0010186
Gebühr frei
Description

free of charge

Data type

boolean

Alias
UMLS CUI [1]
C0033077
Geb.-pfl.
Description

medical fees

Data type

boolean

Alias
UMLS CUI [1]
C0033077
noctu
Description

noctu

Data type

boolean

Alias
UMLS CUI [1,1]
C0240526
UMLS CUI [1,2]
C0439609
Sonstige
Description

other

Data type

boolean

Alias
UMLS CUI [1]
C0205394
Unfall
Description

accident

Data type

boolean

Alias
UMLS CUI [1]
C0000924
Arbeitsunfall
Description

work accident

Data type

boolean

Alias
UMLS CUI [1]
C0586557
Arzneimittel-/Hilfsmittel-Nr.
Description

Arzneimittel-/Hilfsmittel-Nr.

Verordnung
Description

Aid number

Data type

integer

Alias
UMLS CUI [1,1]
C0036605
UMLS CUI [1,2]
C0237753
Faktor
Description

factor

Data type

integer

Alias
UMLS CUI [1]
C1521761
Taxe
Description

Tax

Data type

text

Alias
UMLS CUI [1]
C0039371
aut idem
Description

generic drug

Data type

boolean

Alias
UMLS CUI [1]
C0919188
Abgabedatum in der Apotheke
Description

Abgabedatum in der Apotheke

Abgabedatum in der Apotheke
Description

date of submission

Data type

date

Alias
UMLS CUI [1]
C2980090
Bei Arbeitsunfall auszufüllen!
Description

Bei Arbeitsunfall auszufüllen!

Unfalldatum
Description

Accident date

Data type

date

Alias
UMLS CUI [1]
C0000924
Unfallbetrieb oder Arbeitgebernummer
Description

Accident site

Data type

text

Alias
UMLS CUI [1]
C0337069
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Similar models

KBV Drug Prescription Template 16

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
Arzneimittel
court
Item
BVG
integer
C0178572 (UMLS CUI [1])
aid
Item
Hilfsmittel
integer
C0036605 (UMLS CUI [1])
vaccine
Item
Impfstoff
integer
C0042210 (UMLS CUI [1])
consultation needs
Item
Spr.-St. Bedarf
integer
C0199298 (UMLS CUI [1,1])
C0010186 (UMLS CUI [1,2])
dentristy
Item
Begr.-Pflicht
boolean
C0011438 (UMLS CUI [1])
Institution number
Item
Apotheken-Nummer / IK
text
C0489558 (UMLS CUI [1])
additional payment
Item
Zuzahlung
float
C2734948 (UMLS CUI [1])
total costs
Item
Gesamt-Brutto
float
C0010186 (UMLS CUI [1])
free of charge
Item
Gebühr frei
boolean
C0033077 (UMLS CUI [1])
medical fees
Item
Geb.-pfl.
boolean
C0033077 (UMLS CUI [1])
noctu
Item
noctu
boolean
C0240526 (UMLS CUI [1,1])
C0439609 (UMLS CUI [1,2])
other
Item
Sonstige
boolean
C0205394 (UMLS CUI [1])
accident
Item
Unfall
boolean
C0000924 (UMLS CUI [1])
work accident
Item
Arbeitsunfall
boolean
C0586557 (UMLS CUI [1])
Item Group
Arzneimittel-/Hilfsmittel-Nr.
Aid number
Item
Verordnung
integer
C0036605 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
factor
Item
Faktor
integer
C1521761 (UMLS CUI [1])
Tax
Item
Taxe
text
C0039371 (UMLS CUI [1])
generic drug
Item
aut idem
boolean
C0919188 (UMLS CUI [1])
Item Group
Abgabedatum in der Apotheke
date of submission
Item
Abgabedatum in der Apotheke
date
C2980090 (UMLS CUI [1])
Item Group
Bei Arbeitsunfall auszufüllen!
Accident date
Item
Unfalldatum
date
C0000924 (UMLS CUI [1])
Accident site
Item
Unfallbetrieb oder Arbeitgebernummer
text
C0337069 (UMLS CUI [1])
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