ID

25584

Description

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

Keywords

Versions (2)
  1. 12/21/16 12/21/16 -
  2. 9/6/17 9/6/17 -
Copyright Holder

KBV

Uploaded on

September 6, 2017

DOI

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License

Creative Commons BY-NC 3.0
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KBV Request form laboratory services Template 10A

German

KBV Request form laboratory services Template 10A

1 forms  
Briefkopf
Description

Briefkopf

Krankenkasse bzw. Kostenträger
Description

Health Insurance name

Data type

text

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

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Adresse des Versicherten
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
geb. am
Description

Patient Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Kostenträgerkennung
Description

Insurance Company ID

Data type

integer

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

Insurance number

Data type

integer

Alias
UMLS CUI [1]
C1549712
Status
Description

Status

Data type

integer

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

Facility ID

Data type

integer

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

Physician ID

Data type

integer

Alias
UMLS CUI [1]
C1548646
Datum
Description

Date

Data type

date

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

Anforderungsschein für Laboratoriumsuntersuchungen bei Laborgemeinschaften

Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Kurativ
Description

Curative

Data type

boolean

Alias
UMLS CUI [1]
C1276305
Präventiv
Description

Preventive

Data type

boolean

Alias
UMLS CUI [1]
C0199176
Bei Belegärztlicher Behandlung
Description

Treatment by affiliate physician

Data type

boolean

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

Accident

Data type

boolean

Alias
UMLS CUI [1]
C0000924
Barcode
Description

Barcode

Data type

text

Alias
UMLS CUI [1]
C0004738
Kennziffer
Description

Code number

Data type

text

Alias
UMLS CUI [1]
C0600091
Geschlecht
Description

Gender

Data type

text

Alias
UMLS CUI [1]
C0079399
Abnahmedatum
Description

Date of blood collection

Data type

date

Measurement units
  • TTMMJJ
Alias
UMLS CUI [1]
C1302413
TTMMJJ
Abnahmezeit
Description

Time of blood collection

Data type

time

Measurement units
  • hhmm
Alias
UMLS CUI [1]
C0944745
hhmm
Diagnose
Description

Diagnosis

Data type

text

Alias
UMLS CUI [1]
C0011900
Befundübermittlung eilt
Description

Urgent procedure

Data type

boolean

Alias
UMLS CUI [1]
C3272275
EDTA Blut
Description

EDTA Blut

Großes Blutbild
Description

Blood count

Data type

boolean

Alias
UMLS CUI [1]
C0005771
Kleines Blutbild
Description

Blood count

Data type

boolean

Alias
UMLS CUI [1]
C0005771
HbA1c
Description

HbA1C

Data type

boolean

Alias
UMLS CUI [1]
C0019018
Retikulozyten
Description

Reticulocytes

Data type

boolean

Alias
UMLS CUI [1]
C0206161
Blutsenkung
Description

ESR

Data type

boolean

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

Differential blood count

Data type

boolean

Alias
UMLS CUI [1]
C0162401
Citrat
Description

Citrat

Quick
Description

Quick

Data type

boolean

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

Quick during marcoumar treatment

Data type

boolean

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

Thrombin time

Data type

boolean

Alias
UMLS CUI [1]
C0677634
PTT
Description

PTT value

Data type

boolean

Alias
UMLS CUI [1]
C0030605
Fibrinogen
Description

Fibrinogen

Data type

boolean

Alias
UMLS CUI [1]
C0337428
Serum Vollblut
Description

Serum Vollblut

Alkalische Phosphatase
Description

Alkaline Phosphatase

Data type

boolean

Alias
UMLS CUI [1]
C0484638
Amylase
Description

Amylase measurement

Data type

boolean

Alias
UMLS CUI [1]
C0201883
ASL
Description

Antistreptolysin

Data type

boolean

Alias
UMLS CUI [1]
C1318462
Bilirubin direkt
Description

Direct Bilirubin

Data type

boolean

Alias
UMLS CUI [1]
C0201916
Gesamtbilirubin
Description

total bilirubin

Data type

boolean

Alias
UMLS CUI [1]
C0201913
Calcium
Description

Calcium

Data type

boolean

Alias
UMLS CUI [1]
C0201925
Cholesterin
Description

Cholesterin

Data type

boolean

Alias
UMLS CUI [1]
C1445957
Cholinesterase
Description

Cholinesterase

Data type

boolean

Alias
UMLS CUI [1]
C0202207
CK
Description

Creatin kinase

Data type

boolean

Alias
UMLS CUI [1]
C0201973
CK-MB
Description

Creatine Kinase MB Measurement

Data type

boolean

Alias
UMLS CUI [1]
C0523584
CRP
Description

CRP

Data type

boolean

Alias
UMLS CUI [1]
C0006560
Eisen
Description

Iron

Data type

boolean

Alias
UMLS CUI [1]
C0337439
Eiweiß Elektrophorese
Description

Protein electrophoresis

Data type

boolean

Alias
UMLS CUI [1]
C0201720
Gesamteiweiß
Description

Total protein

Data type

boolean

Alias
UMLS CUI [1]
C0555903
y-GT
Description

gamma GT

Data type

boolean

Alias
UMLS CUI [1]
C0202035
Glukose
Description

Glucose

Data type

boolean

Alias
UMLS CUI [1]
C0337438
GOT
Description

GOT

Data type

boolean

Alias
UMLS CUI [1]
C0004002
GPT
Description

GPT

Data type

boolean

Alias
UMLS CUI [1]
C0201836
Harnsäure
Description

Uric acid

Data type

boolean

Alias
UMLS CUI [1]
C0202239
Harnstoff
Description

Urea measurement

Data type

boolean

Alias
UMLS CUI [1]
C0523961
HBDH
Description

HBDH

Data type

boolean

Alias
UMLS CUI [1]
C1278046
HDL-Cholesterin
Description

HDL-Cholesterol

Data type

boolean

Alias
UMLS CUI [1]
C0023822
IgA
Description

IgA

Data type

boolean

Alias
UMLS CUI [1]
C0202083
IgG
Description

IgG

Data type

boolean

Alias
UMLS CUI [1]
C0202087
IgM
Description

IgM

Data type

boolean

Alias
UMLS CUI [1]
C0202084
Kalium
Description

Potassium

Data type

boolean

Alias
UMLS CUI [1]
C0202194
Kreatinin
Description

Creatinine

Data type

boolean

Alias
UMLS CUI [1]
C0201976
Kreatinin Clearance
Description

Creatinine clearance

Data type

boolean

Alias
UMLS CUI [1]
C0373595
LDH
Description

LDH

Data type

boolean

Alias
UMLS CUI [1]
C0202113
LDL-Cholesterin
Description

LDL-Cholesterol

Data type

boolean

Alias
UMLS CUI [1]
C0202117
Lipase
Description

Lipase measurement

Data type

boolean

Alias
UMLS CUI [1]
C0373670
Natrium
Description

Sodium

Data type

boolean

Alias
UMLS CUI [1]
C0337443
OP-Vorbereitung
Description

OP-Prep

Data type

boolean

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

Phosphate inorganic

Data type

boolean

Alias
UMLS CUI [1]
C0031603
Transferrin
Description

Transferrin

Data type

boolean

Alias
UMLS CUI [1]
C0202105
Triglyceride
Description

Triglycerides

Data type

boolean

Alias
UMLS CUI [1]
C0202236
TSH basal
Description

TSH

Data type

boolean

Alias
UMLS CUI [1]
C0202230
TSH nach TRH
Description

TSH post TRH

Data type

boolean

Alias
UMLS CUI [1]
C0800893
Glukose
Description

Glukose

Glukose 1
Description

Glucose

Data type

boolean

Alias
UMLS CUI [1]
C0337438
Glukose 2
Description

Glucose

Data type

boolean

Alias
UMLS CUI [1]
C0337438
Glukose 3
Description

Glucose

Data type

boolean

Alias
UMLS CUI [1]
C0337438
Glukose 4
Description

Glucose

Data type

boolean

Alias
UMLS CUI [1]
C0337438
Urin
Description

Urin

Urin Status
Description

Urine status

Data type

boolean

Alias
UMLS CUI [1]
C0421368
Mikroalbumin
Description

Microalbumin measurement

Data type

boolean

Alias
UMLS CUI [1]
C0740086
Schwangerschaftstest
Description

Pregnancy test

Data type

boolean

Alias
UMLS CUI [1]
C0032976
Glucose
Description

Glucose measurement, urine

Data type

boolean

Alias
UMLS CUI [1]
C0004076
Amylase
Description

Amylase measurement urine

Data type

boolean

Alias
UMLS CUI [1]
C0201886
Sediment
Description

Urine Sediment Analysis Measurement

Data type

boolean

Alias
UMLS CUI [1]
C2700128
Sonstiges
Description

Sonstiges

Sonstiges
Description

Other

Data type

text

Alias
UMLS CUI [1]
C0205394
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Similar models

KBV Request form laboratory services Template 10A

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
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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