ID

17203

Description

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 (1)
  1. 8/31/16 8/31/16 -
Uploaded on

August 31, 2016

DOI

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License

Creative Commons BY-NC 3.0
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Approval of insurance claim for psychotherapy

German

Approval of insurance claim for psychotherapy

1 forms  
Briefkopf
Description

Briefkopf

Name und Anschrift der Krankenversicherung
Description

Health Insurance name and address

Data type

text

Alias
UMLS CUI [1,1]
C0021682
UMLS CUI [1,2]
C1442065
Name und Anschrift des Patienten
Description

Name and address of the patient

Data type

text

Alias
UMLS CUI [1,1]
C0030705
UMLS CUI [1,2]
C1442065
Antrag vom
Description

Date of application

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1947919
Bewilligung
Description

Bewilligung

Wir erkennen unsere Leistungspflicht an
Description

Diese Feststellung gilt nur so lange, wie ein Leistungsanspsruch gegenüber unserer Krankenkasse besteht. Wir bitten einen Wechsel der Krankenkasse sowohl uns als auch dem Therapeuten unverzüglich mitzuteilen.

Data type

boolean

Alias
UMLS CUI [1,1]
C0162399
UMLS CUI [1,2]
C0021674
Therapieform
Description

Psychotherapy type

Data type

integer

Alias
UMLS CUI [1,1]
C0033968
UMLS CUI [1,2]
C0332307
BMÄ/E-Go Nummer Einzelbehandlung
Description

Uniform rating scale individual treatment

Data type

integer

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C2048936
Bewilligte Stunden pro Woche
Description

Hours per week granted

Data type

integer

Alias
UMLS CUI [1]
C0556976
Durchschnittliche Frequenz pro Woche in Std
Description

Frequency per week

Data type

integer

Alias
UMLS CUI [1]
C0585296
BMÄ/E-Go Nummer Einzelbehandlung zuzüglich der Einbeziehung der Bezugsperson
Description

Rating scale individual treatment inclusion of contact person

Data type

integer

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C2048936
UMLS CUI [1,3]
C0337611
Bewilligte Stunden pro Woche
Description

Hours per week granted

Data type

integer

Alias
UMLS CUI [1]
C0556976
Durchschnittliche Frequenz pro Woche in Std
Description

Frequency per week

Data type

integer

Alias
UMLS CUI [1]
C0585296
BMÄ/E-Go Nummer Gruppenbehandlung
Description

Uniform rating scale group therapy

Data type

integer

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0033971
Bewilligte Stunden pro Woche
Description

Hours per week granted

Data type

integer

Alias
UMLS CUI [1]
C0556976
Durchschnittliche Frequenz pro Woche in Std
Description

Frequency per week

Data type

integer

Alias
UMLS CUI [1]
C0585296
BMÄ/E-Go Nummer Gruppenbehandlung zuzüglich Einbeziehung der Bezugsperson
Description

Uniform rating scale group therapy inclusion of contact person

Data type

integer

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0033971
UMLS CUI [1,3]
C0337611
Bewilligte Stunden pro Woche
Description

Hours per week granted

Data type

integer

Alias
UMLS CUI [1]
C0556976
Durchschnittliche Frequenz pro Woche in Std
Description

Frequency per week

Data type

integer

Alias
UMLS CUI [1]
C0585296
Unterschrift
Description

Signature

Data type

text

Alias
UMLS CUI [1]
C1519316
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Similar models

Approval of insurance claim for psychotherapy

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Briefkopf
Health Insurance name and address
Item
Name und Anschrift der Krankenversicherung
text
C0021682 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
Name and address of the patient
Item
Name und Anschrift des Patienten
text
C0030705 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
Date of application
Item
Antrag vom
date
C0011008 (UMLS CUI [1,1])
C1947919 (UMLS CUI [1,2])
Item Group
Bewilligung
Obligation to pay benefits
Item
Wir erkennen unsere Leistungspflicht an
boolean
C0162399 (UMLS CUI [1,1])
C0021674 (UMLS CUI [1,2])
Item
Therapieform
integer
C0033968 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Psychotherapy type that is granted
Code List
Therapieform
CL Item
Kurzzeittherapie (1)
CL Item
Langzeittherapie (2)
Uniform rating scale individual treatment
Item
BMÄ/E-Go Nummer Einzelbehandlung
integer
C0681889 (UMLS CUI [1,1])
C2048936 (UMLS CUI [1,2])
Hours per week granted
Item
Bewilligte Stunden pro Woche
integer
C0556976 (UMLS CUI [1])
Frequency per week
Item
Durchschnittliche Frequenz pro Woche in Std
integer
C0585296 (UMLS CUI [1])
Rating scale individual treatment inclusion of contact person
Item
BMÄ/E-Go Nummer Einzelbehandlung zuzüglich der Einbeziehung der Bezugsperson
integer
C0681889 (UMLS CUI [1,1])
C2048936 (UMLS CUI [1,2])
C0337611 (UMLS CUI [1,3])
Hours per week granted
Item
Bewilligte Stunden pro Woche
integer
C0556976 (UMLS CUI [1])
Frequency per week
Item
Durchschnittliche Frequenz pro Woche in Std
integer
C0585296 (UMLS CUI [1])
Uniform rating scale group therapy
Item
BMÄ/E-Go Nummer Gruppenbehandlung
integer
C0681889 (UMLS CUI [1,1])
C0033971 (UMLS CUI [1,2])
Hours per week granted
Item
Bewilligte Stunden pro Woche
integer
C0556976 (UMLS CUI [1])
Frequency per week
Item
Durchschnittliche Frequenz pro Woche in Std
integer
C0585296 (UMLS CUI [1])
Uniform rating scale group therapy inclusion of contact person
Item
BMÄ/E-Go Nummer Gruppenbehandlung zuzüglich Einbeziehung der Bezugsperson
integer
C0681889 (UMLS CUI [1,1])
C0033971 (UMLS CUI [1,2])
C0337611 (UMLS CUI [1,3])
Hours per week granted
Item
Bewilligte Stunden pro Woche
integer
C0556976 (UMLS CUI [1])
Frequency per week
Item
Durchschnittliche Frequenz pro Woche in Std
integer
C0585296 (UMLS CUI [1])
Signature
Item
Unterschrift
text
C1519316 (UMLS CUI [1])
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