ID

17247

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. 9/2/16 9/2/16 -
Uploaded on

September 2, 2016

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Refusal of benefits for psychotherapy

German

Refusal of benefits for psychotherapy

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
Name und Anschrift des Therapeuten
Description

Name and address of the psychotherapist

Data type

text

Alias
UMLS CUI [1,1]
C0557555
UMLS CUI [1,2]
C1442065
Kassenmitarbeiter
Description

Contact person

Data type

text

Alias
UMLS CUI [1]
C0337611
Telefon Durchwahl
Description

Phone number

Data type

integer

Alias
UMLS CUI [1]
C1515258
Ablehnung
Description

Ablehnung

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
Die Leistungspflicht für die beantragte Psychotherapie ist nicht gegeben. Der Patient wurde von dieser Entscheidung unterrichted.
Description

Obligation refused

Data type

boolean

Alias
UMLS CUI [1]
C0557187
Eine Ausfertigung der gutachterlichen Stellungnahme wurde Ihnen vom Gutachter übersandt.
Description

Assessor report

Data type

boolean

Alias
UMLS CUI [1,1]
C0401804
UMLS CUI [1,2]
C0242278
Unterschrift
Description

Signature

Data type

text

Alias
UMLS CUI [1]
C1519316
Back to the top of the page

Similar models

Refusal of benefits for psychotherapy

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])
Name and address of the psychotherapist
Item
Name und Anschrift des Therapeuten
text
C0557555 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
Contact person
Item
Kassenmitarbeiter
text
C0337611 (UMLS CUI [1])
Phone number
Item
Telefon Durchwahl
integer
C1515258 (UMLS CUI [1])
Item Group
Ablehnung
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])
Obligation refused
Item
Die Leistungspflicht für die beantragte Psychotherapie ist nicht gegeben. Der Patient wurde von dieser Entscheidung unterrichted.
boolean
C0557187 (UMLS CUI [1])
Assessor report
Item
Eine Ausfertigung der gutachterlichen Stellungnahme wurde Ihnen vom Gutachter übersandt.
boolean
C0401804 (UMLS CUI [1,1])
C0242278 (UMLS CUI [1,2])
Signature
Item
Unterschrift
text
C1519316 (UMLS CUI [1])
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial