ID

25576

Description

Muster 6 - Überweisungsschein (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 (3)
  1. 12/6/16 12/6/16 -
  2. 8/10/17 8/10/17 -
  3. 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 Referral Template 6

German

KBV Referral Template 6

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
Überweisungsschein
Description

Überweisungsschein

Kurativ
Description

Curative

Data type

boolean

Alias
UMLS CUI [1]
C1276305
Präventiv
Description

Preventive

Data type

boolean

Alias
UMLS CUI [1]
C0199176
Behandlung gemäß § 116b SGB V
Description

Treatment according to §116b SGB V

Data type

boolean

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0871028
bei belegärztl. 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
OP-Datum bei Leistungen nach Abschnitt 31.2
Description

Date of surgery

Data type

date

Alias
UMLS CUI [1]
C1628561
Quartal
Description

Quartal

Data type

integer

Measurement units
  • QJJ
Alias
UMLS CUI [1]
C2825406
QJJ
Geschlecht
Description

Gender

Data type

integer

Alias
UMLS CUI [1]
C0079399
Überweisung an
Description

Referral to

Data type

text

Alias
UMLS CUI [1]
C2585021
Ausführung von Auftragsleistungen
Description

Medical services by request

Data type

boolean

Alias
UMLS CUI [1,1]
C0199168
UMLS CUI [1,2]
C0686901
Konsiliaruntersuchung
Description

Patient referral for consultation

Data type

boolean

Alias
UMLS CUI [1]
C0184741
Mit-/Weiterbehandlung
Description

Further treatment

Data type

boolean

Alias
UMLS CUI [1]
C0087111
AU bis
Description

Sick leave end date

Data type

date

Alias
UMLS CUI [1,1]
C0242807
UMLS CUI [1,2]
C0806020
Eingeschränkter Leistungsanspruch gemäß § 16 Abs.3a SGB V
Description

Limited benefit status

Data type

boolean

Alias
UMLS CUI [1,1]
C0557186
UMLS CUI [1,2]
C0439801
Medizinische Informationen
Description

Medizinische Informationen

Diagnose/Verdachtsdiagnose
Description

Diagnosis or suspected diagnosis

Data type

text

Alias
UMLS CUI [1]
C0011900
UMLS CUI [2]
C0332147
Befunde/ Medikation
Description

Findings and Medication

Data type

text

Alias
UMLS CUI [1]
C0582103
UMLS CUI [2]
C0013227
Auftrag
Description

Requested procedure

Data type

text

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C1272683
Brieffuß
Description

Brieffuß

Vertragsarztstempel / Unterschrift des Arztes
Description

Physician Stamp and signature

Data type

text

Alias
UMLS CUI [1]
C1519316
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Similar models

KBV Referral Template 6

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
Überweisungsschein
Curative
Item
Kurativ
boolean
C1276305 (UMLS CUI [1])
Preventive
Item
Präventiv
boolean
C0199176 (UMLS CUI [1])
Treatment according to §116b SGB V
Item
Behandlung gemäß § 116b SGB V
boolean
C0087111 (UMLS CUI [1,1])
C0871028 (UMLS CUI [1,2])
Treatment by affiliate physician
Item
bei belegärztl. 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])
Date of surgery
Item
OP-Datum bei Leistungen nach Abschnitt 31.2
date
C1628561 (UMLS CUI [1])
Quartal
Item
Quartal
integer
C2825406 (UMLS CUI [1])
Item
Geschlecht
integer
C0079399 (UMLS CUI [1])
Gender
Code List
Geschlecht
CL Item
männlich (1)
CL Item
weiblich (2)
Referral to
Item
Überweisung an
text
C2585021 (UMLS CUI [1])
Medical services by request
Item
Ausführung von Auftragsleistungen
boolean
C0199168 (UMLS CUI [1,1])
C0686901 (UMLS CUI [1,2])
Patient referral for consultation
Item
Konsiliaruntersuchung
boolean
C0184741 (UMLS CUI [1])
Further treatment
Item
Mit-/Weiterbehandlung
boolean
C0087111 (UMLS CUI [1])
Sick leave end date
Item
AU bis
date
C0242807 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Limited benefit status
Item
Eingeschränkter Leistungsanspruch gemäß § 16 Abs.3a SGB V
boolean
C0557186 (UMLS CUI [1,1])
C0439801 (UMLS CUI [1,2])
Item Group
Medizinische Informationen
Diagnosis or suspected diagnosis
Item
Diagnose/Verdachtsdiagnose
text
C0011900 (UMLS CUI [1])
C0332147 (UMLS CUI [2])
Findings and Medication
Item
Befunde/ Medikation
text
C0582103 (UMLS CUI [1])
C0013227 (UMLS CUI [2])
Requested procedure
Item
Auftrag
text
C0087111 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
Item Group
Brieffuß
Physician Stamp and signature
Item
Vertragsarztstempel / Unterschrift des Arztes
text
C1519316 (UMLS CUI [1])
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