ID

19634

Description

Muster 53 - Anfrage zum Zusammenhang von Arbeitsunfähigkeitszeiten(Freigabe 04.08.2005). 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 53 - Request relating to inability to work(Released 08-04-2005). 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. 1/17/17 1/17/17 -
  2. 9/7/17 9/7/17 -
Uploaded on

January 17, 2017

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License

Creative Commons BY-NC 3.0
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KBV Request relating to inability to work Template 53

German

KBV Request relating to inability to work Template 53

1 forms  
Anfrage zum Zusammenhang von Arbeitsunfähigkeitszeiten
Description

Anfrage zum Zusammenhang von Arbeitsunfähigkeitszeiten

Sehr geehrte(r) Frau / Herr
Description

physician name

Data type

text

Alias
UMLS CUI [1]
C2361125
Ihr Patient / unser Mitglied Name und Vorname des Versicherten
Description

patient name

Data type

text

Alias
UMLS CUI [1]
C1299487
Anschrift des Versicherten
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
Geburtsdatum
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Versichertennummer
Description

Insurance number

Data type

integer

Alias
UMLS CUI [1]
C1549712
ist seit
Description

incapacitated for work or in inpatient treatment since

Data type

date

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C4049481
UMLS CUI [2,1]
C0808070
UMLS CUI [2,2]
C0019993
incapacitated for work or in inpatient treatment
Description

incapacitated for work or in inpatient treatment

Data type

integer

Alias
UMLS CUI [1]
C4049481
UMLS CUI [2]
C0019993
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Similar models

KBV Request relating to inability to work Template 53

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Anfrage zum Zusammenhang von Arbeitsunfähigkeitszeiten
physician name
Item
Sehr geehrte(r) Frau / Herr
text
C2361125 (UMLS CUI [1])
patient name
Item
Ihr Patient / unser Mitglied Name und Vorname des Versicherten
text
C1299487 (UMLS CUI [1])
Patient address
Item
Anschrift des Versicherten
text
C0421449 (UMLS CUI [1])
Date of birth
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Insurance number
Item
Versichertennummer
integer
C1549712 (UMLS CUI [1])
incapacitated for work or in inpatient treatment since
Item
ist seit
date
C0808070 (UMLS CUI [1,1])
C4049481 (UMLS CUI [1,2])
C0808070 (UMLS CUI [2,1])
C0019993 (UMLS CUI [2,2])
Item
integer
C4049481 (UMLS CUI [1])
C0019993 (UMLS CUI [2])
incapacitated for work or in inpatient treatment
Code List
incapacitated for work or in inpatient treatment
CL Item
arbeitsunfähig erkrankt (1)
CL Item
in stationärer Behandlung (2)
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