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KBV Report to Health Insurance for Persistence of Inability to Work Template 52

1 Formulär  
Heading
Beskrivning

Heading

Health Insurance name
Beskrivning

Health Insurance name

Datatyp

text

Alias
UMLS CUI [1]
C0021682
Patient surname
Beskrivning

Patient surname

Datatyp

text

Alias
UMLS CUI [1]
C0421448
Patient Name
Beskrivning

Patient Name

Datatyp

text

Alias
UMLS CUI [1]
C1299487
Patient address
Beskrivning

Patient address

Datatyp

text

Alias
UMLS CUI [1]
C0421449
Patient Birth Date
Beskrivning

Patient Birth Date

Datatyp

date

Alias
UMLS CUI [1]
C0421451
Insurance ID
Beskrivning

Insurance ID

Datatyp

integer

Alias
UMLS CUI [1]
C1547687
Insurance number
Beskrivning

Insurance number

Datatyp

integer

Alias
UMLS CUI [1]
C1549712
Status
Beskrivning

Status

Datatyp

integer

Alias
UMLS CUI [1]
C0449438
Facility number
Beskrivning

Facility number

Datatyp

integer

Alias
UMLS CUI [1]
C1549700
Physician ID number
Beskrivning

Physician ID number

Datatyp

integer

Alias
UMLS CUI [1]
C1548646
Date
Beskrivning

Date

Datatyp

date

Alias
UMLS CUI [1]
C0011008
1. Diagnosis
Beskrivning

1. Diagnosis

Diagnosis
Beskrivning

Diagnosis

Datatyp

text

Alias
UMLS CUI [1,1]
C4049481
UMLS CUI [1,2]
C0011900
2. Occupation
Beskrivning

2. Occupation

Employment
Beskrivning

Employment

Datatyp

boolean

Alias
UMLS CUI [1]
C0014003
occupation
Beskrivning

occupation

Datatyp

text

Alias
UMLS CUI [1]
C0028811
unemployment benefits
Beskrivning

unemployment benefits

Datatyp

boolean

Alias
UMLS CUI [1]
C0425014
working hours
Beskrivning

working hours

Datatyp

integer

Måttenheter
  • Stunden
Alias
UMLS CUI [1,1]
C0556976
UMLS CUI [1,2]
C0043227
Stunden
undefined item
Beskrivning

undefined item

Datatyp

boolean

Alias
UMLS CUI [1,1]
C4274891
UMLS CUI [1,2]
C2987220
3. recovery to work ability
Beskrivning

3. recovery to work ability

recovery to work ability
Beskrivning

recovery to work ability

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0237820
UMLS CUI [1,2]
C4274891
date of recovery to work ability
Beskrivning

date of recovery to work ability

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0237820
UMLS CUI [1,3]
C4274891
4. diagnostic or therapeutic procedures
Beskrivning

4. diagnostic or therapeutic procedures

Conservative Treatment
Beskrivning

Conservative Treatment

Datatyp

text

Alias
UMLS CUI [1]
C0459914
operative procedure
Beskrivning

operative procedure

Datatyp

text

Alias
UMLS CUI [1]
C0038895
5. treating physicians
Beskrivning

5. treating physicians

Alias
UMLS CUI-1
C1710470
treating physician
Beskrivning

treating physician

Datatyp

text

Alias
UMLS CUI [1]
C1710470
6. Other measures
Beskrivning

6. Other measures

Alias
UMLS CUI-1
C0079809
no measures necessary
Beskrivning

no measures necessary

Datatyp

boolean

Alias
UMLS CUI [1]
C0079809
job rotation
Beskrivning

job rotation

Datatyp

boolean

Alias
UMLS CUI [1]
C1261323
reintegration
Beskrivning

reintegration

Datatyp

boolean

Alias
UMLS CUI [1]
C3527099
other measures
Beskrivning

other measures

Datatyp

text

Alias
UMLS CUI [1]
C0079809
medical rehabilitation
Beskrivning

medical rehabilitation

Datatyp

boolean

Alias
UMLS CUI [1]
C0034991
Psychotherapy
Beskrivning

Psychotherapy

Datatyp

boolean

Alias
UMLS CUI [1]
C0033968
participate in labour market
Beskrivning

participate in labour market

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0079809
UMLS CUI [1,2]
C0679823
UMLS CUI [1,3]
C0014003
7. other issues for overcoming unemployment
Beskrivning

7. other issues for overcoming unemployment

other issues for overcoming unemployment
Beskrivning

other issues for overcoming unemployment

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0033213
UMLS CUI [1,2]
C0014003
which issues
Beskrivning

which issues

Datatyp

text

Alias
UMLS CUI [1,1]
C0033213
UMLS CUI [1,2]
C0014003
8. reduction in earning capacity
Beskrivning

8. reduction in earning capacity

Alias
UMLS CUI-1
C0392756
UMLS CUI-2
C0014003
reduction in earning capacity
Beskrivning

reduction in earning capacity

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0392756
UMLS CUI [1,2]
C0014003
9. Comments to state of health
Beskrivning

9. Comments to state of health

Alias
UMLS CUI-1
C0947611
UMLS CUI-2
C0683314
comments on state of health
Beskrivning

comments on state of health

Datatyp

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C0683314
Signature
Beskrivning

Signature

Alias
UMLS CUI-1
C1519316
Signature date
Beskrivning

Signature date

Datatyp

date

Alias
UMLS CUI [1]
C0807937
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Similar models

KBV Report to Health Insurance for Persistence of Inability to Work Template 52

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Health Insurance name
Item
text
C0021682 (UMLS CUI [1])
Patient surname
Item
text
C0421448 (UMLS CUI [1])
Patient Name
Item
text
C1299487 (UMLS CUI [1])
Patient address
Item
text
C0421449 (UMLS CUI [1])
Patient Birth Date
Item
date
C0421451 (UMLS CUI [1])
Insurance ID
Item
integer
C1547687 (UMLS CUI [1])
Insurance number
Item
integer
C1549712 (UMLS CUI [1])
Status
Item
integer
C0449438 (UMLS CUI [1])
Facility number
Item
integer
C1549700 (UMLS CUI [1])
Physician ID number
Item
integer
C1548646 (UMLS CUI [1])
Date
Item
date
C0011008 (UMLS CUI [1])
Item Group
Diagnosis
Item
text
C4049481 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
Item Group
Employment
Item
boolean
C0014003 (UMLS CUI [1])
occupation
Item
text
C0028811 (UMLS CUI [1])
unemployment benefits
Item
boolean
C0425014 (UMLS CUI [1])
working hours
Item
integer
C0556976 (UMLS CUI [1,1])
C0043227 (UMLS CUI [1,2])
undefined item
Item
boolean
C4274891 (UMLS CUI [1,1])
C2987220 (UMLS CUI [1,2])
recovery to work ability
Item
boolean
C0237820 (UMLS CUI [1,1])
C4274891 (UMLS CUI [1,2])
date of recovery to work ability
Item
date
C0011008 (UMLS CUI [1,1])
C0237820 (UMLS CUI [1,2])
C4274891 (UMLS CUI [1,3])
Conservative Treatment
Item
text
C0459914 (UMLS CUI [1])
operative procedure
Item
text
C0038895 (UMLS CUI [1])
Item Group
C1710470 (UMLS CUI-1)
treating physician
Item
text
C1710470 (UMLS CUI [1])
Item Group
C0079809 (UMLS CUI-1)
no measures necessary
Item
boolean
C0079809 (UMLS CUI [1])
job rotation
Item
boolean
C1261323 (UMLS CUI [1])
reintegration
Item
boolean
C3527099 (UMLS CUI [1])
other measures
Item
text
C0079809 (UMLS CUI [1])
medical rehabilitation
Item
boolean
C0034991 (UMLS CUI [1])
Psychotherapy
Item
boolean
C0033968 (UMLS CUI [1])
participate in labour market
Item
boolean
C0079809 (UMLS CUI [1,1])
C0679823 (UMLS CUI [1,2])
C0014003 (UMLS CUI [1,3])
other issues for overcoming unemployment
Item
boolean
C0033213 (UMLS CUI [1,1])
C0014003 (UMLS CUI [1,2])
which issues
Item
text
C0033213 (UMLS CUI [1,1])
C0014003 (UMLS CUI [1,2])
Item Group
C0392756 (UMLS CUI-1)
C0014003 (UMLS CUI-2)
reduction in earning capacity
Item
boolean
C0392756 (UMLS CUI [1,1])
C0014003 (UMLS CUI [1,2])
Item Group
C0947611 (UMLS CUI-1)
C0683314 (UMLS CUI-2)
comments on state of health
Item
text
C0947611 (UMLS CUI [1,1])
C0683314 (UMLS CUI [1,2])
Item Group
Signature
C1519316 (UMLS CUI-1)
Signature date
Item
Signature date
date
C0807937 (UMLS CUI [1])
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