ID

19796

Description

Muster 86 - Weiterleitungsbogen für angeforderte Befunde an den MDK (Freigabe 01.12.2016). 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 86 - Redirection Form for requested findings to The Medical Service of the Health Funds (MDK) (Released 12-01-2016). 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 (4)
  1. 1/4/17 1/4/17 -
  2. 1/5/17 1/5/17 -
  3. 1/28/17 1/28/17 -
  4. 9/7/17 9/7/17 -
Uploaded on

January 28, 2017

DOI

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License

Creative Commons BY-NC 3.0
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KBV Redirection Form for requested findings to The Medical Service of the Health Funds MDK Template 86

German

KBV Redirection Form for requested findings to The Medical Service of the Health Funds MDK Template 86

1 forms  
Krankenkasse
Description

Krankenkasse

Aktenzeichen Mitteilungsmanagement (MiMa)
Description

reference number

Data type

text

Alias
UMLS CUI [1]
C1706462
Name der Krankenversicherung
Description

Health Insurance name

Data type

text

Alias
UMLS CUI [1]
C0021682
Straße
Description

Street

Data type

text

Alias
UMLS CUI [1]
C1301826
PLZ
Description

postal code

Data type

integer

Alias
UMLS CUI [1]
C0421454
Ort
Description

city

Data type

text

Alias
UMLS CUI [1]
C2316883
Leistungsbereich
Description

service

Data type

text

Alias
UMLS CUI [1]
C0557854
Ansprechpartner Krankenkasse
Description

Ansprechpartner Krankenkasse

Nachname
Description

Last Name

Data type

text

Alias
UMLS CUI [1]
C1301584
Vorname
Description

First Name

Data type

text

Alias
UMLS CUI [1]
C1443235
Telefon
Description

telephone number

Data type

text

Alias
UMLS CUI [1]
C1515258
Fax
Description

Fax number

Data type

integer

Alias
UMLS CUI [1]
C1549619
E-Mail
Description

E-Mail

Data type

text

Alias
UMLS CUI [1]
C1705961
Daten des Versicherten
Description

Daten des Versicherten

Nachname
Description

Patient surname

Data type

text

Alias
UMLS CUI [1]
C0421448
Patientenname
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Patient Geburtsdatum
Description

Patient Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Straße
Description

Street

Data type

text

Alias
UMLS CUI [1]
C1301826
Ort
Description

city

Data type

text

Alias
UMLS CUI [1]
C2316883
Aktenzeichen Krankenkasse
Description

Insurance ID

Data type

integer

Alias
UMLS CUI [1]
C1547687
KV-Nummer
Description

Insurance number

Data type

integer

Alias
UMLS CUI [1]
C1549712
Daten des Arztes/Leistungserbringers
Description

Daten des Arztes/Leistungserbringers

Name, Vorname/Firma
Description

Physician name

Data type

text

Alias
UMLS CUI [1]
C2361125
Straße
Description

street

Data type

text

Alias
UMLS CUI [1]
C1301826
PLZ
Description

postal code

Data type

integer

Alias
UMLS CUI [1]
C1514254
Ort
Description

city

Data type

text

Alias
UMLS CUI [1]
C2316883
Arzt-Nummer (LANR)
Description

Physician ID

Data type

integer

Alias
UMLS CUI [1]
C1550333
IK des Leistungserbringers
Description

Institution number

Data type

text

Alias
UMLS CUI [1]
C0489558
Anforderungsdatum
Description

date of request

Data type

date

Alias
UMLS CUI [1,1]
C1272683
UMLS CUI [1,2]
C0011008
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Similar models

KBV Redirection Form for requested findings to The Medical Service of the Health Funds MDK Template 86

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Krankenkasse
reference number
Item
Aktenzeichen Mitteilungsmanagement (MiMa)
text
C1706462 (UMLS CUI [1])
Health Insurance name
Item
Name der Krankenversicherung
text
C0021682 (UMLS CUI [1])
Street
Item
Straße
text
C1301826 (UMLS CUI [1])
postal code
Item
PLZ
integer
C0421454 (UMLS CUI [1])
city
Item
Ort
text
C2316883 (UMLS CUI [1])
service
Item
Leistungsbereich
text
C0557854 (UMLS CUI [1])
Item Group
Ansprechpartner Krankenkasse
Last Name
Item
Nachname
text
C1301584 (UMLS CUI [1])
First Name
Item
Vorname
text
C1443235 (UMLS CUI [1])
telephone number
Item
Telefon
text
C1515258 (UMLS CUI [1])
Fax number
Item
Fax
integer
C1549619 (UMLS CUI [1])
E-Mail
Item
E-Mail
text
C1705961 (UMLS CUI [1])
Item Group
Daten des Versicherten
Patient surname
Item
Nachname
text
C0421448 (UMLS CUI [1])
Patient Name
Item
Patientenname
text
C1299487 (UMLS CUI [1])
Patient Birth Date
Item
Patient Geburtsdatum
date
C0421451 (UMLS CUI [1])
Street
Item
Straße
text
C1301826 (UMLS CUI [1])
city
Item
Ort
text
C2316883 (UMLS CUI [1])
Insurance ID
Item
Aktenzeichen Krankenkasse
integer
C1547687 (UMLS CUI [1])
Insurance number
Item
KV-Nummer
integer
C1549712 (UMLS CUI [1])
Item Group
Daten des Arztes/Leistungserbringers
Physician name
Item
Name, Vorname/Firma
text
C2361125 (UMLS CUI [1])
street
Item
Straße
text
C1301826 (UMLS CUI [1])
postal code
Item
PLZ
integer
C1514254 (UMLS CUI [1])
city
Item
Ort
text
C2316883 (UMLS CUI [1])
Physician ID
Item
Arzt-Nummer (LANR)
integer
C1550333 (UMLS CUI [1])
Institution number
Item
IK des Leistungserbringers
text
C0489558 (UMLS CUI [1])
date of request
Item
Anforderungsdatum
date
C1272683 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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