ID

19803

Description

Muster 51 - Anfrage zur Zuständigkeit eines sonstigen Kostenträgers (Freigabe 08.08.2005). 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 51 - Request for Responsibility of another Healthcare Payer (Released 08-08-2005). 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 (7)
  1. 1/21/17 1/21/17 -
  2. 1/21/17 1/21/17 -
  3. 1/28/17 1/28/17 -
  4. 1/28/17 1/28/17 -
  5. 1/28/17 1/28/17 -
  6. 1/28/17 1/28/17 -
  7. 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 Request for Responsibility of another Healthcare Payer Template 51

German English

KBV Request for Responsibility of another Healthcare Payer Template 51

1 forms  
Heading
Description

Heading

physician name
Description

physician name

Data type

text

Alias
UMLS CUI [1]
C2361125
date of contact
Description

date of contact

Data type

date

Alias
UMLS CUI [1]
C0805839
patient name
Description

patient name

Data type

text

Alias
UMLS CUI [1]
C1299487
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Patient address
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
Insurance number
Description

Insurance number

Data type

integer

Alias
UMLS CUI [1]
C1549712
certificate of incapacity
Description

certificate of incapacity

Data type

boolean

Alias
UMLS CUI [1]
C0869463
prescription
Description

prescription

Data type

text

Alias
UMLS CUI [1]
C0033080
prescription of inpatient treatment
Description

prescription of inpatient treatment

Data type

boolean

Alias
UMLS CUI [1,1]
C0033080
UMLS CUI [1,2]
C0019993
Issue
Description

Issue

accident
Description

accident

Data type

integer

Alias
UMLS CUI [1]
C0000924
disease
Description

disease

Data type

text

Alias
UMLS CUI [1]
C0012634
regarding recital 1 Accident
Description

regarding recital 1 Accident

hospitalization because of accident
Description

hospitalization because of accident

Data type

boolean

Alias
UMLS CUI [1,1]
C0019993
UMLS CUI [1,2]
C0000924
patient transfer to other physician
Description

patient transfer to other physician

Data type

boolean

Alias
UMLS CUI [1]
C0420382
referral by other physician
Description

referral by other physician

Data type

boolean

Alias
UMLS CUI [1]
C0583834
physician name
Description

physician name

Data type

text

Alias
UMLS CUI [1]
C2361125
physician address
Description

physician address

Data type

text

Alias
UMLS CUI [1,1]
C1442065
UMLS CUI [1,2]
C0031831
any prescription
Description

any prescription

Data type

boolean

Alias
UMLS CUI [1]
C0033080
name prescription
Description

name prescription

Data type

text

ongoing treatment
Description

ongoing treatment

Data type

boolean

Alias
UMLS CUI [1,1]
C0549178
UMLS CUI [1,2]
C0087111
late effects
Description

late effects

Data type

integer

Alias
UMLS CUI [1]
C0543419
EBM
Description

EBM

treatment date
Description

treatment date

Data type

date

Alias
UMLS CUI [1]
C3173309
Uniform rating scale
Description

Uniform rating scale

Data type

integer

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0205375
regarding recital 2 Context to illness
Description

regarding recital 2 Context to illness

context of diagnosis to causative illness
Description

context of diagnosis to causative illness

Data type

integer

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0542559
UMLS CUI [1,3]
C0012634
only in case of inability to work
Description

only in case of inability to work

reason for certificate of inability to work or hospitalization
Description

reason for certificate of inability to work or hospitalization

Data type

integer

Alias
UMLS CUI [1,1]
C0007836
UMLS CUI [1,2]
C4049481
UMLS CUI [1,3]
C0392360
Illness start date
Description

Illness start date

Data type

date

Alias
UMLS CUI [1,1]
C0221423
UMLS CUI [1,2]
C0808070
Illness end date
Description

Illness end date

Data type

date

Alias
UMLS CUI [1,1]
C0221423
UMLS CUI [1,2]
C0806020
EBM
Description

EBM

treatment date
Description

treatment date

Data type

date

Alias
UMLS CUI [1]
C3173309
Uniform rating scale
Description

Uniform rating scale

Data type

integer

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0205375
Signature
Description

Signature

Signature date
Description

Signature date

Data type

date

Alias
UMLS CUI [1]
C0807937
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Similar models

KBV Request for Responsibility of another Healthcare Payer Template 51

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
physician name
Item
text
C2361125 (UMLS CUI [1])
date of contact
Item
date
C0805839 (UMLS CUI [1])
patient name
Item
text
C1299487 (UMLS CUI [1])
Date of birth
Item
date
C0421451 (UMLS CUI [1])
Patient address
Item
text
C0421449 (UMLS CUI [1])
Insurance number
Item
integer
C1549712 (UMLS CUI [1])
certificate of incapacity
Item
boolean
C0869463 (UMLS CUI [1])
prescription
Item
text
C0033080 (UMLS CUI [1])
prescription of inpatient treatment
Item
boolean
C0033080 (UMLS CUI [1,1])
C0019993 (UMLS CUI [1,2])
Item Group
Item
integer
C0000924 (UMLS CUI [1])
accident
Code List
accident
CL Item
 (1)
CL Item
 (2)
disease
Item
text
C0012634 (UMLS CUI [1])
hospitalization because of accident
Item
boolean
C0019993 (UMLS CUI [1,1])
C0000924 (UMLS CUI [1,2])
patient transfer to other physician
Item
boolean
C0420382 (UMLS CUI [1])
referral by other physician
Item
boolean
C0583834 (UMLS CUI [1])
physician name
Item
text
C2361125 (UMLS CUI [1])
physician address
Item
text
C1442065 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
any prescription
Item
boolean
C0033080 (UMLS CUI [1])
name prescription
Item
text
ongoing treatment
Item
boolean
C0549178 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Item
integer
C0543419 (UMLS CUI [1])
late effects
Code List
late effects
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
Item Group
treatment date
Item
date
C3173309 (UMLS CUI [1])
Uniform rating scale
Item
integer
C0681889 (UMLS CUI [1,1])
C0205375 (UMLS CUI [1,2])
Item
integer
C0011900 (UMLS CUI [1,1])
C0542559 (UMLS CUI [1,2])
C0012634 (UMLS CUI [1,3])
context of diagnosis to causative illness
Code List
context of diagnosis to causative illness
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
Item
integer
C0007836 (UMLS CUI [1,1])
C4049481 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
reason for certificate of inability to work or hospitalization
Code List
reason for certificate of inability to work or hospitalization
CL Item
 (1)
CL Item
 (2)
Illness start date
Item
date
C0221423 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Illness end date
Item
date
C0221423 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item Group
treatment date
Item
date
C3173309 (UMLS CUI [1])
Uniform rating scale
Item
integer
C0681889 (UMLS CUI [1,1])
C0205375 (UMLS CUI [1,2])
Item Group
Signature
Signature date
Item
Signature date
date
C0807937 (UMLS CUI [1])
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