ID

19809

Beschrijving

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

Trefwoorden

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28. Januar 2017

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KBV Request for Responsibility of another Healthcare Payer Template 51

Duits Engels

KBV Request for Responsibility of another Healthcare Payer Template 51

1 Formulieren  
Heading 2
Beschrijving

Heading 2

physician name
Beschrijving

physician name

Datatype

text

Alias
UMLS CUI [1]
C2361125
date of contact
Beschrijving

date of contact

Datatype

date

Alias
UMLS CUI [1]
C0805839
patient name
Beschrijving

patient name

Datatype

text

Alias
UMLS CUI [1]
C1299487
Date of birth
Beschrijving

Date of birth

Datatype

date

Alias
UMLS CUI [1]
C0421451
Patient address
Beschrijving

Patient address

Datatype

text

Alias
UMLS CUI [1]
C0421449
Insurance number
Beschrijving

Insurance number

Datatype

integer

Alias
UMLS CUI [1]
C1549712
certificate of incapacity
Beschrijving

certificate of incapacity

Datatype

boolean

Alias
UMLS CUI [1]
C0869463
prescription
Beschrijving

prescription

Datatype

text

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

prescription of inpatient treatment

Datatype

boolean

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

Issue

accident
Beschrijving

accident

Datatype

integer

Alias
UMLS CUI [1]
C0000924
disease
Beschrijving

disease

Datatype

text

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

regarding recital 1 Accident

hospitalization because of accident
Beschrijving

hospitalization because of accident

Datatype

boolean

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

patient transfer to other physician

Datatype

boolean

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

referral by other physician

Datatype

boolean

Alias
UMLS CUI [1]
C0583834
physician name
Beschrijving

physician name

Datatype

text

Alias
UMLS CUI [1]
C2361125
physician address
Beschrijving

physician address

Datatype

text

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

any prescription

Datatype

boolean

Alias
UMLS CUI [1]
C0033080
name prescription
Beschrijving

name prescription

Datatype

text

ongoing treatment
Beschrijving

ongoing treatment

Datatype

boolean

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

late effects

Datatype

integer

Alias
UMLS CUI [1]
C0543419
EBM
Beschrijving

EBM

treatment date
Beschrijving

treatment date

Datatype

date

Alias
UMLS CUI [1]
C3173309
Uniform rating scale
Beschrijving

Uniform rating scale

Datatype

integer

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

regarding recital 2 Context to illness

context of diagnosis to causative illness
Beschrijving

context of diagnosis to causative illness

Datatype

integer

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0542559
UMLS CUI [1,3]
C0277554
only in case of inability to work
Beschrijving

only in case of inability to work

reason for certificate of inability to work or hospitalization
Beschrijving

reason for certificate of inability to work or hospitalization

Datatype

integer

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

Illness start date

Datatype

date

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

Illness end date

Datatype

date

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

EBM

treatment date
Beschrijving

treatment date

Datatype

date

Alias
UMLS CUI [1]
C3173309
Uniform rating scale
Beschrijving

Uniform rating scale

Datatype

integer

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

Signature

Signature date
Beschrijving

Signature date

Datatype

date

Alias
UMLS CUI [1]
C0807937
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Similar models

KBV Request for Responsibility of another Healthcare Payer Template 51

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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])
C0277554 (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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