ID

25544

Description

Muster 2 - Verordnung von Krankenhausbehandlung (Freigabe: 01.09.2014) - 10.2014, Formulare für die vertragsärztliche Versorgung 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 Forms for contract medical care 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 (5)
  1. 9/5/16 9/5/16 -
  2. 8/10/17 8/10/17 -
  3. 8/10/17 8/10/17 -
  4. 9/5/17 9/5/17 -
  5. 9/5/17 9/5/17 -
Copyright Holder

KBV

Uploaded on

September 5, 2017

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

KBV Referral to hospital Template 2

German

KBV Referral to hospital Template 2a

3 forms  
Briefkopf
Description

Briefkopf

Krankenkasse bzw. Kostenträger
Description

Health Insurance name

Data type

text

Alias
UMLS CUI [1]
C0021682
Name, Vorname des Versicherten
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Adresse des Versicherten
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
geb. am
Description

Patient Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Kostenträgerkennung
Description

Insurance Company ID

Data type

integer

Alias
UMLS CUI [1]
C1547687
Versicherten-Nr.
Description

Insurance number

Data type

integer

Alias
UMLS CUI [1]
C1549712
Status
Description

Status

Data type

integer

Alias
UMLS CUI [1]
C0449438
Betriebsstätten-Nr.
Description

Facility ID

Data type

integer

Alias
UMLS CUI [1]
C1549700
Arzt-Nr.
Description

Physician ID

Data type

integer

Alias
UMLS CUI [1]
C1548646
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Verordnung von Krankenhausbehandlung
Description

Verordnung von Krankenhausbehandlung

Art der Krankenhauseinweisung
Description

Type of hospital referral

Data type

integer

Alias
UMLS CUI [1,1]
C0019982
UMLS CUI [1,2]
C0332307
Nächsterreichbare, geeignete Krankenhäuser
Description

Next suitable hospital

Data type

text

Alias
UMLS CUI [1]
C0019982
Diagnose
Description

Diagnosis

Data type

text

Alias
UMLS CUI [1]
C0011900
Brieffuß
Description

Brieffuß

Vertragsarztstempel / Unterschrift des Arztes
Description

Physician Stamp and signature

Data type

text

Alias
UMLS CUI [1]
C1519316
Kostenverpflichtungserklärung
Description

Kostenverpflichtungserklärung

Kostenverpflichtungserklärung der Krankenkasse
Description

Insurance benefits

Data type

boolean

Alias
UMLS CUI [1]
C0021674
Krankenhausaufnahme erfolgt(e) am
Description

Date hospital admission

Data type

date

Alias
UMLS CUI [1]
C0806429
Stempel und Unterschrift des Krankenhauses
Description

Hospital stamp and signature

Data type

text

Alias
UMLS CUI [1]
C1519316
Back to the top of the page

Similar models

KBV Referral to hospital Template 2a

3 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Briefkopf
Health Insurance name
Item
Krankenkasse bzw. Kostenträger
text
C0021682 (UMLS CUI [1])
Patient Name
Item
Name, Vorname des Versicherten
text
C1299487 (UMLS CUI [1])
Patient address
Item
Adresse des Versicherten
text
C0421449 (UMLS CUI [1])
Patient Birth Date
Item
geb. am
date
C0421451 (UMLS CUI [1])
Insurance Company ID
Item
Kostenträgerkennung
integer
C1547687 (UMLS CUI [1])
Insurance number
Item
Versicherten-Nr.
integer
C1549712 (UMLS CUI [1])
Status
Item
Status
integer
C0449438 (UMLS CUI [1])
Facility ID
Item
Betriebsstätten-Nr.
integer
C1549700 (UMLS CUI [1])
Physician ID
Item
Arzt-Nr.
integer
C1548646 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Item Group
Verordnung von Krankenhausbehandlung
Item
Art der Krankenhauseinweisung
integer
C0019982 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Type of hospital referral
Code List
Art der Krankenhauseinweisung
CL Item
Belegarztbehandlung (1)
CL Item
Notfall (2)
CL Item
Unfall/ Unfallfolgen (3)
CL Item
Versorgungsleiden (BVG) (4)
Next suitable hospital
Item
Nächsterreichbare, geeignete Krankenhäuser
text
C0019982 (UMLS CUI [1])
Diagnosis
Item
Diagnose
text
C0011900 (UMLS CUI [1])
Item Group
Brieffuß
Physician Stamp and signature
Item
Vertragsarztstempel / Unterschrift des Arztes
text
C1519316 (UMLS CUI [1])
Item Group
Kostenverpflichtungserklärung
Insurance benefits
Item
Kostenverpflichtungserklärung der Krankenkasse
boolean
C0021674 (UMLS CUI [1])
Date hospital admission
Item
Krankenhausaufnahme erfolgt(e) am
date
C0806429 (UMLS CUI [1])
Hospital stamp and signature
Item
Stempel und Unterschrift des Krankenhauses
text
C1519316 (UMLS CUI [1])
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial