KBV Referral to investigate somatic causes before starting psychotherapy Template 7

Briefkopf
Descripción

Briefkopf

Krankenkasse bzw. Kostenträger
Descripción

Health Insurance name

Tipo de datos

text

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

Patient Name

Tipo de datos

text

Alias
UMLS CUI [1]
C1299487
Adresse des Versicherten
Descripción

Patient address

Tipo de datos

text

Alias
UMLS CUI [1]
C0421449
geb. am
Descripción

Patient Birth Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0421451
Kostenträgerkennung
Descripción

Insurance Company ID

Tipo de datos

integer

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

Insurance number

Tipo de datos

integer

Alias
UMLS CUI [1]
C1549712
Status
Descripción

Status

Tipo de datos

integer

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

Facility ID

Tipo de datos

integer

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

Physician ID

Tipo de datos

integer

Alias
UMLS CUI [1]
C1548646
Datum
Descripción

Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
Medizinische Informationen
Descripción

Medizinische Informationen

Diagnosen/ Indikation zur Psychotherapie
Descripción

Diagnosis or indication for psychotherapy

Tipo de datos

text

Alias
UMLS CUI [1]
C0011900
UMLS CUI [2]
C2315323
Informationen für den Arzt
Descripción

Further information to the physician

Tipo de datos

text

Alias
UMLS CUI [1]
C2598106
Ausstellungsdatum
Descripción

Date of completion

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0850287
Stempel /Unterschrift des Therapeuten
Descripción

Stamp and Signature

Tipo de datos

text

Alias
UMLS CUI [1]
C1519316

Similar models

KBV Referral to investigate somatic causes before starting psychotherapy Template 7

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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
Medizinische Informationen
Diagnosis or indication for psychotherapy
Item
Diagnosen/ Indikation zur Psychotherapie
text
C0011900 (UMLS CUI [1])
C2315323 (UMLS CUI [2])
Further information to the physician
Item
Informationen für den Arzt
text
C2598106 (UMLS CUI [1])
Date of completion
Item
Ausstellungsdatum
date
C0011008 (UMLS CUI [1,1])
C0850287 (UMLS CUI [1,2])
Stamp and Signature
Item
Stempel /Unterschrift des Therapeuten
text
C1519316 (UMLS CUI [1])