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KBV Report to Health Insurance for Persistence of Inability to Work Template 52

1 formularios  
Header
Descripción

Header

Health Insurance name
Descripción

Health Insurance name

Tipo de datos

text

Alias
UMLS CUI [1]
C0021682
Patient surname
Descripción

Patient surname

Tipo de datos

text

Alias
UMLS CUI [1]
C0421448
Patient Name
Descripción

Patient Name

Tipo de datos

text

Alias
UMLS CUI [1]
C1299487
Patient address
Descripción

Patient address

Tipo de datos

text

Alias
UMLS CUI [1]
C0421449
Patient Birth Date
Descripción

Patient Birth Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0421451
Insurance ID
Descripción

Insurance ID

Tipo de datos

integer

Alias
UMLS CUI [1]
C1547687
Insurance number
Descripción

Insurance number

Tipo de datos

integer

Alias
UMLS CUI [1]
C1549712
Status
Descripción

Status

Tipo de datos

integer

Alias
UMLS CUI [1]
C0449438
Facility number
Descripción

Facility number

Tipo de datos

integer

Alias
UMLS CUI [1]
C1549700
Physician ID number
Descripción

Physician ID number

Tipo de datos

integer

Alias
UMLS CUI [1]
C1548646
Date
Descripción

Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
Diagnosis
Descripción

Diagnosis

Diagnosis
Descripción

Diagnosis

Tipo de datos

text

Alias
UMLS CUI [1,1]
C4049481
UMLS CUI [1,2]
C2598420
Occupation
Descripción

Occupation

Employment
Descripción

Employment

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0014003
occupation
Descripción

occupation

Tipo de datos

text

Alias
UMLS CUI [1]
C0028811
unemployment benefits
Descripción

unemployment benefits

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0425014
working hours
Descripción

working hours

Tipo de datos

integer

Unidades de medida
  • Stunden
Alias
UMLS CUI [1,1]
C0556976
UMLS CUI [1,2]
C0043227
Stunden
undefined item
Descripción

undefined item

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C4274891
UMLS CUI [1,2]
C2987220
recovery to work ability
Descripción

recovery to work ability

recovery to work ability
Descripción

recovery to work ability

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0237820
UMLS CUI [1,2]
C4274891
date of recovery to work ability
Descripción

date of recovery to work ability

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0237820
UMLS CUI [1,3]
C4274891
diagnostic or therapeutic procedures
Descripción

diagnostic or therapeutic procedures

Conservative Treatment
Descripción

Conservative Treatment

Tipo de datos

text

Alias
UMLS CUI [1]
C0459914
operative procedure
Descripción

operative procedure

Tipo de datos

text

Alias
UMLS CUI [1]
C0038895
treating physicians
Descripción

treating physicians

treating physician
Descripción

treating physician

Tipo de datos

text

Alias
UMLS CUI [1]
C1710470
Other measures
Descripción

Other measures

no measures necessary
Descripción

no measures necessary

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0079809
job rotation
Descripción

job rotation

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1261323
reintegration
Descripción

reintegration

Tipo de datos

boolean

Alias
UMLS CUI [1]
C3527099
other measures
Descripción

other measures

Tipo de datos

text

Alias
UMLS CUI [1]
C0079809
medical rehabilitation
Descripción

medical rehabilitation

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0034991
Psychotherapy
Descripción

Psychotherapy

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0033968
participate in labour market
Descripción

participate in labour market

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0079809
UMLS CUI [1,2]
C0679823
UMLS CUI [1,3]
C0014003
other issues for overcoming unemployment
Descripción

other issues for overcoming unemployment

other issues for overcoming unemployment
Descripción

other issues for overcoming unemployment

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0033213
UMLS CUI [1,2]
C0014003
which issues
Descripción

which issues

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0033213
UMLS CUI [1,2]
C0014003
reduction in earning capacity
Descripción

reduction in earning capacity

reduction in earning capacity
Descripción

reduction in earning capacity

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0392756
UMLS CUI [1,2]
C0014003
Comments to state of health
Descripción

Comments to state of health

comments on state of health
Descripción

comments on state of health

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C0683314
Footer
Descripción

Footer

Signature date
Descripción

Signature date

Tipo de datos

date

Alias
UMLS CUI [1]
C0807937
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Similar models

KBV Report to Health Insurance for Persistence of Inability to Work Template 52

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Health Insurance name
Item
text
C0021682 (UMLS CUI [1])
Patient surname
Item
text
C0421448 (UMLS CUI [1])
Patient Name
Item
text
C1299487 (UMLS CUI [1])
Patient address
Item
text
C0421449 (UMLS CUI [1])
Patient Birth Date
Item
date
C0421451 (UMLS CUI [1])
Insurance ID
Item
integer
C1547687 (UMLS CUI [1])
Insurance number
Item
integer
C1549712 (UMLS CUI [1])
Status
Item
integer
C0449438 (UMLS CUI [1])
Facility number
Item
integer
C1549700 (UMLS CUI [1])
Physician ID number
Item
integer
C1548646 (UMLS CUI [1])
Date
Item
date
C0011008 (UMLS CUI [1])
Item Group
Diagnosis
Item
text
C4049481 (UMLS CUI [1,1])
C2598420 (UMLS CUI [1,2])
Item Group
Employment
Item
boolean
C0014003 (UMLS CUI [1])
occupation
Item
text
C0028811 (UMLS CUI [1])
unemployment benefits
Item
boolean
C0425014 (UMLS CUI [1])
working hours
Item
integer
C0556976 (UMLS CUI [1,1])
C0043227 (UMLS CUI [1,2])
undefined item
Item
boolean
C4274891 (UMLS CUI [1,1])
C2987220 (UMLS CUI [1,2])
recovery to work ability
Item
boolean
C0237820 (UMLS CUI [1,1])
C4274891 (UMLS CUI [1,2])
date of recovery to work ability
Item
date
C0011008 (UMLS CUI [1,1])
C0237820 (UMLS CUI [1,2])
C4274891 (UMLS CUI [1,3])
Conservative Treatment
Item
text
C0459914 (UMLS CUI [1])
operative procedure
Item
text
C0038895 (UMLS CUI [1])
treating physician
Item
text
C1710470 (UMLS CUI [1])
Item Group
no measures necessary
Item
boolean
C0079809 (UMLS CUI [1])
job rotation
Item
boolean
C1261323 (UMLS CUI [1])
reintegration
Item
boolean
C3527099 (UMLS CUI [1])
other measures
Item
text
C0079809 (UMLS CUI [1])
medical rehabilitation
Item
boolean
C0034991 (UMLS CUI [1])
Psychotherapy
Item
boolean
C0033968 (UMLS CUI [1])
participate in labour market
Item
boolean
C0079809 (UMLS CUI [1,1])
C0679823 (UMLS CUI [1,2])
C0014003 (UMLS CUI [1,3])
other issues for overcoming unemployment
Item
boolean
C0033213 (UMLS CUI [1,1])
C0014003 (UMLS CUI [1,2])
which issues
Item
text
C0033213 (UMLS CUI [1,1])
C0014003 (UMLS CUI [1,2])
reduction in earning capacity
Item
boolean
C0392756 (UMLS CUI [1,1])
C0014003 (UMLS CUI [1,2])
comments on state of health
Item
text
C0947611 (UMLS CUI [1,1])
C0683314 (UMLS CUI [1,2])
Item Group
Signature date
Item
Signature date
date
C0807937 (UMLS CUI [1])
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