ID

25616

Description

Muster 52 - Bericht für die Krankenkasse bei Fortbestehen der Arbeitsunfähigkeit (Freigabe 21.058.2015). 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 52 - Report to Health Insurance for Persistence of Inability to Work (Released 05-21-2015). 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 (3)
  1. 1/21/17 1/21/17 -
  2. 1/28/17 1/28/17 -
  3. 9/7/17 9/7/17 -
Copyright Holder

KBV

Uploaded on

September 7, 2017

DOI

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License

Creative Commons BY-NC 3.0
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KBV Report to Health Insurance for Persistence of Inability to Work Template 52

German English

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

1 forms  
Header
Description

Header

Health Insurance name
Description

Health Insurance name

Data type

text

Alias
UMLS CUI [1]
C0021682
Patient surname
Description

Patient surname

Data type

text

Alias
UMLS CUI [1]
C0421448
Patient Name
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Patient address
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
Patient Birth Date
Description

Patient Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Insurance ID
Description

Insurance ID

Data type

integer

Alias
UMLS CUI [1]
C1547687
Insurance number
Description

Insurance number

Data type

integer

Alias
UMLS CUI [1]
C1549712
Status
Description

Status

Data type

integer

Alias
UMLS CUI [1]
C0449438
Facility number
Description

Facility number

Data type

integer

Alias
UMLS CUI [1]
C1549700
Physician ID number
Description

Physician ID number

Data type

integer

Alias
UMLS CUI [1]
C1548646
Date
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Diagnosis
Description

Diagnosis

Diagnosis
Description

Diagnosis

Data type

text

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

Occupation

Employment
Description

Employment

Data type

boolean

Alias
UMLS CUI [1]
C0014003
occupation
Description

occupation

Data type

text

Alias
UMLS CUI [1]
C0028811
unemployment benefits
Description

unemployment benefits

Data type

boolean

Alias
UMLS CUI [1]
C0425014
working hours
Description

working hours

Data type

integer

Measurement units
  • Stunden
Alias
UMLS CUI [1,1]
C0556976
UMLS CUI [1,2]
C0043227
Stunden
undefined item
Description

undefined item

Data type

boolean

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

recovery to work ability

recovery to work ability
Description

recovery to work ability

Data type

boolean

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

date of recovery to work ability

Data type

date

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

diagnostic or therapeutic procedures

Conservative Treatment
Description

Conservative Treatment

Data type

text

Alias
UMLS CUI [1]
C0459914
operative procedure
Description

operative procedure

Data type

text

Alias
UMLS CUI [1]
C0038895
treating physicians
Description

treating physicians

treating physician
Description

treating physician

Data type

text

Alias
UMLS CUI [1]
C1710470
Other measures
Description

Other measures

no measures necessary
Description

no measures necessary

Data type

boolean

Alias
UMLS CUI [1]
C0079809
job rotation
Description

job rotation

Data type

boolean

Alias
UMLS CUI [1]
C1261323
reintegration
Description

reintegration

Data type

boolean

Alias
UMLS CUI [1]
C3527099
other measures
Description

other measures

Data type

text

Alias
UMLS CUI [1]
C0079809
medical rehabilitation
Description

medical rehabilitation

Data type

boolean

Alias
UMLS CUI [1]
C0034991
Psychotherapy
Description

Psychotherapy

Data type

boolean

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

participate in labour market

Data type

boolean

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

other issues for overcoming unemployment

other issues for overcoming unemployment
Description

other issues for overcoming unemployment

Data type

boolean

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

which issues

Data type

text

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

reduction in earning capacity

reduction in earning capacity
Description

reduction in earning capacity

Data type

boolean

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

Comments to state of health

comments on state of health
Description

comments on state of health

Data type

text

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

Footer

Signature date
Description

Signature date

Data type

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 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
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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