Informações:
Falhas:
ID
43544
Descrição
Routine documentation in German hospitals. Source file name: AM010101_Bogen_abrechnungsrelevanter_Diagnosen _Prozeduren/ Ambulante Leistungen Privatpatienten Anästhesie.013 Examplary forms provided by DMI (http://www.dmi.de/)
Link
Palavras-chave
Versões (2)
- 30/05/2016 30/05/2016 -
- 20/09/2021 20/09/2021 -
Transferido a
20 de setembro de 2021
DOI
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Licença
Creative Commons BY-NC 3.0
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Outpatient services for private patients anesthesia Form for billing relevant diagnosis and procedures Routine documentation in German hospitals DMI
Outpatient services for private patients anesthesia Form for billing relevant diagnosis and procedures
Similar models
Outpatient services for private patients anesthesia Form for billing relevant diagnosis and procedures
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Medical consultation Narcosis
Item
Eingehende Beratung/ Narkose - Aufklärung mind. 10 Minuten
boolean
C3826021 (UMLS CUI [1,1])
C0234447 (UMLS CUI [1,2])
C0234447 (UMLS CUI [1,2])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
Medical consultation Narcosis
Item
Eingehende Beratung/ Narkose - Aufklärung mind. 20 Minuten
boolean
C3826021 (UMLS CUI [1,1])
C0234447 (UMLS CUI [1,2])
C0234447 (UMLS CUI [1,2])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
informed consent Malignant Neoplasms
Item
Aufklärung bei Risikopatienten Malignomverdacht
boolean
C0021430 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,2])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
Physical examination
Item
Untersuchung/ Ganzkörperstatus
boolean
C0031809 (UMLS CUI [1])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
clinical examination of symptoms
Item
Symptombezogene untersuchung
boolean
C1456356 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,2])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
Oxygen saturation measurement
Item
Oxymetrische Untersuchung (O2- Sättigung)
boolean
C0523807 (UMLS CUI [1])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
Transcutaneous measurement of hemoglobin (Hgb)
Item
Transcutane Messung des Hb- Wertes mittels Fingerclipgerät
boolean
C3526438 (UMLS CUI [1])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
Blood pressure measurement
Item
Blutdruckmessung
boolean
C0005824 (UMLS CUI [1])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
ECG at rest
Item
EKG in Ruhe
boolean
C2960418 (UMLS CUI [1])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
Pulmonary function test
Item
Lungenfunktionstest
boolean
C0024119 (UMLS CUI [1])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
medical certificate
Item
Bescheinigung/ Kurzbrief
boolean
C0260844 (UMLS CUI [1])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
indirect anamnesis
Item
Fremdanamnese
boolean
C0262926 (UMLS CUI [1])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
telephone call Physicians
Item
Telefonat Arzt
boolean
C0302186 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,2])
Number
Item
Anzahl
integer
C0449788 (UMLS CUI [1])
Comment
Item
Weitere Anmerkungen/ Ergänzungen:
text
C0947611 (UMLS CUI [1])
Item Group
Zuschläge für erbrachte leistungen
C0015754 (UMLS CUI-1)
C0199168 (UMLS CUI-2)
C0199168 (UMLS CUI-2)
consulting hours
Item
Außerhalb der Sprechstunde
boolean
Medical service
Item
Zwischen 20 und 22 oder 6 Und 8 Uhr
boolean
C0199168 (UMLS CUI [1])
Medical service
Item
Zwischen 22 oder 6 Uhr
boolean
C0199168 (UMLS CUI [1])
Medical service
Item
am Samstagen, Sonn- und Feiertagen
boolean
C0199168 (UMLS CUI [1])