臺灣健保事前審查實作指引
1.1.1 - STU1.1.1

臺灣健保事前審查實作指引 - Downloaded Version null See the Directory of published versions

## : 事前審查-申復、有共病 - JSON Representation

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    {
      "resourceType" : "Claim",
      "id" : "cla-3",
      "meta" : {
        "profile" : [
          🔗 "https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-twpas"
        ]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Claim-twpas.html\">癌藥事前審查-Claim TWPAS</a></p></div><p><b>狀態</b>：Active</p><p><b>類型</b>：Institutional<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/CodeSystem/claim-type\">ClaimTypeCodes</a>#institutional)</span></p><p><b>就醫科別</b>：<a href=\"Encounter-enc-min.html\">Encounter/enc-min</a> &quot;胸腔暨重症加護&quot;</p><p><b>原受理編號</b>：202405301000002</p><p><b>申報類別</b>：申復<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-nhi-apply-type.html\">NHI-申報類別值集</a>#3)</span></p><p><b>目的</b>：Preauthorization</p><p><b>病人</b>：<a href=\"Patient-pat-min.html\">Patient/pat-min</a> &quot;王大明&quot;</p><p><b>申請日期</b>：2024-05-30</p><p><b>申請醫師</b>：<a href=\"Practitioner-pra-min.html\">Practitioner/pra-min</a></p><p><b>醫事機構代碼</b>：<a href=\"Organization-org-hosp-example.html\">Organization/org-hosp-example</a></p><p><b>申請案件類別</b>：一般事前審查申請<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-nhi-tmhb-type.html\">NHI-申請案件類別值集</a>#1)</span></p><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：1</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type weight}\">病人體重</span></p><p><b>value</b>：59.65 kg<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM codekg = 'kg')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：2</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type height}\">病人身高</span></p><p><b>value</b>：170 cm<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM codecm = 'cm')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：3</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type pregnancyBreastfeedingStatus}\">是否懷孕或哺乳</span></p><p><b>value</b>：false</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：4</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type imagingReport}\">影像報告</span></p><p><b>value</b>：<a href=\"DiagnosticReport-diaRep-ima-min.html\">DiagnosticReport/diaRep-ima-min</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：5</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type cancerStage}\">癌症分期量表</span></p><p><b>value</b>：<a href=\"Observation-obs-cancer-figo.html\">Observation/obs-cancer-figo</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：6</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type examinationReport}\">檢查報告</span></p><p><b>value</b>：<a href=\"DiagnosticReport-diaRep-min.html\">DiagnosticReport/diaRep-min</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：7</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type geneInfo}\">基因資訊</span></p><p><b>value</b>：<a href=\"Observation-obs-diagnostic-min.html\">Observation/obs-diagnostic-min</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：8</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type tests}\">檢驗(查)</span></p><p><b>value</b>：<a href=\"Observation-obs-lab-min.html\">Observation/obs-lab-min</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：9</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type patientAssessment}\">病人狀態評估</span></p><p><b>value</b>：<a href=\"Observation-obs-pat-nyha.html\">Observation/obs-pat-nyha</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：10</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type medicationRequest}\">用藥品項</span></p><p><b>value</b>：<a href=\"MedicationRequest-medReq-treat.html\">MedicationRequest/medReq-treat</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：11</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type radiotherapy}\">放射/照光治療</span></p><p><b>value</b>：<a href=\"Procedure-pro-min.html\">Procedure/pro-min</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：12</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type carePlanDocument}\">治療計畫文件</span></p><p><b>value</b>：<a href=\"DocumentReference-doc-careplan-min.html\">DocumentReference/doc-careplan-min</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：13</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type medicalRecord}\">病歷資料</span></p><p><b>value</b>：<a href=\"DocumentReference-doc-medicalRecord-min.html\">DocumentReference/doc-medicalRecord-min</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>：14</p><p><b>category</b>：<span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type treatmentAssessment}\">結果資訊</span></p><p><b>value</b>：<a href=\"Observation-obs-tx-min.html\">Observation/obs-tx-min</a></p></blockquote><h3>Diagnoses</h3><p><b>診斷日期</b>：2024-01-01</p><p><b>國際疾病分類代碼</b>：慢性右心臟衰竭<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw\">臺灣健保署2023年中文版ICD-10-CM值集</a>#I50.812)</span></p><p><b>共病</b>：第一型糖尿病，伴有糖尿病的神經病變<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw\">臺灣健保署2023年中文版ICD-10-CM值集</a>#E10.40)</span></p><p><b>簡要病摘</b>：Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI</p><h3>Procedures</h3><p><b>手術(或其他處置)日期</b>：2024-01-01</p><p><b>手術(或其他處置)項目</b>：經由自體開口或人工造口心包腔近接放射性同位素抗腫瘤液態藥劑輸入<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-pcs-2023-tw\">臺灣健保署2023年中文版ICD-10-PCS值集</a>#3E0Y704)</span></p><h3>Insurances</h3><p><b>sequence</b>：1</p><p><b>coverage</b>：<a href=\"Coverage-cov-min.html\">Coverage/cov-min</a></p><h3>Items</h3><p><b>事前審查品項</b>：<a href=\"MedicationRequest-medReq-apply-2.html\">MedicationRequest/medReq-apply-2</a></p><p><b>事前審查申請數量(單位)</b>：70 (tablets <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"https://hl7.org/fhir/R4/valueset-ucum-common.html\">Common UCUM units</a>#{tbl})</span>)</p><p><b>醫令類別</b>：藥品<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-nhi-order-type.html\">NHI-健保事前審查-醫令類別值集</a>#1)</span></p><p><b>續用註記</b>：初次使用<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-nhi-continuation-status.html\">NHI-續用註記值集</a>#1)</span></p><p><b>用藥線別</b>：第一線治療<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-nhi-line-of-therapy.html\">NHI-用藥線別值集</a>#1)</span></p><p><b>給付適應症</b>：C50P1<span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-nhi-apply-reason.html\">NHI-給付適應症值集</a>#C50P1)</span></p></div>"
      },
      "extension" : [
        {
          "url" : "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-claim-encounter",
          "valueReference" : {
            🔗 "reference" : "Encounter/enc-min"
          }
        }
      ],
      "identifier" : [
        {
          "value" : "202405301000002"
        }
      ],
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
            "code" : "institutional"
          }
        ]
      },
      "subType" : {
        "coding" : [
          {
            "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-type",
            "code" : "3",
            "display" : "申復"
          }
        ]
      },
      "use" : "preauthorization",
      "patient" : {
        🔗 "reference" : "Patient/pat-min"
      },
      "created" : "2024-05-30",
      "enterer" : {
        🔗 "reference" : "Practitioner/pra-min"
      },
      "provider" : {
        🔗 "reference" : "Organization/org-hosp-example"
      },
      "priority" : {
        "coding" : [
          {
            "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-tmhb-type",
            "code" : "1",
            "display" : "一般事前審查申請"
          }
        ]
      },
      "supportingInfo" : [
        {
          "sequence" : 1,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "weight"
              }
            ]
          },
          "valueQuantity" : {
            "value" : 59.65,
            "system" : "http://unitsofmeasure.org",
            "code" : "kg"
          }
        },
        {
          "sequence" : 2,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "height"
              }
            ]
          },
          "valueQuantity" : {
            "value" : 170,
            "system" : "http://unitsofmeasure.org",
            "code" : "cm"
          }
        },
        {
          "sequence" : 3,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "pregnancyBreastfeedingStatus"
              }
            ]
          },
          "valueBoolean" : false
        },
        {
          "sequence" : 4,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "imagingReport"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "DiagnosticReport/diaRep-ima-min"
          }
        },
        {
          "sequence" : 5,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "cancerStage"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Observation/obs-cancer-figo"
          }
        },
        {
          "sequence" : 6,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "examinationReport"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "DiagnosticReport/diaRep-min"
          }
        },
        {
          "sequence" : 7,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "geneInfo"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Observation/obs-diagnostic-min"
          }
        },
        {
          "sequence" : 8,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "tests"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Observation/obs-lab-min"
          }
        },
        {
          "sequence" : 9,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "patientAssessment"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Observation/obs-pat-nyha"
          }
        },
        {
          "sequence" : 10,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "medicationRequest"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "MedicationRequest/medReq-treat"
          }
        },
        {
          "sequence" : 11,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "radiotherapy"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Procedure/pro-min"
          }
        },
        {
          "sequence" : 12,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "carePlanDocument"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "DocumentReference/doc-careplan-min"
          }
        },
        {
          "sequence" : 13,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "medicalRecord"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "DocumentReference/doc-medicalRecord-min"
          }
        },
        {
          "sequence" : 14,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "treatmentAssessment"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Observation/obs-tx-min"
          }
        }
      ],
      "diagnosis" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate",
              "valueDate" : "2024-01-01"
            }
          ],
          "sequence" : 1,
          "diagnosisCodeableConcept" : {
            "coding" : [
              {
                "system" : "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw",
                "code" : "I50.812"
              }
            ]
          },
          "type" : [
            {
              "text" : "Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI"
            }
          ]
        },
        {
          "sequence" : 2,
          "diagnosisCodeableConcept" : {
            "coding" : [
              {
                "system" : "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw",
                "code" : "E10.40"
              }
            ]
          }
        }
      ],
      "procedure" : [
        {
          "sequence" : 1,
          "date" : "2024-01-01",
          "procedureCodeableConcept" : {
            "coding" : [
              {
                "system" : "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-pcs-2023-tw",
                "code" : "3E0Y704"
              }
            ]
          }
        }
      ],
      "insurance" : [
        {
          "sequence" : 1,
          "focal" : true,
          "coverage" : {
            🔗 "reference" : "Coverage/cov-min"
          }
        }
      ],
      "item" : [
        {
          "extension" : [
            {
              "url" : "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-requestedService",
              "valueReference" : {
                🔗 "reference" : "MedicationRequest/medReq-apply-2"
              }
            }
          ],
          "sequence" : 1,
          "productOrService" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-order-type",
                "code" : "1",
                "display" : "藥品"
              }
            ]
          },
          "modifier" : [
            {
              "coding" : [
                {
                  "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-continuation-status",
                  "code" : "1",
                  "display" : "初次使用"
                }
              ]
            },
            {
              "coding" : [
                {
                  "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-line-of-therapy",
                  "code" : "1",
                  "display" : "第一線治療"
                }
              ]
            }
          ],
          "programCode" : [
            {
              "coding" : [
                {
                  "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-reason",
                  "code" : "C50P1"
                }
              ]
            }
          ],
          "quantity" : {
            "value" : 70,
            "system" : "http://unitsofmeasure.org",
            "code" : "{tbl}"
          }
        }
      ]
    }