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

## : 免疫製劑事前審查 - JSON Representation

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    {
      "resourceType" : "Claim",
      "id" : "cla-imm",
      "meta" : {
        "profile" : [
          🔗 "https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-immunologic-agent-twpas"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim cla-imm</b></p><a name=\"cla-imm\"> </a><a name=\"hccla-imm\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Claim-immunologic-agent-twpas.html\">免疫製劑事前審查-Claim Immunologic Aagent TWPAS</a></p></div><p><b>ClaimEncounter</b>: <a href=\"Encounter-enc-min.html\">Encounter: status = planned; class = ambulatory (ActCode#AMB); serviceType = 胸腔暨重症加護</a></p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>subType</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-type 1}\">送核</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-pat-min.html\">王大明 Male, DoB: 2001-01-01 ( Medical record number\u00a0(use:\u00a0official,\u00a0))</a></p><p><b>created</b>: 2024-05-30</p><p><b>enterer</b>: <a href=\"Practitioner-pra-min.html\">Practitioner: identifier = National Person Identifier where the xxx is the ISO table 3166 3-character (alphabetic) country code,Medical License number</a></p><p><b>provider</b>: <a href=\"Organization-org-hosp-example.html\">Organization 臺北市立聯合醫院</a></p><p><b>priority</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-tmhb-type 1}\">一般事前審查申請</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 bloodgroup}\">病人血型</span></p><p><b>value</b>: <a href=\"Observation-obs-blood-group.html\">Observation ABO and Rh group [Type] in Blood</a></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\">Diagnostic Report for '左上肢動脈血管內超音波' for '-&gt;王大明 Male, DoB: 2001-01-01 ( Medical record number\u00a0(use:\u00a0official,\u00a0))'</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\">Diagnostic Report for 'Prostate Pathology biopsy report' for '-&gt;王大明 Male, DoB: 2001-01-01 ( Medical record number\u00a0(use:\u00a0official,\u00a0))'</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 Platelets [#/volume] in Blood by Automated count</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 tests}\">檢驗(查)</span></p><p><b>value</b>: <a href=\"Observation-obs-lab-cbc.html\">Observation CBC panel - Blood by Automated count</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 patientAssessment}\">病人狀態評估</span></p><p><b>value</b>: <a href=\"Observation-obs-pat-nyha.html\">Observation Functional capacity NYHA</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 medicationRequest}\">用藥品項</span></p><p><b>value</b>: <a href=\"MedicationRequest-medReq-treat.html\">MedicationRequest: status = completed; statusReason = Try another treatment first; intent = order; category = 健保; medication[x] = ANTI-COUGH SYRUP &quot;WASHINGTON&quot;</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 radiotherapy}\">放射/照光治療</span></p><p><b>value</b>: <a href=\"Procedure-pro-min.html\">Procedure 骨髓高溫療法</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 carePlanDocument}\">治療計畫文件</span></p><p><b>value</b>: <a href=\"DocumentReference-doc-careplan-min.html\">DocumentReference: status = current; category = 治療計畫文件</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 medicalRecord}\">病歷資料</span></p><p><b>value</b>: <a href=\"DocumentReference-doc-medicalRecord-min.html\">DocumentReference: status = current; category = 病歷資料</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 15</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 International Working Group(IWG) Consensus Criteria</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 16</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type opd}\">門診病歷</span></p><p><b>value</b>: <a href=\"Composition-opd.html\">Composition 門診病歷</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 17</p><p><b>category</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type allergy}\">過敏史</span></p><p><b>value</b>: <a href=\"AllergyIntolerance-all-min.html\">AllergyIntolerance </a></p></blockquote><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><span title=\"Codes:{https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw I50.812}\">慢性右心臟衰竭</span></td><td><span title=\"Codes:\">Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI</span></td></tr></table><h3>Procedures</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Date</b></td><td><b>Procedure[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>2024-01-01</td><td><span title=\"Codes:{https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-pcs-2023-tw 3E0Y704}\">經自然開口或人工造口心包腔液態近接放射性同位素抗腫瘤藥劑輸入</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-cov-min.html\">Coverage: status = active</a></td></tr></table><blockquote><p><b>item</b></p><p><b>RequestedService</b>: <a href=\"MedicationRequest-medReq-apply.html\">MedicationRequest: status = on-hold; intent = plan; medication[x] = Alunbrig film-coated tablets 30mg</a></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-order-type 1}\">藥品</span></p><p><b>modifier</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-continuation-status 1}\">初次使用</span>, <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-line-of-therapy 1}\">第一線治療</span></p><p><b>programCode</b>: <span title=\"Codes:\">ALK陽性的晚期非小細胞肺癌第一線治療</span></p><p><b>quantity</b>: 52 {tbl}<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code{tbl} = '{tbl}')</span></p></blockquote><blockquote><p><b>item</b></p><p><b>RequestedService</b>: <a href=\"MedicationRequest-medReq-apply-2.html\">MedicationRequest: status = on-hold; intent = plan; medication[x] = Herzuma Inj. 440mg, Lyophilized powder for injection</a></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-order-type 1}\">藥品</span></p><p><b>modifier</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-continuation-status 1}\">初次使用</span>, <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-line-of-therapy 1}\">第一線治療</span></p><p><b>programCode</b>: <span title=\"Codes:{https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-reason C50P1}\">早期乳癌-未發生腋下淋巴結轉移</span></p><p><b>quantity</b>: 70 {tbl}<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code{tbl} = '{tbl}')</span></p></blockquote></div>"
      },
      "extension" : [
        {
          "url" : "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-claim-encounter",
          "valueReference" : {
            🔗 "reference" : "Encounter/enc-min"
          }
        }
      ],
      "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" : "1",
            "display" : "送核"
          }
        ]
      },
      "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" : "bloodgroup"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Observation/obs-blood-group"
          }
        },
        {
          "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" : 6,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "examinationReport"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "DiagnosticReport/diaRep-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" : "tests"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Observation/obs-lab-cbc"
          }
        },
        {
          "sequence" : 10,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "patientAssessment"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Observation/obs-pat-nyha"
          }
        },
        {
          "sequence" : 11,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "medicationRequest"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "MedicationRequest/medReq-treat"
          }
        },
        {
          "sequence" : 12,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "radiotherapy"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Procedure/pro-min"
          }
        },
        {
          "sequence" : 13,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "carePlanDocument"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "DocumentReference/doc-careplan-min"
          }
        },
        {
          "sequence" : 14,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "medicalRecord"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "DocumentReference/doc-medicalRecord-min"
          }
        },
        {
          "sequence" : 15,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "treatmentAssessment"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Observation/obs-tx-min"
          }
        },
        {
          "sequence" : 16,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "opd"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "Composition/opd"
          }
        },
        {
          "sequence" : 17,
          "category" : {
            "coding" : [
              {
                "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-supporting-info-type",
                "code" : "allergy"
              }
            ]
          },
          "valueReference" : {
            🔗 "reference" : "AllergyIntolerance/all-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"
            }
          ]
        }
      ],
      "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"
              }
            }
          ],
          "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" : [
            {
              "text" : "ALK陽性的晚期非小細胞肺癌第一線治療"
            }
          ],
          "quantity" : {
            "value" : 52,
            "system" : "http://unitsofmeasure.org",
            "code" : "{tbl}"
          }
        },
        {
          "extension" : [
            {
              "url" : "https://nhicore.nhi.gov.tw/pas/StructureDefinition/extension-requestedService",
              "valueReference" : {
                🔗 "reference" : "MedicationRequest/medReq-apply-2"
              }
            }
          ],
          "sequence" : 2,
          "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}"
          }
        }
      ]
    }