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Profile: 癌藥事前審查-Claim TWPAS

狀態：Active

類型：Institutional (ClaimTypeCodes#institutional)

就醫科別：Encounter/enc-min "胸腔暨重症加護"

申報類別：送核 (NHI-申報類別值集#1)

目的：Preauthorization

病人：Patient/pat-min "王大明"

申請日期：2024-05-30

申請醫師：Practitioner/pra-min

醫事機構代碼：Organization/org-hosp-example

申請案件類別：一般事前審查申請 (NHI-申請案件類別值集#1)

supportingInfo

sequence：1

category：病人體重

value：59.65 kg (Details: UCUM codekg = 'kg')

supportingInfo

sequence：2

category：病人身高

value：170 cm (Details: UCUM codecm = 'cm')

supportingInfo

sequence：3

category：是否懷孕或哺乳

value：false

supportingInfo

sequence：4

category：影像報告

value：DiagnosticReport/diaRep-ima-min

supportingInfo

sequence：5

category：癌症分期量表

value：Observation/obs-cancer-figo

supportingInfo

sequence：6

category：檢查報告

value：DiagnosticReport/diaRep-min

supportingInfo

sequence：7

category：基因資訊

value：Observation/obs-diagnostic-min

supportingInfo

sequence：8

category：檢驗檢查-單項

value：Observation/obs-lab-min

supportingInfo

sequence：9

category：檢驗檢查-套組(全套血液檢查)

value：Observation/obs-lab-cbc

supportingInfo

sequence：10

category：病人狀態評估

value：Observation/obs-pat-nyha

supportingInfo

sequence：11

category：用藥品項

value：MedicationRequest/medReq-treat

supportingInfo

sequence：12

category：放射治療

value：Procedure/pro-min

supportingInfo

sequence：13

category：治療計畫文件

value：DocumentReference/doc-careplan-min

supportingInfo

sequence：14

category：病歷資料

value：DocumentReference/doc-medicalRecord-min

supportingInfo

sequence：15

category：結果資訊

value：Observation/obs-tx-min

Diagnoses

診斷日期：2024-01-01

國際疾病分類代碼：慢性右心臟衰竭 (臺灣健保署2023年中文版ICD-10-CM值集#I50.812)

簡要病摘：Adenocarcinoma, descending colon, cT3N2M1a, cStage IVA, KRAS G12V, with multiple liver metastases, status post FOLFIRI

Procedures

手術(或其他處置)日期：2024-01-01

手術(或其他處置)項目：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 (臺灣健保署2023年中文版ICD-10-PCS值集#3E0Y704)

Insurances

sequence：1

coverage：Coverage/cov-min

申請項目

事前審查品項：MedicationRequest/medReq-apply

事前審查申請數量(單位)：52 (tablets (Common UCUM units#{tbl}))

醫令類別：藥品 (NHI-健保事前審查-醫令類別值集#1)

續用註記：初次使用 (NHI-續用註記值集#1)

用藥線別：第一線治療 (NHI-用藥線別值集#1)

給付適應症：ALK陽性的晚期非小細胞肺癌第一線治療

事前審查品項：MedicationRequest/medReq-apply-2

事前審查申請數量(單位)：70 (tablets (Common UCUM units#{tbl}))

醫令類別：藥品 (NHI-健保事前審查-醫令類別值集#1)

續用註記：初次使用 (NHI-續用註記值集#1)

用藥線別：第一線治療 (NHI-用藥線別值集#1)

給付適應症：C50P1 (NHI-給付適應症值集#C50P1)

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