臺灣健保事前審查實作指引
1.2.4 - STU1.2.4

This page is part of the 臺灣健保癌症用藥事前審查實作指引(TWPAS IG) (v1.2.4: STU1.2.4) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: 事前審查回覆 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/ClaimResponse/claim-response-example> a fhir:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "claim-response-example"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas" ;
       fhir:index 0 ;
       fhir:link <https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas>
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.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-ClaimResponse-twpas.html\">事前審查結果-ClaimResponse TWPAS</a></p></div><p><b>狀態</b>：Active</p><p><b>類型</b>：<span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>用途</b>：Preauthorization</p><p><b>病人</b>：<a href=\"Patient-pat-min.html\">Patient/pat-min</a></p><p><b>核定日期</b>：2024-07-30</p><p><b>關聯的事前審查</b>：<a href=\"Claim-cla-1.html\">Claim/cla-1</a></p><p><b>保險商</b>：<a href=\"Organization-org-nhi.html\">Organization 衛生福利部中央健康保險署</a></p><p><b>requestor</b>：<a href=\"Organization-org-hosp-example.html\">Organization 醫事機構</a></p><p><b>處置狀態</b>：Processing Complete</p><p><b>案件受理狀態</b>：審畢結果</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>：1</p><h3>受理審查案件核定註記</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>類型</b></td><td><b>受理審查案件核定註記</b></td><td><b>核定數量</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td><td>同意備查 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"CodeSystem-nhi-approve-comment.html\">NHI-健保事前審查-核定註記</a>#1) </span>)</td><td>2</td></tr></table><h3>個別醫令核定註記</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>類型</b></td><td><b>Claim.item.sequence</b></td><td><b>個別醫令核定註記</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td><td>1</td><td>同意備查 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"CodeSystem-nhi-approve-comment.html\">NHI-健保事前審查-核定註記</a>#1) </span>)</td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td><td>2</td><td>同意備查 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"CodeSystem-nhi-approve-comment.html\">NHI-健保事前審查-核定註記</a>#1) </span>)</td></tr></table></blockquote></div>"
  ] ;
  fhir:ClaimResponse.status [ fhir:value "active"] ;
  fhir:ClaimResponse.type [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ] ;
       fhir:Coding.code [ fhir:value "institutional" ]
     ]
  ] ;
  fhir:ClaimResponse.use [ fhir:value "preauthorization"] ;
  fhir:ClaimResponse.patient [
     fhir:link <http://hl7.org/fhir/Patient/pat-min> ;
     fhir:Reference.reference [ fhir:value "Patient/pat-min" ]
  ] ;
  fhir:ClaimResponse.created [ fhir:value "2024-07-30"^^xsd:date] ;
  fhir:ClaimResponse.insurer [
     fhir:link <http://hl7.org/fhir/Organization/org-nhi> ;
     fhir:Reference.reference [ fhir:value "Organization/org-nhi" ]
  ] ;
  fhir:ClaimResponse.requestor [
     fhir:link <http://hl7.org/fhir/Organization/org-hosp-example> ;
     fhir:Reference.reference [ fhir:value "Organization/org-hosp-example" ]
  ] ;
  fhir:ClaimResponse.request [
     fhir:link <http://hl7.org/fhir/Claim/cla-1> ;
     fhir:Reference.reference [ fhir:value "Claim/cla-1" ]
  ] ;
  fhir:ClaimResponse.outcome [ fhir:value "complete"] ;
  fhir:ClaimResponse.disposition [ fhir:value "審畢結果"] ;
  fhir:ClaimResponse.item [
     fhir:index 0 ;
     fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ClaimResponse.item.adjudication [
       fhir:index 0 ;
       fhir:ClaimResponse.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index 0 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "submitted" ]
         ]
       ] ;
       fhir:ClaimResponse.item.adjudication.reason [
         fhir:CodeableConcept.coding [
           fhir:index 0 ;
           fhir:Coding.system [ fhir:value "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-approve-comment" ] ;
           fhir:Coding.code [ fhir:value "1" ]
         ]
       ] ;
       fhir:ClaimResponse.item.adjudication.value [ fhir:value "2"^^xsd:decimal ]
     ] ;
     fhir:ClaimResponse.item.detail [
       fhir:index 0 ;
       fhir:ClaimResponse.item.detail.detailSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
       fhir:ClaimResponse.item.detail.adjudication [
         fhir:index 0 ;
         fhir:ClaimResponse.item.adjudication.category [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
             fhir:Coding.code [ fhir:value "submitted" ]
           ]
         ] ;
         fhir:ClaimResponse.item.adjudication.reason [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-approve-comment" ] ;
             fhir:Coding.code [ fhir:value "1" ]
           ]
         ]
       ]
     ], [
       fhir:index 1 ;
       fhir:ClaimResponse.item.detail.detailSequence [ fhir:value "2"^^xsd:positiveInteger ] ;
       fhir:ClaimResponse.item.detail.adjudication [
         fhir:index 0 ;
         fhir:ClaimResponse.item.adjudication.category [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
             fhir:Coding.code [ fhir:value "submitted" ]
           ]
         ] ;
         fhir:ClaimResponse.item.adjudication.reason [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-approve-comment" ] ;
             fhir:Coding.code [ fhir:value "1" ]
           ]
         ]
       ]
     ]
  ] .

<http://hl7.org/fhir/Patient/pat-min> a fhir:Patient .

<http://hl7.org/fhir/Organization/org-nhi> a fhir:Organization .

<http://hl7.org/fhir/Organization/org-hosp-example> a fhir:Organization .

<http://hl7.org/fhir/Claim/cla-1> a fhir:Claim .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/ClaimResponse/claim-response-example.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/ClaimResponse/claim-response-example.ttl> .