臺灣癌症用藥事前審查實作指引
1.0.0 - release

This page is part of the 臺灣癌症用藥事前審查實作指引(TWPAS IG) (v1.0.0: Release) 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

Resource Profile: 事前審查-Claim TWPAS

Official URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/Claim-twpas Version: 1.0.0
Active as of 2024-10-16 Computable Name: ClaimTWPAS

此事前審查-Claim TWPAS Profile說明本IG如何進一步定義FHIR的Claim Resource以呈現癌藥事前審查之內容

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
sequence-1: diagnosis.sequence一定會有一個「1」，且只能出現一次。
supportingInfo: 至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... encounter S 1..1 Reference(就醫科別-Encounter TWPAS) 就醫科別，為細分科之就醫科別，作為審查分科用。【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-claim-encounter
... identifier S 0..1 Identifier 原受理編號，若申報類別為申復，則填寫原送核階段受理編號。
... status 1..1 code active | cancelled | draft | entered-in-error
Required Pattern: active
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: institutional
... subType S 1..1 CodeableConcept 申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Binding: NHI-申報類別值集 (required)
... use 1..1 code claim | preauthorization | predetermination
Required Pattern: preauthorization
... patient S 1..1 Reference(病人資訊-Patient TWPAS) 病人資訊
... created S 1..1 dateTime 申請日期，YYYY-MM-DD，機構自填，健保署收案後另建受理日期。
... enterer S 1..1 Reference(醫事人員-Practitioner TWPAS) 申請醫師，必須存在於醫事人員基本資料檔內，並於合約生效起迄日內。
... provider S 1..1 Reference(醫事機構-Organization TWPAS) 醫事機構代碼，必須存在於醫事機構基本資料檔內。
... priority S 1..1 CodeableConcept 申請案件類別，1:一般事前審查申請 | 3:自主審查報備 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。
Binding: NHI-申請案件類別值集 (required)
... Slices for supportingInfo 2..* BackboneElement Supporting information
Slice: Unordered, Open by value:category
.... supportingInfo:All Slices Content/Rules for all slices
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: NHI-補充資訊類別值集 (required)
.... supportingInfo:weight 1..1 BackboneElement 病人體重
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: weight
..... timing[x] 0..0
..... value[x] S 1..1 Quantity Data to be provided
...... value SC 1..1 decimal 體重，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... system 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code 1..1 code Coded form of the unit
Required Pattern: kg
.... supportingInfo:height 1..1 BackboneElement 病人身高
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: height
..... timing[x] 0..0
..... value[x] S 1..1 Quantity Data to be provided
...... value SC 1..1 decimal 身高(cm)，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... system 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code 1..1 code Coded form of the unit
Required Pattern: cm
.... supportingInfo:pregnancy 0..1 BackboneElement 是否懷孕或哺乳
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pregnancyBreastfeedingStatus
..... timing[x] 0..0
..... value[x] S 1..1 boolean 是否懷孕或哺乳，false:未懷孕或哺乳 | true:有懷孕或哺乳
.... supportingInfo:imagingReport 0..* BackboneElement 影像報告
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: imagingReport
..... timing[x] 0..0
..... value[x] S 1..1 Reference(影像報告-DiagnosticReport Image TWPAS) 影像報告
.... supportingInfo:cancerStage 0..* BackboneElement 癌症分期量表
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: cancerStage
..... timing[x] 0..0
..... value[x] S 1..1 Reference(癌症分期量表-Observation Cancer Stage TWPAS) 癌症分期量表
.... supportingInfo:examinationReport 0..* BackboneElement 檢查報告
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: examinationReport
..... timing[x] 0..0
..... value[x] S 1..1 Reference(檢查報告-DiagnosticReport TWPAS) 檢查報告
.... supportingInfo:companionDiagnostics 0..* BackboneElement 基因資訊
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: companionDiagnostics
..... timing[x] 0..0
..... value[x] S 1..1 Reference(基因資訊-Observation Diagnostic TWPAS) 基因資訊
.... supportingInfo:tests 0..* BackboneElement 檢驗(查)
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: tests
..... timing[x] 0..0
..... value[x] S 1..1 Reference(檢驗檢查-Observation Laboratory Result TWPAS) 檢驗(查)
.... supportingInfo:patientAssessment 0..* BackboneElement 病人狀態評估
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientAssessment
..... timing[x] 0..0
..... value[x] S 1..1 Reference(病人狀態評估-Observation Patient Assessment TWPAS) 病人狀態評估
.... supportingInfo:medicationRequest 0..* BackboneElement 用藥品項
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicationRequest
..... timing[x] 0..0
..... value[x] S 1..1 Reference(用藥品項-MedicationRequest Treat TWPAS) 用藥品項
.... supportingInfo:radiotherapy 0..* BackboneElement 放射治療
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: radiotherapy
..... timing[x] 0..0
..... value[x] S 1..1 Reference(放射治療-Procedure TWPAS) 放射治療
.... supportingInfo:carePlanDocument 0..* BackboneElement 治療計畫文件，P-IO(免疫檢查點抑制劑治療計畫)、P-CART(CAR-T多團隊會議紀錄)、P-STEMCELL(造血幹細胞移植計畫書)，附件形式PDF
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: carePlanDocument
..... timing[x] 0..0
..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) 治療計畫文件
.... supportingInfo:medicalRecord 0..* BackboneElement 病歷資料（非屬影像報告檢查驗報告部分）
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicalRecord
..... timing[x] 0..0
..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) Data to be provided
.... supportingInfo:treatmentAssessment 0..* BackboneElement 結果資訊
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: treatmentAssessment
..... timing[x] 0..0
..... value[x] S 1..1 Reference(治療後疾病狀態評估-Observation Treatment Assessment TWPAS) 結果資訊
... diagnosis SC 1..* BackboneElement sequence=1時為主要疾病；sequence>=2代表共病。
diagnosis: diagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... recordedDate S 0..* date 診斷日期，sequence=1時為必填，表示為用藥事前審查之主要疾病；其他共病不須填寫診斷日期。YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
.... sequence 1..1 positiveInt sequence=1時為主要疾病；sequence>=2代表共病。
.... diagnosis[x] S 1..1 CodeableConcept 國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。
Binding: 臺灣健保署2021年中文版ICD-10-CM值集 (required)
.... type 0..1 CodeableConcept Timing or nature of the diagnosis
..... text S 0..1 string 簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。
... procedure
.... date S 1..1 dateTime 手術(或其他處置)日期
.... procedure[x] S 1..1 CodeableConcept 手術(或其他處置)項目，經動脈導管肝臟腫瘤化學栓塞術(TACE)及冷凍療法等非屬手術。ICD-10-PCS 或 健保代碼 或 其他。
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (example)
..... Slices for coding 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
...... coding:icd10-pcs-2021 S 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (required)
...... coding:medical-service-payment S 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署醫療服務給付項目-處置或手術值集 (required)
... insurance
.... sequence 1..1 positiveInt Insurance instance identifier
Required Pattern: 1
.... coverage 1..1 Reference(健保事前審查計畫-Coverage TWPAS) Insurance information
... item 1..* BackboneElement Product or service provided
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... requestedService S 1..1 Reference(事前審查品項-MedicationRequest Apply TWPAS) 事前審查品項【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-requestedService
.... productOrService S 1..1 CodeableConcept 醫令類別
Binding: NHI-醫令類別值集 (required)
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-order-type
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 4
.... Slices for modifier 1..2 CodeableConcept Product or service billing modifiers
Slice: Unordered, Open by value:coding.system
..... modifier:continuation S 1..1 CodeableConcept 續用註記，1:初次使用 | 2:申請再次使用
Binding: NHI-續用註記值集 (required)
...... coding 1..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-continuation-status
....... code 1..1 code 1:初次使用 | 2:申請再次使用
..... modifier:lot S 0..1 CodeableConcept 用藥線別，0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
Binding: NHI-用藥線別值集 (required)
...... coding 1..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-line-of-therapy
....... code S 1..1 code 0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
.... programCode SC 1..1 CodeableConcept 給付適應症條件，藥品給付規定內所規範之適應症或條件，若有特定事前審查品項代碼應以代碼填報。
applyReason-2: text、coding擇一填寫。
..... coding 0..* Coding 給付適應症條件，當事前審查品項代碼為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，才可填寫。
Binding: NHI-給付適應症值集 (required)
..... text 0..1 string 給付適應症條件，事前審查品項代碼不為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，請自行輸入文字。
.... quantity S 1..1 SimpleQuantity Count of products or services
..... value S 1..1 decimal 事前審查申請數量
..... code S 1..1 code 事前審查申請數量單位
.... bodySite 0..1 CodeableConcept 申請部位，R:右側 | L:左側 | B:兩側。(此專案暫不檢核，未來待確認)
Binding: NHI-申請部位值集 (required)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet / CodeURI
Claim.subTyperequiredNHIApplyType (a valid code from NHI-申報類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-type
from this IG
Claim.priorityrequiredNHITMHBType (a valid code from NHI-申請案件類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-tmhb-type
from this IG
Claim.supportingInfo.categoryrequiredNHIPASSupportingInfoType (a valid code from NHI-補充資訊類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-supporting-info-type
from this IG
Claim.diagnosis.diagnosis[x]requiredTW2021ICD10CM
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-cm-2021-tw
Claim.procedure.procedure[x]exampleTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:icd10-pcs-2021requiredTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:medical-service-paymentrequiredTWMedicalServicePayment
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/procedure-tw
Claim.item.productOrServicerequiredPattern: 4
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-order-type
from this IG
Claim.item.modifier:continuationrequiredNHIContinuationStatus (a valid code from NHI-續用註記)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-continuation-status
from this IG
Claim.item.modifier:lotrequiredNHILOT (a valid code from NHI-用藥線別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-line-of-therapy
from this IG
Claim.item.programCode.codingrequiredNHIApplyReason (a valid code from NHI-給付適應症)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-reason
from this IG
Claim.item.bodySiterequiredNHIApplySide (a valid code from NHI-申請部位)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-side
from this IG

Constraints

IdGradePath(s)DetailsRequirements
HTWTerrorClaim.supportingInfo:weight.value[x].value, Claim.supportingInfo:height.value[x].value整數至多3位數及小數至多2位數
: value.toString().matches('^[0-9]{1,3}(.[0-9]{1,2})?$')
applyReason-2errorClaim.item.programCodetext、coding擇一填寫。
: text.exists() xor coding.exists()
diagnosiserrorClaim.diagnosisdiagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
: sequence=1 implies (extension.where(url = 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate').value.ofType(date).exists() and type.text.exists() )
sequence-1errorClaimdiagnosis.sequence一定會有一個「1」，且只能出現一次。
: diagnosis.where(sequence = 1).count() = 1
supportingInfoerrorClaim至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
: supportingInfo.category.exists(coding.code = 'examinationReport') or supportingInfo.category.exists(coding.code = 'imagingReport') or supportingInfo.category.exists(coding.code = 'companionDiagnostics')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
sequence-1: diagnosis.sequence一定會有一個「1」，且只能出現一次。
supportingInfo: 至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... encounter S 1..1 Reference(就醫科別-Encounter TWPAS) 就醫科別，為細分科之就醫科別，作為審查分科用。【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-claim-encounter
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Required Pattern: active
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: institutional
... subType S 1..1 CodeableConcept 申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Binding: NHI-申報類別值集 (required)
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: preauthorization
... patient SΣ 1..1 Reference(病人資訊-Patient TWPAS) 病人資訊
... created SΣ 1..1 dateTime 申請日期，YYYY-MM-DD，機構自填，健保署收案後另建受理日期。
... enterer S 1..1 Reference(醫事人員-Practitioner TWPAS) 申請醫師，必須存在於醫事人員基本資料檔內，並於合約生效起迄日內。
... provider SΣ 1..1 Reference(醫事機構-Organization TWPAS) 醫事機構代碼，必須存在於醫事機構基本資料檔內。
... priority SΣ 1..1 CodeableConcept 申請案件類別，1:一般事前審查申請 | 3:自主審查報備 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。
Binding: NHI-申請案件類別值集 (required)
... Slices for supportingInfo 2..* BackboneElement Supporting information
Slice: Unordered, Open by value:category
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: NHI-補充資訊類別值集 (required)
.... supportingInfo:weight 1..1 BackboneElement 病人體重
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: weight
..... value[x] S 1..1 Quantity Data to be provided
...... value SΣC 1..1 decimal 體重，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... system ΣC 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 code Coded form of the unit
Required Pattern: kg
.... supportingInfo:height 1..1 BackboneElement 病人身高
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: height
..... value[x] S 1..1 Quantity Data to be provided
...... value SΣC 1..1 decimal 身高(cm)，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... system ΣC 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 code Coded form of the unit
Required Pattern: cm
.... supportingInfo:pregnancy 0..1 BackboneElement 是否懷孕或哺乳
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pregnancyBreastfeedingStatus
..... value[x] S 1..1 boolean 是否懷孕或哺乳，false:未懷孕或哺乳 | true:有懷孕或哺乳
.... supportingInfo:imagingReport 0..* BackboneElement 影像報告
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: imagingReport
..... value[x] S 1..1 Reference(影像報告-DiagnosticReport Image TWPAS) 影像報告
.... supportingInfo:cancerStage 0..* BackboneElement 癌症分期量表
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: cancerStage
..... value[x] S 1..1 Reference(癌症分期量表-Observation Cancer Stage TWPAS) 癌症分期量表
.... supportingInfo:examinationReport 0..* BackboneElement 檢查報告
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: examinationReport
..... value[x] S 1..1 Reference(檢查報告-DiagnosticReport TWPAS) 檢查報告
.... supportingInfo:companionDiagnostics 0..* BackboneElement 基因資訊
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: companionDiagnostics
..... value[x] S 1..1 Reference(基因資訊-Observation Diagnostic TWPAS) 基因資訊
.... supportingInfo:tests 0..* BackboneElement 檢驗(查)
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: tests
..... value[x] S 1..1 Reference(檢驗檢查-Observation Laboratory Result TWPAS) 檢驗(查)
.... supportingInfo:patientAssessment 0..* BackboneElement 病人狀態評估
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientAssessment
..... value[x] S 1..1 Reference(病人狀態評估-Observation Patient Assessment TWPAS) 病人狀態評估
.... supportingInfo:medicationRequest 0..* BackboneElement 用藥品項
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicationRequest
..... value[x] S 1..1 Reference(用藥品項-MedicationRequest Treat TWPAS) 用藥品項
.... supportingInfo:radiotherapy 0..* BackboneElement 放射治療
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: radiotherapy
..... value[x] S 1..1 Reference(放射治療-Procedure TWPAS) 放射治療
.... supportingInfo:carePlanDocument 0..* BackboneElement 治療計畫文件，P-IO(免疫檢查點抑制劑治療計畫)、P-CART(CAR-T多團隊會議紀錄)、P-STEMCELL(造血幹細胞移植計畫書)，附件形式PDF
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: carePlanDocument
..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) 治療計畫文件
.... supportingInfo:medicalRecord 0..* BackboneElement 病歷資料（非屬影像報告檢查驗報告部分）
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicalRecord
..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) Data to be provided
.... supportingInfo:treatmentAssessment 0..* BackboneElement 結果資訊
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: treatmentAssessment
..... value[x] S 1..1 Reference(治療後疾病狀態評估-Observation Treatment Assessment TWPAS) 結果資訊
... diagnosis SC 1..* BackboneElement sequence=1時為主要疾病；sequence>=2代表共病。
diagnosis: diagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... recordedDate S 0..* date 診斷日期，sequence=1時為必填，表示為用藥事前審查之主要疾病；其他共病不須填寫診斷日期。YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt sequence=1時為主要疾病；sequence>=2代表共病。
.... diagnosis[x] S 1..1 CodeableConcept 國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。
Binding: 臺灣健保署2021年中文版ICD-10-CM值集 (required)
.... type 0..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


..... text SΣ 0..1 string 簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。
... procedure 0..* BackboneElement Clinical procedures performed
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... date S 1..1 dateTime 手術(或其他處置)日期
.... procedure[x] S 1..1 CodeableConcept 手術(或其他處置)項目，經動脈導管肝臟腫瘤化學栓塞術(TACE)及冷凍療法等非屬手術。ICD-10-PCS 或 健保代碼 或 其他。
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (example)
..... Slices for coding Σ 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
...... coding:icd10-pcs-2021 SΣ 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (required)
...... coding:medical-service-payment SΣ 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署醫療服務給付項目-處置或手術值集 (required)
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
Required Pattern: 1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(健保事前審查計畫-Coverage TWPAS) Insurance information
... item 1..* BackboneElement Product or service provided
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... requestedService S 1..1 Reference(事前審查品項-MedicationRequest Apply TWPAS) 事前審查品項【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-requestedService
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... productOrService S 1..1 CodeableConcept 醫令類別
Binding: NHI-醫令類別值集 (required)
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-order-type
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 4
.... Slices for modifier 1..2 CodeableConcept Product or service billing modifiers
Slice: Unordered, Open by value:coding.system
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... modifier:continuation S 1..1 CodeableConcept 續用註記，1:初次使用 | 2:申請再次使用
Binding: NHI-續用註記值集 (required)
...... coding Σ 1..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-continuation-status
....... code Σ 1..1 code 1:初次使用 | 2:申請再次使用
..... modifier:lot S 0..1 CodeableConcept 用藥線別，0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
Binding: NHI-用藥線別值集 (required)
...... coding Σ 1..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-line-of-therapy
....... code SΣ 1..1 code 0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
.... programCode SC 1..1 CodeableConcept 給付適應症條件，藥品給付規定內所規範之適應症或條件，若有特定事前審查品項代碼應以代碼填報。
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


applyReason-2: text、coding擇一填寫。
..... coding Σ 0..* Coding 給付適應症條件，當事前審查品項代碼為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，才可填寫。
Binding: NHI-給付適應症值集 (required)
..... text Σ 0..1 string 給付適應症條件，事前審查品項代碼不為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，請自行輸入文字。
.... quantity S 1..1 SimpleQuantity Count of products or services
..... value SΣ 1..1 decimal 事前審查申請數量
..... code SΣ 1..1 code 事前審查申請數量單位
.... bodySite 0..1 CodeableConcept 申請部位，R:右側 | L:左側 | B:兩側。(此專案暫不檢核，未來待確認)
Binding: NHI-申請部位值集 (required)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.statusrequiredPattern: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensiblePattern: institutional
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.subTyperequiredNHIApplyType (a valid code from NHI-申報類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-type
from this IG
Claim.userequiredPattern: preauthorization
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityrequiredNHITMHBType (a valid code from NHI-申請案件類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-tmhb-type
from this IG
Claim.supportingInfo.categoryrequiredNHIPASSupportingInfoType (a valid code from NHI-補充資訊類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-supporting-info-type
from this IG
Claim.supportingInfo:weight.categoryexamplePattern: weight
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:weight.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Claim.supportingInfo:height.categoryexamplePattern: height
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:height.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Claim.supportingInfo:pregnancy.categoryexamplePattern: pregnancyBreastfeedingStatus
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:imagingReport.categoryexamplePattern: imagingReport
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:cancerStage.categoryexamplePattern: cancerStage
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:examinationReport.categoryexamplePattern: examinationReport
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:companionDiagnostics.categoryexamplePattern: companionDiagnostics
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:tests.categoryexamplePattern: tests
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:patientAssessment.categoryexamplePattern: patientAssessment
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:medicationRequest.categoryexamplePattern: medicationRequest
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:radiotherapy.categoryexamplePattern: radiotherapy
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:carePlanDocument.categoryexamplePattern: carePlanDocument
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:medicalRecord.categoryexamplePattern: medicalRecord
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:treatmentAssessment.categoryexamplePattern: treatmentAssessment
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.diagnosis.diagnosis[x]requiredTW2021ICD10CM
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-cm-2021-tw
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.procedure.procedure[x]exampleTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:icd10-pcs-2021requiredTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:medical-service-paymentrequiredTWMedicalServicePayment
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/procedure-tw
Claim.item.productOrServicerequiredPattern: 4
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-order-type
from this IG
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.modifier:continuationrequiredNHIContinuationStatus (a valid code from NHI-續用註記)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-continuation-status
from this IG
Claim.item.modifier:lotrequiredNHILOT (a valid code from NHI-用藥線別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-line-of-therapy
from this IG
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.programCode.codingrequiredNHIApplyReason (a valid code from NHI-給付適應症)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-reason
from this IG
Claim.item.bodySiterequiredNHIApplySide (a valid code from NHI-申請部位)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-side
from this IG

Constraints

IdGradePath(s)DetailsRequirements
HTWTerrorClaim.supportingInfo:weight.value[x].value, Claim.supportingInfo:height.value[x].value整數至多3位數及小數至多2位數
: value.toString().matches('^[0-9]{1,3}(.[0-9]{1,2})?$')
applyReason-2errorClaim.item.programCodetext、coding擇一填寫。
: text.exists() xor coding.exists()
diagnosiserrorClaim.diagnosisdiagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
: sequence=1 implies (extension.where(url = 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate').value.ofType(date).exists() and type.text.exists() )
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
sequence-1errorClaimdiagnosis.sequence一定會有一個「1」，且只能出現一次。
: diagnosis.where(sequence = 1).count() = 1
supportingInfoerrorClaim至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
: supportingInfo.category.exists(coding.code = 'examinationReport') or supportingInfo.category.exists(coding.code = 'imagingReport') or supportingInfo.category.exists(coding.code = 'companionDiagnostics')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
sequence-1: diagnosis.sequence一定會有一個「1」，且只能出現一次。
supportingInfo: 至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... encounter S 1..1 Reference(就醫科別-Encounter TWPAS) 就醫科別，為細分科之就醫科別，作為審查分科用。【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-claim-encounter
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..1 Identifier 原受理編號，若申報類別為申復，則填寫原送核階段受理編號。
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Required Pattern: active
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: institutional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType S 1..1 CodeableConcept 申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Binding: NHI-申報類別值集 (required)
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: preauthorization
... patient SΣ 1..1 Reference(病人資訊-Patient TWPAS) 病人資訊
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime 申請日期，YYYY-MM-DD，機構自填，健保署收案後另建受理日期。
... enterer S 1..1 Reference(醫事人員-Practitioner TWPAS) 申請醫師，必須存在於醫事人員基本資料檔內，並於合約生效起迄日內。
... insurer Σ 0..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(醫事機構-Organization TWPAS) 醫事機構代碼，必須存在於醫事機構基本資料檔內。
... priority SΣ 1..1 CodeableConcept 申請案件類別，1:一般事前審查申請 | 3:自主審查報備 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。
Binding: NHI-申請案件類別值集 (required)
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment referral
... facility 0..1 Reference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... Slices for supportingInfo 2..* BackboneElement Supporting information
Slice: Unordered, Open by value:category
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: NHI-補充資訊類別值集 (required)
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:weight 1..1 BackboneElement 病人體重
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: weight
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Quantity Data to be provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣC 1..1 decimal 體重，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit Σ 0..1 string Unit representation
...... system ΣC 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 code Coded form of the unit
Required Pattern: kg
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:height 1..1 BackboneElement 病人身高
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: height
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Quantity Data to be provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣC 1..1 decimal 身高(cm)，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit Σ 0..1 string Unit representation
...... system ΣC 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 code Coded form of the unit
Required Pattern: cm
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:pregnancy 0..1 BackboneElement 是否懷孕或哺乳
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pregnancyBreastfeedingStatus
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 boolean 是否懷孕或哺乳，false:未懷孕或哺乳 | true:有懷孕或哺乳
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:imagingReport 0..* BackboneElement 影像報告
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: imagingReport
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(影像報告-DiagnosticReport Image TWPAS) 影像報告
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:cancerStage 0..* BackboneElement 癌症分期量表
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: cancerStage
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(癌症分期量表-Observation Cancer Stage TWPAS) 癌症分期量表
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:examinationReport 0..* BackboneElement 檢查報告
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: examinationReport
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(檢查報告-DiagnosticReport TWPAS) 檢查報告
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:companionDiagnostics 0..* BackboneElement 基因資訊
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: companionDiagnostics
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(基因資訊-Observation Diagnostic TWPAS) 基因資訊
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:tests 0..* BackboneElement 檢驗(查)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: tests
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(檢驗檢查-Observation Laboratory Result TWPAS) 檢驗(查)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:patientAssessment 0..* BackboneElement 病人狀態評估
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientAssessment
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(病人狀態評估-Observation Patient Assessment TWPAS) 病人狀態評估
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:medicationRequest 0..* BackboneElement 用藥品項
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicationRequest
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(用藥品項-MedicationRequest Treat TWPAS) 用藥品項
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:radiotherapy 0..* BackboneElement 放射治療
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: radiotherapy
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(放射治療-Procedure TWPAS) 放射治療
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:carePlanDocument 0..* BackboneElement 治療計畫文件，P-IO(免疫檢查點抑制劑治療計畫)、P-CART(CAR-T多團隊會議紀錄)、P-STEMCELL(造血幹細胞移植計畫書)，附件形式PDF
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: carePlanDocument
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) 治療計畫文件
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:medicalRecord 0..* BackboneElement 病歷資料（非屬影像報告檢查驗報告部分）
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicalRecord
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:treatmentAssessment 0..* BackboneElement 結果資訊
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: treatmentAssessment
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(治療後疾病狀態評估-Observation Treatment Assessment TWPAS) 結果資訊
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis SC 1..* BackboneElement sequence=1時為主要疾病；sequence>=2代表共病。
diagnosis: diagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... recordedDate S 0..* date 診斷日期，sequence=1時為必填，表示為用藥事前審查之主要疾病；其他共病不須填寫診斷日期。YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt sequence=1時為主要疾病；sequence>=2代表共病。
.... diagnosis[x] S 1..1 CodeableConcept 國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。
Binding: 臺灣健保署2021年中文版ICD-10-CM值集 (required)
.... type 0..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..* Coding Code defined by a terminology system
..... text SΣ 0..1 string 簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date S 1..1 dateTime 手術(或其他處置)日期
.... procedure[x] S 1..1 CodeableConcept 手術(或其他處置)項目，經動脈導管肝臟腫瘤化學栓塞術(TACE)及冷凍療法等非屬手術。ICD-10-PCS 或 健保代碼 或 其他。
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... Slices for coding Σ 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
...... coding:icd10-pcs-2021 SΣ 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (required)
...... coding:medical-service-payment SΣ 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署醫療服務給付項目-處置或手術值集 (required)
..... text Σ 0..1 string Plain text representation of the concept
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
Required Pattern: 1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(健保事前審查計畫-Coverage TWPAS) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item 1..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... requestedService S 1..1 Reference(事前審查品項-MedicationRequest Apply TWPAS) 事前審查品項【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-requestedService
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

.... productOrService S 1..1 CodeableConcept 醫令類別
Binding: NHI-醫令類別值集 (required)
Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-order-type
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 4
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... Slices for modifier 1..2 CodeableConcept Product or service billing modifiers
Slice: Unordered, Open by value:coding.system
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... modifier:continuation S 1..1 CodeableConcept 續用註記，1:初次使用 | 2:申請再次使用
Binding: NHI-續用註記值集 (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-continuation-status
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code 1:初次使用 | 2:申請再次使用
....... display Σ 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... modifier:lot S 0..1 CodeableConcept 用藥線別，0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
Binding: NHI-用藥線別值集 (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-line-of-therapy
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code 0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
....... display Σ 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
.... programCode SC 1..1 CodeableConcept 給付適應症條件，藥品給付規定內所規範之適應症或條件，若有特定事前審查品項代碼應以代碼填報。
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


applyReason-2: text、coding擇一填寫。
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..* Coding 給付適應症條件，當事前審查品項代碼為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，才可填寫。
Binding: NHI-給付適應症值集 (required)
..... text Σ 0..1 string 給付適應症條件，事前審查品項代碼不為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，請自行輸入文字。
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity S 1..1 SimpleQuantity Count of products or services
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣ 1..1 decimal 事前審查申請數量
..... unit Σ 0..1 string Unit representation
..... system ΣC 0..1 uri System that defines coded unit form
..... code SΣ 1..1 code 事前審查申請數量單位
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept 申請部位，R:右側 | L:左側 | B:兩側。(此專案暫不檢核，未來待確認)
Binding: NHI-申請部位值集 (required)
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity 0..1 SimpleQuantity Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity 0..1 SimpleQuantity Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Claim.statusrequiredPattern: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensiblePattern: institutional
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.subTyperequiredNHIApplyType (a valid code from NHI-申報類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-type
from this IG
Claim.userequiredPattern: preauthorization
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityrequiredNHITMHBType (a valid code from NHI-申請案件類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-tmhb-type
from this IG
Claim.fundsReserveexampleFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryrequiredNHIPASSupportingInfoType (a valid code from NHI-補充資訊類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-supporting-info-type
from this IG
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:weight.categoryexamplePattern: weight
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:weight.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:weight.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Claim.supportingInfo:weight.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:height.categoryexamplePattern: height
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:height.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:height.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Claim.supportingInfo:height.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:pregnancy.categoryexamplePattern: pregnancyBreastfeedingStatus
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:pregnancy.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:pregnancy.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:imagingReport.categoryexamplePattern: imagingReport
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:imagingReport.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:imagingReport.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:cancerStage.categoryexamplePattern: cancerStage
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:cancerStage.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:cancerStage.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:examinationReport.categoryexamplePattern: examinationReport
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:examinationReport.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:examinationReport.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:companionDiagnostics.categoryexamplePattern: companionDiagnostics
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:companionDiagnostics.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:companionDiagnostics.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:tests.categoryexamplePattern: tests
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:tests.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:tests.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:patientAssessment.categoryexamplePattern: patientAssessment
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:patientAssessment.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:patientAssessment.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:medicationRequest.categoryexamplePattern: medicationRequest
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:medicationRequest.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:medicationRequest.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:radiotherapy.categoryexamplePattern: radiotherapy
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:radiotherapy.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:radiotherapy.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:carePlanDocument.categoryexamplePattern: carePlanDocument
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:carePlanDocument.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:carePlanDocument.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:medicalRecord.categoryexamplePattern: medicalRecord
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:medicalRecord.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:medicalRecord.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:treatmentAssessment.categoryexamplePattern: treatmentAssessment
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:treatmentAssessment.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:treatmentAssessment.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]requiredTW2021ICD10CM
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-cm-2021-tw
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.procedure.typeexampleExampleProcedureTypeCodes
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure.procedure[x]exampleTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:icd10-pcs-2021requiredTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:medical-service-paymentrequiredTWMedicalServicePayment
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/procedure-tw
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.productOrServicerequiredPattern: 4
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-order-type
from this IG
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.modifier:continuationrequiredNHIContinuationStatus (a valid code from NHI-續用註記)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-continuation-status
from this IG
Claim.item.modifier:lotrequiredNHILOT (a valid code from NHI-用藥線別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-line-of-therapy
from this IG
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.programCode.codingrequiredNHIApplyReason (a valid code from NHI-給付適應症)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-reason
from this IG
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
from the FHIR Standard
Claim.item.bodySiterequiredNHIApplySide (a valid code from NHI-申請部位)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-side
from this IG
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
HTWTerrorClaim.supportingInfo:weight.value[x].value, Claim.supportingInfo:height.value[x].value整數至多3位數及小數至多2位數
: value.toString().matches('^[0-9]{1,3}(.[0-9]{1,2})?$')
applyReason-2errorClaim.item.programCodetext、coding擇一填寫。
: text.exists() xor coding.exists()
diagnosiserrorClaim.diagnosisdiagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
: sequence=1 implies (extension.where(url = 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate').value.ofType(date).exists() and type.text.exists() )
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
sequence-1errorClaimdiagnosis.sequence一定會有一個「1」，且只能出現一次。
: diagnosis.where(sequence = 1).count() = 1
supportingInfoerrorClaim至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
: supportingInfo.category.exists(coding.code = 'examinationReport') or supportingInfo.category.exists(coding.code = 'imagingReport') or supportingInfo.category.exists(coding.code = 'companionDiagnostics')

This structure is derived from Claim

Summary

Mandatory: 27 elements(17 nested mandatory elements)
Must-Support: 41 elements
Prohibited: 14 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.supportingInfo
  • The element 1 is sliced based on the value of Claim.procedure.procedure[x].coding
  • The element 1 is sliced based on the value of Claim.item.modifier

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
sequence-1: diagnosis.sequence一定會有一個「1」，且只能出現一次。
supportingInfo: 至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... encounter S 1..1 Reference(就醫科別-Encounter TWPAS) 就醫科別，為細分科之就醫科別，作為審查分科用。【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-claim-encounter
... identifier S 0..1 Identifier 原受理編號，若申報類別為申復，則填寫原送核階段受理編號。
... status 1..1 code active | cancelled | draft | entered-in-error
Required Pattern: active
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: institutional
... subType S 1..1 CodeableConcept 申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Binding: NHI-申報類別值集 (required)
... use 1..1 code claim | preauthorization | predetermination
Required Pattern: preauthorization
... patient S 1..1 Reference(病人資訊-Patient TWPAS) 病人資訊
... created S 1..1 dateTime 申請日期，YYYY-MM-DD，機構自填，健保署收案後另建受理日期。
... enterer S 1..1 Reference(醫事人員-Practitioner TWPAS) 申請醫師，必須存在於醫事人員基本資料檔內，並於合約生效起迄日內。
... provider S 1..1 Reference(醫事機構-Organization TWPAS) 醫事機構代碼，必須存在於醫事機構基本資料檔內。
... priority S 1..1 CodeableConcept 申請案件類別，1:一般事前審查申請 | 3:自主審查報備 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。
Binding: NHI-申請案件類別值集 (required)
... Slices for supportingInfo 2..* BackboneElement Supporting information
Slice: Unordered, Open by value:category
.... supportingInfo:All Slices Content/Rules for all slices
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: NHI-補充資訊類別值集 (required)
.... supportingInfo:weight 1..1 BackboneElement 病人體重
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: weight
..... timing[x] 0..0
..... value[x] S 1..1 Quantity Data to be provided
...... value SC 1..1 decimal 體重，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... system 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code 1..1 code Coded form of the unit
Required Pattern: kg
.... supportingInfo:height 1..1 BackboneElement 病人身高
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: height
..... timing[x] 0..0
..... value[x] S 1..1 Quantity Data to be provided
...... value SC 1..1 decimal 身高(cm)，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... system 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code 1..1 code Coded form of the unit
Required Pattern: cm
.... supportingInfo:pregnancy 0..1 BackboneElement 是否懷孕或哺乳
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pregnancyBreastfeedingStatus
..... timing[x] 0..0
..... value[x] S 1..1 boolean 是否懷孕或哺乳，false:未懷孕或哺乳 | true:有懷孕或哺乳
.... supportingInfo:imagingReport 0..* BackboneElement 影像報告
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: imagingReport
..... timing[x] 0..0
..... value[x] S 1..1 Reference(影像報告-DiagnosticReport Image TWPAS) 影像報告
.... supportingInfo:cancerStage 0..* BackboneElement 癌症分期量表
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: cancerStage
..... timing[x] 0..0
..... value[x] S 1..1 Reference(癌症分期量表-Observation Cancer Stage TWPAS) 癌症分期量表
.... supportingInfo:examinationReport 0..* BackboneElement 檢查報告
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: examinationReport
..... timing[x] 0..0
..... value[x] S 1..1 Reference(檢查報告-DiagnosticReport TWPAS) 檢查報告
.... supportingInfo:companionDiagnostics 0..* BackboneElement 基因資訊
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: companionDiagnostics
..... timing[x] 0..0
..... value[x] S 1..1 Reference(基因資訊-Observation Diagnostic TWPAS) 基因資訊
.... supportingInfo:tests 0..* BackboneElement 檢驗(查)
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: tests
..... timing[x] 0..0
..... value[x] S 1..1 Reference(檢驗檢查-Observation Laboratory Result TWPAS) 檢驗(查)
.... supportingInfo:patientAssessment 0..* BackboneElement 病人狀態評估
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientAssessment
..... timing[x] 0..0
..... value[x] S 1..1 Reference(病人狀態評估-Observation Patient Assessment TWPAS) 病人狀態評估
.... supportingInfo:medicationRequest 0..* BackboneElement 用藥品項
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicationRequest
..... timing[x] 0..0
..... value[x] S 1..1 Reference(用藥品項-MedicationRequest Treat TWPAS) 用藥品項
.... supportingInfo:radiotherapy 0..* BackboneElement 放射治療
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: radiotherapy
..... timing[x] 0..0
..... value[x] S 1..1 Reference(放射治療-Procedure TWPAS) 放射治療
.... supportingInfo:carePlanDocument 0..* BackboneElement 治療計畫文件，P-IO(免疫檢查點抑制劑治療計畫)、P-CART(CAR-T多團隊會議紀錄)、P-STEMCELL(造血幹細胞移植計畫書)，附件形式PDF
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: carePlanDocument
..... timing[x] 0..0
..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) 治療計畫文件
.... supportingInfo:medicalRecord 0..* BackboneElement 病歷資料（非屬影像報告檢查驗報告部分）
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicalRecord
..... timing[x] 0..0
..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) Data to be provided
.... supportingInfo:treatmentAssessment 0..* BackboneElement 結果資訊
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: treatmentAssessment
..... timing[x] 0..0
..... value[x] S 1..1 Reference(治療後疾病狀態評估-Observation Treatment Assessment TWPAS) 結果資訊
... diagnosis SC 1..* BackboneElement sequence=1時為主要疾病；sequence>=2代表共病。
diagnosis: diagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... recordedDate S 0..* date 診斷日期，sequence=1時為必填，表示為用藥事前審查之主要疾病；其他共病不須填寫診斷日期。YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
.... sequence 1..1 positiveInt sequence=1時為主要疾病；sequence>=2代表共病。
.... diagnosis[x] S 1..1 CodeableConcept 國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。
Binding: 臺灣健保署2021年中文版ICD-10-CM值集 (required)
.... type 0..1 CodeableConcept Timing or nature of the diagnosis
..... text S 0..1 string 簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。
... procedure
.... date S 1..1 dateTime 手術(或其他處置)日期
.... procedure[x] S 1..1 CodeableConcept 手術(或其他處置)項目，經動脈導管肝臟腫瘤化學栓塞術(TACE)及冷凍療法等非屬手術。ICD-10-PCS 或 健保代碼 或 其他。
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (example)
..... Slices for coding 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
...... coding:icd10-pcs-2021 S 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (required)
...... coding:medical-service-payment S 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署醫療服務給付項目-處置或手術值集 (required)
... insurance
.... sequence 1..1 positiveInt Insurance instance identifier
Required Pattern: 1
.... coverage 1..1 Reference(健保事前審查計畫-Coverage TWPAS) Insurance information
... item 1..* BackboneElement Product or service provided
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... requestedService S 1..1 Reference(事前審查品項-MedicationRequest Apply TWPAS) 事前審查品項【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-requestedService
.... productOrService S 1..1 CodeableConcept 醫令類別
Binding: NHI-醫令類別值集 (required)
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-order-type
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 4
.... Slices for modifier 1..2 CodeableConcept Product or service billing modifiers
Slice: Unordered, Open by value:coding.system
..... modifier:continuation S 1..1 CodeableConcept 續用註記，1:初次使用 | 2:申請再次使用
Binding: NHI-續用註記值集 (required)
...... coding 1..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-continuation-status
....... code 1..1 code 1:初次使用 | 2:申請再次使用
..... modifier:lot S 0..1 CodeableConcept 用藥線別，0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
Binding: NHI-用藥線別值集 (required)
...... coding 1..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-line-of-therapy
....... code S 1..1 code 0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
.... programCode SC 1..1 CodeableConcept 給付適應症條件，藥品給付規定內所規範之適應症或條件，若有特定事前審查品項代碼應以代碼填報。
applyReason-2: text、coding擇一填寫。
..... coding 0..* Coding 給付適應症條件，當事前審查品項代碼為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，才可填寫。
Binding: NHI-給付適應症值集 (required)
..... text 0..1 string 給付適應症條件，事前審查品項代碼不為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，請自行輸入文字。
.... quantity S 1..1 SimpleQuantity Count of products or services
..... value S 1..1 decimal 事前審查申請數量
..... code S 1..1 code 事前審查申請數量單位
.... bodySite 0..1 CodeableConcept 申請部位，R:右側 | L:左側 | B:兩側。(此專案暫不檢核，未來待確認)
Binding: NHI-申請部位值集 (required)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet / CodeURI
Claim.subTyperequiredNHIApplyType (a valid code from NHI-申報類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-type
from this IG
Claim.priorityrequiredNHITMHBType (a valid code from NHI-申請案件類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-tmhb-type
from this IG
Claim.supportingInfo.categoryrequiredNHIPASSupportingInfoType (a valid code from NHI-補充資訊類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-supporting-info-type
from this IG
Claim.diagnosis.diagnosis[x]requiredTW2021ICD10CM
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-cm-2021-tw
Claim.procedure.procedure[x]exampleTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:icd10-pcs-2021requiredTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:medical-service-paymentrequiredTWMedicalServicePayment
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/procedure-tw
Claim.item.productOrServicerequiredPattern: 4
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-order-type
from this IG
Claim.item.modifier:continuationrequiredNHIContinuationStatus (a valid code from NHI-續用註記)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-continuation-status
from this IG
Claim.item.modifier:lotrequiredNHILOT (a valid code from NHI-用藥線別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-line-of-therapy
from this IG
Claim.item.programCode.codingrequiredNHIApplyReason (a valid code from NHI-給付適應症)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-reason
from this IG
Claim.item.bodySiterequiredNHIApplySide (a valid code from NHI-申請部位)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-side
from this IG

Constraints

IdGradePath(s)DetailsRequirements
HTWTerrorClaim.supportingInfo:weight.value[x].value, Claim.supportingInfo:height.value[x].value整數至多3位數及小數至多2位數
: value.toString().matches('^[0-9]{1,3}(.[0-9]{1,2})?$')
applyReason-2errorClaim.item.programCodetext、coding擇一填寫。
: text.exists() xor coding.exists()
diagnosiserrorClaim.diagnosisdiagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
: sequence=1 implies (extension.where(url = 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate').value.ofType(date).exists() and type.text.exists() )
sequence-1errorClaimdiagnosis.sequence一定會有一個「1」，且只能出現一次。
: diagnosis.where(sequence = 1).count() = 1
supportingInfoerrorClaim至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
: supportingInfo.category.exists(coding.code = 'examinationReport') or supportingInfo.category.exists(coding.code = 'imagingReport') or supportingInfo.category.exists(coding.code = 'companionDiagnostics')

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
sequence-1: diagnosis.sequence一定會有一個「1」，且只能出現一次。
supportingInfo: 至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... encounter S 1..1 Reference(就醫科別-Encounter TWPAS) 就醫科別，為細分科之就醫科別，作為審查分科用。【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-claim-encounter
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Required Pattern: active
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: institutional
... subType S 1..1 CodeableConcept 申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Binding: NHI-申報類別值集 (required)
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: preauthorization
... patient SΣ 1..1 Reference(病人資訊-Patient TWPAS) 病人資訊
... created SΣ 1..1 dateTime 申請日期，YYYY-MM-DD，機構自填，健保署收案後另建受理日期。
... enterer S 1..1 Reference(醫事人員-Practitioner TWPAS) 申請醫師，必須存在於醫事人員基本資料檔內，並於合約生效起迄日內。
... provider SΣ 1..1 Reference(醫事機構-Organization TWPAS) 醫事機構代碼，必須存在於醫事機構基本資料檔內。
... priority SΣ 1..1 CodeableConcept 申請案件類別，1:一般事前審查申請 | 3:自主審查報備 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。
Binding: NHI-申請案件類別值集 (required)
... Slices for supportingInfo 2..* BackboneElement Supporting information
Slice: Unordered, Open by value:category
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: NHI-補充資訊類別值集 (required)
.... supportingInfo:weight 1..1 BackboneElement 病人體重
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: weight
..... value[x] S 1..1 Quantity Data to be provided
...... value SΣC 1..1 decimal 體重，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... system ΣC 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 code Coded form of the unit
Required Pattern: kg
.... supportingInfo:height 1..1 BackboneElement 病人身高
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: height
..... value[x] S 1..1 Quantity Data to be provided
...... value SΣC 1..1 decimal 身高(cm)，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... system ΣC 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 code Coded form of the unit
Required Pattern: cm
.... supportingInfo:pregnancy 0..1 BackboneElement 是否懷孕或哺乳
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pregnancyBreastfeedingStatus
..... value[x] S 1..1 boolean 是否懷孕或哺乳，false:未懷孕或哺乳 | true:有懷孕或哺乳
.... supportingInfo:imagingReport 0..* BackboneElement 影像報告
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: imagingReport
..... value[x] S 1..1 Reference(影像報告-DiagnosticReport Image TWPAS) 影像報告
.... supportingInfo:cancerStage 0..* BackboneElement 癌症分期量表
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: cancerStage
..... value[x] S 1..1 Reference(癌症分期量表-Observation Cancer Stage TWPAS) 癌症分期量表
.... supportingInfo:examinationReport 0..* BackboneElement 檢查報告
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: examinationReport
..... value[x] S 1..1 Reference(檢查報告-DiagnosticReport TWPAS) 檢查報告
.... supportingInfo:companionDiagnostics 0..* BackboneElement 基因資訊
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: companionDiagnostics
..... value[x] S 1..1 Reference(基因資訊-Observation Diagnostic TWPAS) 基因資訊
.... supportingInfo:tests 0..* BackboneElement 檢驗(查)
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: tests
..... value[x] S 1..1 Reference(檢驗檢查-Observation Laboratory Result TWPAS) 檢驗(查)
.... supportingInfo:patientAssessment 0..* BackboneElement 病人狀態評估
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientAssessment
..... value[x] S 1..1 Reference(病人狀態評估-Observation Patient Assessment TWPAS) 病人狀態評估
.... supportingInfo:medicationRequest 0..* BackboneElement 用藥品項
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicationRequest
..... value[x] S 1..1 Reference(用藥品項-MedicationRequest Treat TWPAS) 用藥品項
.... supportingInfo:radiotherapy 0..* BackboneElement 放射治療
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: radiotherapy
..... value[x] S 1..1 Reference(放射治療-Procedure TWPAS) 放射治療
.... supportingInfo:carePlanDocument 0..* BackboneElement 治療計畫文件，P-IO(免疫檢查點抑制劑治療計畫)、P-CART(CAR-T多團隊會議紀錄)、P-STEMCELL(造血幹細胞移植計畫書)，附件形式PDF
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: carePlanDocument
..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) 治療計畫文件
.... supportingInfo:medicalRecord 0..* BackboneElement 病歷資料（非屬影像報告檢查驗報告部分）
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicalRecord
..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) Data to be provided
.... supportingInfo:treatmentAssessment 0..* BackboneElement 結果資訊
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: treatmentAssessment
..... value[x] S 1..1 Reference(治療後疾病狀態評估-Observation Treatment Assessment TWPAS) 結果資訊
... diagnosis SC 1..* BackboneElement sequence=1時為主要疾病；sequence>=2代表共病。
diagnosis: diagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... recordedDate S 0..* date 診斷日期，sequence=1時為必填，表示為用藥事前審查之主要疾病；其他共病不須填寫診斷日期。YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt sequence=1時為主要疾病；sequence>=2代表共病。
.... diagnosis[x] S 1..1 CodeableConcept 國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。
Binding: 臺灣健保署2021年中文版ICD-10-CM值集 (required)
.... type 0..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


..... text SΣ 0..1 string 簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。
... procedure 0..* BackboneElement Clinical procedures performed
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... date S 1..1 dateTime 手術(或其他處置)日期
.... procedure[x] S 1..1 CodeableConcept 手術(或其他處置)項目，經動脈導管肝臟腫瘤化學栓塞術(TACE)及冷凍療法等非屬手術。ICD-10-PCS 或 健保代碼 或 其他。
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (example)
..... Slices for coding Σ 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
...... coding:icd10-pcs-2021 SΣ 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (required)
...... coding:medical-service-payment SΣ 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署醫療服務給付項目-處置或手術值集 (required)
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
Required Pattern: 1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(健保事前審查計畫-Coverage TWPAS) Insurance information
... item 1..* BackboneElement Product or service provided
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... requestedService S 1..1 Reference(事前審查品項-MedicationRequest Apply TWPAS) 事前審查品項【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-requestedService
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... productOrService S 1..1 CodeableConcept 醫令類別
Binding: NHI-醫令類別值集 (required)
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-order-type
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 4
.... Slices for modifier 1..2 CodeableConcept Product or service billing modifiers
Slice: Unordered, Open by value:coding.system
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... modifier:continuation S 1..1 CodeableConcept 續用註記，1:初次使用 | 2:申請再次使用
Binding: NHI-續用註記值集 (required)
...... coding Σ 1..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-continuation-status
....... code Σ 1..1 code 1:初次使用 | 2:申請再次使用
..... modifier:lot S 0..1 CodeableConcept 用藥線別，0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
Binding: NHI-用藥線別值集 (required)
...... coding Σ 1..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-line-of-therapy
....... code SΣ 1..1 code 0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
.... programCode SC 1..1 CodeableConcept 給付適應症條件，藥品給付規定內所規範之適應症或條件，若有特定事前審查品項代碼應以代碼填報。
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


applyReason-2: text、coding擇一填寫。
..... coding Σ 0..* Coding 給付適應症條件，當事前審查品項代碼為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，才可填寫。
Binding: NHI-給付適應症值集 (required)
..... text Σ 0..1 string 給付適應症條件，事前審查品項代碼不為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，請自行輸入文字。
.... quantity S 1..1 SimpleQuantity Count of products or services
..... value SΣ 1..1 decimal 事前審查申請數量
..... code SΣ 1..1 code 事前審查申請數量單位
.... bodySite 0..1 CodeableConcept 申請部位，R:右側 | L:左側 | B:兩側。(此專案暫不檢核，未來待確認)
Binding: NHI-申請部位值集 (required)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.statusrequiredPattern: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensiblePattern: institutional
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.subTyperequiredNHIApplyType (a valid code from NHI-申報類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-type
from this IG
Claim.userequiredPattern: preauthorization
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityrequiredNHITMHBType (a valid code from NHI-申請案件類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-tmhb-type
from this IG
Claim.supportingInfo.categoryrequiredNHIPASSupportingInfoType (a valid code from NHI-補充資訊類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-supporting-info-type
from this IG
Claim.supportingInfo:weight.categoryexamplePattern: weight
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:weight.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Claim.supportingInfo:height.categoryexamplePattern: height
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:height.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Claim.supportingInfo:pregnancy.categoryexamplePattern: pregnancyBreastfeedingStatus
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:imagingReport.categoryexamplePattern: imagingReport
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:cancerStage.categoryexamplePattern: cancerStage
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:examinationReport.categoryexamplePattern: examinationReport
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:companionDiagnostics.categoryexamplePattern: companionDiagnostics
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:tests.categoryexamplePattern: tests
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:patientAssessment.categoryexamplePattern: patientAssessment
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:medicationRequest.categoryexamplePattern: medicationRequest
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:radiotherapy.categoryexamplePattern: radiotherapy
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:carePlanDocument.categoryexamplePattern: carePlanDocument
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:medicalRecord.categoryexamplePattern: medicalRecord
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:treatmentAssessment.categoryexamplePattern: treatmentAssessment
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.diagnosis.diagnosis[x]requiredTW2021ICD10CM
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-cm-2021-tw
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.procedure.procedure[x]exampleTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:icd10-pcs-2021requiredTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:medical-service-paymentrequiredTWMedicalServicePayment
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/procedure-tw
Claim.item.productOrServicerequiredPattern: 4
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-order-type
from this IG
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.modifier:continuationrequiredNHIContinuationStatus (a valid code from NHI-續用註記)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-continuation-status
from this IG
Claim.item.modifier:lotrequiredNHILOT (a valid code from NHI-用藥線別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-line-of-therapy
from this IG
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.programCode.codingrequiredNHIApplyReason (a valid code from NHI-給付適應症)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-reason
from this IG
Claim.item.bodySiterequiredNHIApplySide (a valid code from NHI-申請部位)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-side
from this IG

Constraints

IdGradePath(s)DetailsRequirements
HTWTerrorClaim.supportingInfo:weight.value[x].value, Claim.supportingInfo:height.value[x].value整數至多3位數及小數至多2位數
: value.toString().matches('^[0-9]{1,3}(.[0-9]{1,2})?$')
applyReason-2errorClaim.item.programCodetext、coding擇一填寫。
: text.exists() xor coding.exists()
diagnosiserrorClaim.diagnosisdiagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
: sequence=1 implies (extension.where(url = 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate').value.ofType(date).exists() and type.text.exists() )
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
sequence-1errorClaimdiagnosis.sequence一定會有一個「1」，且只能出現一次。
: diagnosis.where(sequence = 1).count() = 1
supportingInfoerrorClaim至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
: supportingInfo.category.exists(coding.code = 'examinationReport') or supportingInfo.category.exists(coding.code = 'imagingReport') or supportingInfo.category.exists(coding.code = 'companionDiagnostics')

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
sequence-1: diagnosis.sequence一定會有一個「1」，且只能出現一次。
supportingInfo: 至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... encounter S 1..1 Reference(就醫科別-Encounter TWPAS) 就醫科別，為細分科之就醫科別，作為審查分科用。【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-claim-encounter
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..1 Identifier 原受理編號，若申報類別為申復，則填寫原送核階段受理編號。
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Required Pattern: active
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: institutional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType S 1..1 CodeableConcept 申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Binding: NHI-申報類別值集 (required)
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: preauthorization
... patient SΣ 1..1 Reference(病人資訊-Patient TWPAS) 病人資訊
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime 申請日期，YYYY-MM-DD，機構自填，健保署收案後另建受理日期。
... enterer S 1..1 Reference(醫事人員-Practitioner TWPAS) 申請醫師，必須存在於醫事人員基本資料檔內，並於合約生效起迄日內。
... insurer Σ 0..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(醫事機構-Organization TWPAS) 醫事機構代碼，必須存在於醫事機構基本資料檔內。
... priority SΣ 1..1 CodeableConcept 申請案件類別，1:一般事前審查申請 | 3:自主審查報備 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。
Binding: NHI-申請案件類別值集 (required)
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment referral
... facility 0..1 Reference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... Slices for supportingInfo 2..* BackboneElement Supporting information
Slice: Unordered, Open by value:category
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: NHI-補充資訊類別值集 (required)
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:weight 1..1 BackboneElement 病人體重
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: weight
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Quantity Data to be provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣC 1..1 decimal 體重，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit Σ 0..1 string Unit representation
...... system ΣC 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 code Coded form of the unit
Required Pattern: kg
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:height 1..1 BackboneElement 病人身高
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: height
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Quantity Data to be provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣC 1..1 decimal 身高(cm)，整數至多3位數及小數至多2位數。
HTWT: 整數至多3位數及小數至多2位數
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit Σ 0..1 string Unit representation
...... system ΣC 1..1 uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 code Coded form of the unit
Required Pattern: cm
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:pregnancy 0..1 BackboneElement 是否懷孕或哺乳
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pregnancyBreastfeedingStatus
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 boolean 是否懷孕或哺乳，false:未懷孕或哺乳 | true:有懷孕或哺乳
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:imagingReport 0..* BackboneElement 影像報告
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: imagingReport
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(影像報告-DiagnosticReport Image TWPAS) 影像報告
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:cancerStage 0..* BackboneElement 癌症分期量表
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: cancerStage
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(癌症分期量表-Observation Cancer Stage TWPAS) 癌症分期量表
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:examinationReport 0..* BackboneElement 檢查報告
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: examinationReport
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(檢查報告-DiagnosticReport TWPAS) 檢查報告
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:companionDiagnostics 0..* BackboneElement 基因資訊
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: companionDiagnostics
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(基因資訊-Observation Diagnostic TWPAS) 基因資訊
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:tests 0..* BackboneElement 檢驗(查)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: tests
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(檢驗檢查-Observation Laboratory Result TWPAS) 檢驗(查)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:patientAssessment 0..* BackboneElement 病人狀態評估
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientAssessment
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(病人狀態評估-Observation Patient Assessment TWPAS) 病人狀態評估
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:medicationRequest 0..* BackboneElement 用藥品項
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicationRequest
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(用藥品項-MedicationRequest Treat TWPAS) 用藥品項
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:radiotherapy 0..* BackboneElement 放射治療
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: radiotherapy
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(放射治療-Procedure TWPAS) 放射治療
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:carePlanDocument 0..* BackboneElement 治療計畫文件，P-IO(免疫檢查點抑制劑治療計畫)、P-CART(CAR-T多團隊會議紀錄)、P-STEMCELL(造血幹細胞移植計畫書)，附件形式PDF
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: carePlanDocument
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) 治療計畫文件
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:medicalRecord 0..* BackboneElement 病歷資料（非屬影像報告檢查驗報告部分）
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: medicalRecord
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(文件參照-DocumentReference TWPAS) Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:treatmentAssessment 0..* BackboneElement 結果資訊
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-supporting-info-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: treatmentAssessment
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... value[x] S 1..1 Reference(治療後疾病狀態評估-Observation Treatment Assessment TWPAS) 結果資訊
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis SC 1..* BackboneElement sequence=1時為主要疾病；sequence>=2代表共病。
diagnosis: diagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... recordedDate S 0..* date 診斷日期，sequence=1時為必填，表示為用藥事前審查之主要疾病；其他共病不須填寫診斷日期。YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt sequence=1時為主要疾病；sequence>=2代表共病。
.... diagnosis[x] S 1..1 CodeableConcept 國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。
Binding: 臺灣健保署2021年中文版ICD-10-CM值集 (required)
.... type 0..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..* Coding Code defined by a terminology system
..... text SΣ 0..1 string 簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date S 1..1 dateTime 手術(或其他處置)日期
.... procedure[x] S 1..1 CodeableConcept 手術(或其他處置)項目，經動脈導管肝臟腫瘤化學栓塞術(TACE)及冷凍療法等非屬手術。ICD-10-PCS 或 健保代碼 或 其他。
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... Slices for coding Σ 1..1 Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
...... coding:icd10-pcs-2021 SΣ 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署2021年中文版ICD-10-PCS值集 (required)
...... coding:medical-service-payment SΣ 0..1 Coding Code defined by a terminology system
Binding: 臺灣健保署醫療服務給付項目-處置或手術值集 (required)
..... text Σ 0..1 string Plain text representation of the concept
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
Required Pattern: 1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(健保事前審查計畫-Coverage TWPAS) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item 1..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... requestedService S 1..1 Reference(事前審查品項-MedicationRequest Apply TWPAS) 事前審查品項【此為參考Da Vinci PAS IG的extension設計】
URL: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/extension-requestedService
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

.... productOrService S 1..1 CodeableConcept 醫令類別
Binding: NHI-醫令類別值集 (required)
Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-order-type
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 4
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... Slices for modifier 1..2 CodeableConcept Product or service billing modifiers
Slice: Unordered, Open by value:coding.system
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... modifier:continuation S 1..1 CodeableConcept 續用註記，1:初次使用 | 2:申請再次使用
Binding: NHI-續用註記值集 (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-continuation-status
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code 1:初次使用 | 2:申請再次使用
....... display Σ 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... modifier:lot S 0..1 CodeableConcept 用藥線別，0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
Binding: NHI-用藥線別值集 (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 1..1 uri Identity of the terminology system
Required Pattern: https://twcore.mohw.gov.tw/ig/pas/CodeSystem/nhi-line-of-therapy
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code 0:不適用 | 1:第一線治療 | 2:第二線治療 | 3:第三線治療 | 4:第四線治療 | 5:第五線治療
....... display Σ 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
.... programCode SC 1..1 CodeableConcept 給付適應症條件，藥品給付規定內所規範之適應症或條件，若有特定事前審查品項代碼應以代碼填報。
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


applyReason-2: text、coding擇一填寫。
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..* Coding 給付適應症條件，當事前審查品項代碼為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，才可填寫。
Binding: NHI-給付適應症值集 (required)
..... text Σ 0..1 string 給付適應症條件，事前審查品項代碼不為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5時，請自行輸入文字。
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity S 1..1 SimpleQuantity Count of products or services
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣ 1..1 decimal 事前審查申請數量
..... unit Σ 0..1 string Unit representation
..... system ΣC 0..1 uri System that defines coded unit form
..... code SΣ 1..1 code 事前審查申請數量單位
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept 申請部位，R:右側 | L:左側 | B:兩側。(此專案暫不檢核，未來待確認)
Binding: NHI-申請部位值集 (required)
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity 0..1 SimpleQuantity Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity 0..1 SimpleQuantity Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Claim.statusrequiredPattern: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensiblePattern: institutional
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.subTyperequiredNHIApplyType (a valid code from NHI-申報類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-type
from this IG
Claim.userequiredPattern: preauthorization
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityrequiredNHITMHBType (a valid code from NHI-申請案件類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-tmhb-type
from this IG
Claim.fundsReserveexampleFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryrequiredNHIPASSupportingInfoType (a valid code from NHI-補充資訊類別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-supporting-info-type
from this IG
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:weight.categoryexamplePattern: weight
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:weight.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:weight.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Claim.supportingInfo:weight.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:height.categoryexamplePattern: height
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:height.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:height.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Claim.supportingInfo:height.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:pregnancy.categoryexamplePattern: pregnancyBreastfeedingStatus
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:pregnancy.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:pregnancy.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:imagingReport.categoryexamplePattern: imagingReport
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:imagingReport.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:imagingReport.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:cancerStage.categoryexamplePattern: cancerStage
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:cancerStage.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:cancerStage.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:examinationReport.categoryexamplePattern: examinationReport
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:examinationReport.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:examinationReport.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:companionDiagnostics.categoryexamplePattern: companionDiagnostics
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:companionDiagnostics.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:companionDiagnostics.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:tests.categoryexamplePattern: tests
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:tests.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:tests.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:patientAssessment.categoryexamplePattern: patientAssessment
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:patientAssessment.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:patientAssessment.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:medicationRequest.categoryexamplePattern: medicationRequest
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:medicationRequest.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:medicationRequest.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:radiotherapy.categoryexamplePattern: radiotherapy
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:radiotherapy.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:radiotherapy.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:carePlanDocument.categoryexamplePattern: carePlanDocument
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:carePlanDocument.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:carePlanDocument.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:medicalRecord.categoryexamplePattern: medicalRecord
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:medicalRecord.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:medicalRecord.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:treatmentAssessment.categoryexamplePattern: treatmentAssessment
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:treatmentAssessment.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:treatmentAssessment.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]requiredTW2021ICD10CM
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-cm-2021-tw
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.procedure.typeexampleExampleProcedureTypeCodes
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure.procedure[x]exampleTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:icd10-pcs-2021requiredTW2021ICD10PCS
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/icd-10-pcs-2021-tw
Claim.procedure.procedure[x].coding:medical-service-paymentrequiredTWMedicalServicePayment
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/procedure-tw
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.productOrServicerequiredPattern: 4
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-order-type
from this IG
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.modifier:continuationrequiredNHIContinuationStatus (a valid code from NHI-續用註記)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-continuation-status
from this IG
Claim.item.modifier:lotrequiredNHILOT (a valid code from NHI-用藥線別)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-line-of-therapy
from this IG
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.programCode.codingrequiredNHIApplyReason (a valid code from NHI-給付適應症)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-reason
from this IG
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
from the FHIR Standard
Claim.item.bodySiterequiredNHIApplySide (a valid code from NHI-申請部位)
https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-apply-side
from this IG
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
HTWTerrorClaim.supportingInfo:weight.value[x].value, Claim.supportingInfo:height.value[x].value整數至多3位數及小數至多2位數
: value.toString().matches('^[0-9]{1,3}(.[0-9]{1,2})?$')
applyReason-2errorClaim.item.programCodetext、coding擇一填寫。
: text.exists() xor coding.exists()
diagnosiserrorClaim.diagnosisdiagnosis.sequence=1時才需填寫診斷日期、簡要病摘(申請原因)
: sequence=1 implies (extension.where(url = 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate').value.ofType(date).exists() and type.text.exists() )
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
sequence-1errorClaimdiagnosis.sequence一定會有一個「1」，且只能出現一次。
: diagnosis.where(sequence = 1).count() = 1
supportingInfoerrorClaim至少還需提供檢查報告、影像報告、基因資訊中任一樣資訊。
: supportingInfo.category.exists(coding.code = 'examinationReport') or supportingInfo.category.exists(coding.code = 'imagingReport') or supportingInfo.category.exists(coding.code = 'companionDiagnostics')

This structure is derived from Claim

Summary

Mandatory: 27 elements(17 nested mandatory elements)
Must-Support: 41 elements
Prohibited: 14 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.supportingInfo
  • The element 1 is sliced based on the value of Claim.procedure.procedure[x].coding
  • The element 1 is sliced based on the value of Claim.item.modifier

 

Other representations of profile: CSV, Excel, Schematron

Notes:

以下概述了此Profile所需的RESTful FHIR互動功能。有關TWPAS支援的RESTful互動功能的完整清單，請參閱TWPAS Server能力聲明。

建議應該支援以下查詢參數：

  1. 必須（SHALL） 支援透過查詢參數 identifier 查詢所有Claim：
    (如何透過token查詢)
    GET [base]/Claim?identifier=[code]

    例子：
    (1) GET [base]/Claim?identifier=20240831010109051701

  2. 必須（SHALL） 支援透過查詢參數 patient 查詢所有Claim：
    (如何透過reference查詢)
    GET [base]/Claim?patient={Type/}[id]

    例子：
    (1) GET [base]/Claim?patient=Patient/pat-min (2) GET [base]/Claim?patient=pat-min

  3. 必須（SHALL） 支援透過查詢參數 func-type 查詢所有Claim：
    (如何透過reference查詢)
    GET [base]/Claim?func-type={Type/}[id]

    例子：
    (1) GET [base]/Claim?func-type=Encounter/enc-min (2) GET [base]/Claim?func-type=enc-min