מדריך למטמיע - טופס 17
1.0.0 - ci-build
This page is part of the T17 IG (v1.0.0: draft-1 Draft) 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
<Bundle xmlns="http://hl7.org/fhir">
<id value="partial-authroization-with-commitment-num-multiple-codes"/>
<meta>
<versionId value="2"/>
<lastUpdated value="2023-10-30T09:55:36.234+00:00"/>
<source value="#TJ6bhIX9MTvxMUWt"/>
</meta>
<type value="collection"/>
<entry>
<fullUrl value="urn:uuid:7528e4d8-d2de-4e38-9792-eb0013e0570b"/>
<resource>
<CoverageEligibilityResponse>
<id value="b3b72e7b-5390-43a0-9499-af300f6a8d7b"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="CoverageEligibilityResponse_b3b72e7b-5390-43a0-9499-af300f6a8d7b"> </a><p class="res-header-id"><b>Generated Narrative: CoverageEligibilityResponse b3b72e7b-5390-43a0-9499-af300f6a8d7b</b></p><a name="b3b72e7b-5390-43a0-9499-af300f6a8d7b"> </a><a name="hcb3b72e7b-5390-43a0-9499-af300f6a8d7b"> </a><a name="b3b72e7b-5390-43a0-9499-af300f6a8d7b-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-uri.html" title="As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt
This oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid:
Note that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.
This OID may also be used in CD.codeSystem.">URI</a>/urn:uuid:b3b72e7b-5390-43a0-9499-af300f6a8d7b</p><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage Validation</p><p><b>patient</b>: Identifier: <code>http://fhir.leumit.co.il/identifier/magnetic-card</code>/1-123456-123456-789</p><p><b>created</b>: 2023-07-02 13:44:58+0000</p><p><b>requestor</b>: בי"ח איכילוב (Identifier: Israeli Legal Entity/500106919)</p><p><b>request</b>: Identifier: <code>http://fhir.tlvmc.gov.il/identifier/preauth-req-no</code>/3772</p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: הבקשה להתחייבות אושרה חלקית</p><p><b>insurer</b>: לאומית (Identifier: Israeli Legal Entity/580039899)</p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href="Bundle-authorization-and-falure-multiple-codes.html#Coverage_3819">Bundle: type = collection</a></p><p><b>benefitPeriod</b>: 2023-09-01 --> 2023-10-01</p><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title="Codes:{http://fhir.health.gov.il/cs/medical-service-moh L9258}">בדיקת רופא ילדים במרפאה</span></p><p><b>excluded</b>: false</p><p><b>name</b>: בדיקת רופא - התמחות בכליות</p><p><b>description</b>: בדיקת רופא ילדים עם התמחות לכליות</p><h3>Benefits</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:">benefit</span></td><td>3</td><td>1</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title="Codes:{http://fhir.health.gov.il/cs/medical-service-moh L9261}">בדיקת רופא כירורג בית החזה במרפאה</span></p><p><b>modifier</b>: <span title="Codes:{http://fhir.health.gov.il/cs/moh-form17-issue-code service-not-covered}">השירות אינו בסל</span></p><p><b>excluded</b>: true</p><p><b>name</b>: בדיקת רופא - התמחות כללית</p><p><b>description</b>: התמחות כללית</p></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title="Codes:{http://fhir.health.gov.il/cs/medical-service-moh L9266}">בדיקת רופא כירורג שד במרפאה</span></p><p><b>modifier</b>: <span title="Codes:{http://fhir.health.gov.il/cs/moh-form17-issue-code service-not-covered}">השירות אינו בסל</span></p><p><b>excluded</b>: true</p><p><b>name</b>: בדיקת רופא - התמחות x מסוג</p><p><b>description</b>: התמחות x</p></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title="Codes:{http://fhir.health.gov.il/cs/medical-service-moh 99242}">בדיקת רופא מומחה במרפאה, למעט בדיקות להן קוד מיוחד</span></p><p><b>modifier</b>: <span title="Codes:{http://fhir.health.gov.il/cs/moh-form17-issue-code service-not-covered}">השירות אינו בסל</span></p><p><b>excluded</b>: true</p><p><b>name</b>: בדיקת רופא - התמחות y מסוג</p><p><b>description</b>: התמחות y</p></blockquote></blockquote></div>
</text>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:b3b72e7b-5390-43a0-9499-af300f6a8d7b"/>
</identifier>
<status value="active"/>
<purpose value="validation"/>
<patient>
<identifier>
<system
value="http://fhir.leumit.co.il/identifier/magnetic-card"/>
<value value="1-123456-123456-789"/>
</identifier>
</patient>
<created value="2023-07-02T13:44:58.429Z"/>
<requestor>
<type value="Organization"/>
<identifier>
<system
value="http://fhir.health.gov.il/identifier/legal-entity"/>
<value value="500106919"/>
</identifier>
<display value="בי"ח איכילוב"/>
</requestor>
<request>
<identifier>
<system
value="http://fhir.tlvmc.gov.il/identifier/preauth-req-no"/>
<value value="3772"/>
</identifier>
</request>
<outcome value="complete"/>
<disposition value="הבקשה להתחייבות אושרה חלקית"/>
<insurer>
<identifier>
<system
value="http://fhir.health.gov.il/identifier/legal-entity"/>
<value value="580039899"/>
</identifier>
<display value="לאומית"/>
</insurer>
<insurance>
<coverage>
<reference value="Coverage/3819"/>
<identifier>
<system
value="http://fhir.leumit.co.il/identifier/obligation-num"/>
<value value="1-1222223"/>
</identifier>
</coverage>
<benefitPeriod>
<start value="2023-09-01"/>
<end value="2023-10-01"/>
</benefitPeriod>
<item>
<productOrService>
<coding>
<system
value="http://fhir.health.gov.il/cs/medical-service-moh"/>
<code value="L9258"/>
<display value="בדיקת רופא ילדים במרפאה"/>
</coding>
</productOrService>
<excluded value="false"/>
<name value="בדיקת רופא - התמחות בכליות"/>
<description value="בדיקת רופא ילדים עם התמחות לכליות"/>
<benefit>
<type>
<text value="benefit"/>
</type>
<allowedUnsignedInt value="3"/>
<usedUnsignedInt value="1"/>
</benefit>
</item>
<item>
<productOrService>
<coding>
<system
value="http://fhir.health.gov.il/cs/medical-service-moh"/>
<code value="L9261"/>
<display value="בדיקת רופא כירורג בית החזה במרפאה"/>
</coding>
</productOrService>
<modifier>
<coding>
<system
value="http://fhir.health.gov.il/cs/moh-form17-issue-code"/>
<code value="service-not-covered"/>
<display value="השירות אינו בסל"/>
</coding>
</modifier>
<excluded value="true"/>
<name value="בדיקת רופא - התמחות כללית"/>
<description value="התמחות כללית"/>
</item>
<item>
<productOrService>
<coding>
<system
value="http://fhir.health.gov.il/cs/medical-service-moh"/>
<code value="L9266"/>
<display value="בדיקת רופא כירורג שד במרפאה"/>
</coding>
</productOrService>
<modifier>
<coding>
<system
value="http://fhir.health.gov.il/cs/moh-form17-issue-code"/>
<code value="service-not-covered"/>
<display value="השירות אינו בסל"/>
</coding>
</modifier>
<excluded value="true"/>
<name value="בדיקת רופא - התמחות x מסוג"/>
<description value="התמחות x"/>
</item>
<item>
<productOrService>
<coding>
<system
value="http://fhir.health.gov.il/cs/medical-service-moh"/>
<code value="99242"/>
<display
value="בדיקת רופא מומחה במרפאה, למעט בדיקות להן קוד מיוחד"/>
</coding>
</productOrService>
<modifier>
<coding>
<system
value="http://fhir.health.gov.il/cs/moh-form17-issue-code"/>
<code value="service-not-covered"/>
<display value="השירות אינו בסל"/>
</coding>
</modifier>
<excluded value="true"/>
<name value="בדיקת רופא - התמחות y מסוג"/>
<description value="התמחות y"/>
</item>
</insurance>
</CoverageEligibilityResponse>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:1f8407ea-c10d-481e-9cef-829bc2560b6f"/>
<resource>
<DocumentReference>
<id value="Inline-Instance-for-4065-1"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="DocumentReference_Inline-Instance-for-4065-1"> </a><p class="res-header-id"><b>Generated Narrative: DocumentReference Inline-Instance-for-4065-1</b></p><a name="Inline-Instance-for-4065-1"> </a><a name="hcInline-Instance-for-4065-1"> </a><a name="Inline-Instance-for-4065-1-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-uri.html" title="As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt
This oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid:
Note that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.
This OID may also be used in CD.codeSystem.">URI</a>/urn:uuid:cb512709-9276-4afd-9271-4990e5ef2889</p><p><b>status</b>: Current</p><p><b>type</b>: <span title="Codes:{http://loinc.org 64291-8}">מסמך התחייבות מאושרת</span></p><p><b>subject</b>: Identifier: <code>http://fhir.leumit.co.il/identifier/magnetic-card</code>/1-123456-123456-789</p><p><b>date</b>: 2023-07-04 05:02:03+0000</p><p><b>authenticator</b>: לאומית (Identifier: Israeli Legal Entity/580039899)</p><p><b>description</b>: מסמך אישור התחייבות לקבלת שירות בבית החולים</p><blockquote><p><b>content</b></p><h3>Attachments</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ContentType</b></td><td><b>Url</b></td></tr><tr><td style="display: none">*</td><td>application/pdf</td><td><a href="https://simplifier.net/resolve?scope=il.core.fhir.r4@0.14.2&canonical=http://example.org/xds/mhd/Binary/07a6483f-732b-461e-86b6-edb665c45510">http://example.org/xds/mhd/Binary/07a6483f-732b-461e-86b6-edb665c45510</a></td></tr></table></blockquote><h3>Contexts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Related</b></td></tr><tr><td style="display: none">*</td><td><a href="Bundle-authorization-and-falure-multiple-codes.html#Coverage_3819">Bundle: type = collection</a></td></tr></table></div>
</text>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:cb512709-9276-4afd-9271-4990e5ef2889"/>
</identifier>
<status value="current"/>
<type>
<coding>
<system value="http://loinc.org"/>
<code value="64291-8"/>
<display value="Health insurance-related form"/>
</coding>
<text value="מסמך התחייבות מאושרת"/>
</type>
<subject>
<type value="Patient"/>
<identifier>
<system
value="http://fhir.leumit.co.il/identifier/magnetic-card"/>
<value value="1-123456-123456-789"/>
</identifier>
</subject>
<date value="2023-07-04T05:02:03.001Z"/>
<authenticator>
<type value="Organization"/>
<identifier>
<system
value="http://fhir.health.gov.il/identifier/legal-entity"/>
<value value="580039899"/>
</identifier>
<display value="לאומית"/>
</authenticator>
<description value="מסמך אישור התחייבות לקבלת שירות בבית החולים"/>
<content>
<attachment>
<contentType value="application/pdf"/>
<url
value="http://example.org/xds/mhd/Binary/07a6483f-732b-461e-86b6-edb665c45510"/>
</attachment>
</content>
<context>
<related>
<reference value="Coverage/3819"/>
<type value="Coverage"/>
</related>
</context>
</DocumentReference>
</resource>
</entry>
<entry>
<fullUrl value="http://hapi-fhir.outburn.co.il/fhir/Coverage/3819"/>
<resource>
<Coverage>
<id value="3819"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_3819"> </a><p class="res-header-id"><b>Generated Narrative: Coverage 3819</b></p><a name="3819"> </a><a name="hc3819"> </a><a name="3819-en-US"> </a><p><b>identifier</b>: <code>http://fhir.leumit.co.il/identifier/obligation-num</code>/1-1222223</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://fhir.health.gov.il/cs/coverage-type OBL}">התחייבות</span></p><p><b>beneficiary</b>: Identifier: <code>http://fhir.leumit.co.il/identifier/magnetic-card</code>/1-123456-123456-789</p><p><b>period</b>: 2023-09-01 --> 2023-10-01</p><p><b>payor</b>: לאומית (Identifier: Israeli Legal Entity/580039899)</p><h3>Classes</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://fhir.health.gov.il/cs/coverage-class OBL-BASKET}">OBL-BASKET</span></td><td>התחייבות במסגרת הסל</td></tr></table><h3>CostToBeneficiaries</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-copay-type deductible}">גובה השתתפות עצמית</span></td><td><span title="Israeli New Shekel">₪200.00</span> (ILS)</td></tr></table></div>
</text>
<identifier>
<system value="http://fhir.leumit.co.il/identifier/obligation-num"/>
<value value="1-1222223"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://fhir.health.gov.il/cs/coverage-type"/>
<code value="OBL"/>
<display value="התחייבות"/>
</coding>
</type>
<beneficiary>
<identifier>
<system
value="http://fhir.leumit.co.il/identifier/magnetic-card"/>
<value value="1-123456-123456-789"/>
</identifier>
</beneficiary>
<period>
<start value="2023-09-01"/>
<end value="2023-10-01"/>
</period>
<payor>
<identifier>
<system
value="http://fhir.health.gov.il/identifier/legal-entity"/>
<value value="580039899"/>
</identifier>
<display value="לאומית"/>
</payor>
<class>
<type>
<coding>
<system value="http://fhir.health.gov.il/cs/coverage-class"/>
<code value="OBL-BASKET"/>
</coding>
</type>
<value value="התחייבות במסגרת הסל"/>
</class>
<costToBeneficiary>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-copay-type"/>
<code value="deductible"/>
<display value="Deductible"/>
</coding>
<text value="גובה השתתפות עצמית"/>
</type>
<valueMoney>
<value value="200"/>
<currency value="ILS"/>
</valueMoney>
</costToBeneficiary>
</Coverage>
</resource>
</entry>
</Bundle>