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. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "authroization-with-commitment-num-multiple-codes",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2023-07-20T12:19:49.347+00:00",
"source" : "#c2biduXBMK25v6AU"
},
"type" : "collection",
"entry" : [
{
"fullUrl" : "urn:uuid:7528e4d8-d2de-4e38-9792-eb0013e0570b",
"resource" : {
"resourceType" : "CoverageEligibilityResponse",
"id" : "106917e1-a8e6-4ead-b419-83e7a43c9c4d",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityResponse_106917e1-a8e6-4ead-b419-83e7a43c9c4d\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse 106917e1-a8e6-4ead-b419-83e7a43c9c4d</b></p><a name=\"106917e1-a8e6-4ead-b419-83e7a43c9c4d\"> </a><a name=\"hc106917e1-a8e6-4ead-b419-83e7a43c9c4d\"> </a><a name=\"106917e1-a8e6-4ead-b419-83e7a43c9c4d-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 \r\n\r\nThis 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: \r\n\r\nNote 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.\r\n\r\nThis OID may also be used in CD.codeSystem.\">URI</a>/urn:uuid:106917e1-a8e6-4ead-b419-83e7a43c9c4d</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</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>excluded</b>: false</p><p><b>name</b>: בדיקת רופא - התמחות כללית</p><p><b>description</b>: התמחות כללית</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>2</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 L9266}\">בדיקת רופא כירורג שד במרפאה</span></p><p><b>excluded</b>: false</p><p><b>name</b>: בדיקת רופא - התמחות x</p><p><b>description</b>: התמחות x</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>2</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 99242}\">בדיקת רופא מומחה במרפאה, למעט בדיקות להן קוד מיוחד</span></p><p><b>excluded</b>: false</p><p><b>name</b>: בדיקת רופא - התמחות y</p><p><b>description</b>: התמחות y</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>4</td><td>2</td></tr></table></blockquote></blockquote></div>"
},
"identifier" : [
{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuid:106917e1-a8e6-4ead-b419-83e7a43c9c4d"
}
],
"status" : "active",
"purpose" : [
"validation"
],
"patient" : {
"identifier" : {
"system" : "http://fhir.leumit.co.il/identifier/magnetic-card",
"value" : "1-123456-123456-789"
}
},
"created" : "2023-07-02T13:44:58.429Z",
"requestor" : {
"type" : "Organization",
"identifier" : {
"system" : "http://fhir.health.gov.il/identifier/legal-entity",
"value" : "500106919"
},
"display" : "בי\"ח איכילוב"
},
"request" : {
"identifier" : {
"system" : "http://fhir.tlvmc.gov.il/identifier/preauth-req-no",
"value" : "3772"
}
},
"outcome" : "complete",
"disposition" : "הבקשה להתחייבות אושרה",
"insurer" : {
"identifier" : {
"system" : "http://fhir.health.gov.il/identifier/legal-entity",
"value" : "580039899"
},
"display" : "לאומית"
},
"insurance" : [
{
"coverage" : {
"reference" : "Coverage/3819",
"identifier" : {
"system" : "http://fhir.leumit.co.il/identifier/obligation-num",
"value" : "1-1222223"
}
},
"benefitPeriod" : {
"start" : "2023-09-01",
"end" : "2023-10-01"
},
"item" : [
{
"productOrService" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/medical-service-moh",
"code" : "L9258",
"display" : "בדיקת רופא ילדים במרפאה"
}
]
},
"excluded" : false,
"name" : "בדיקת רופא - התמחות בכליות",
"description" : "בדיקת רופא ילדים עם התמחות לכליות",
"benefit" : [
{
"type" : {
"text" : "benefit"
},
"allowedUnsignedInt" : 3,
"usedUnsignedInt" : 1
}
]
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/medical-service-moh",
"code" : "L9261",
"display" : "בדיקת רופא כירורג בית החזה במרפאה"
}
]
},
"excluded" : false,
"name" : "בדיקת רופא - התמחות כללית",
"description" : "התמחות כללית",
"benefit" : [
{
"type" : {
"text" : "benefit"
},
"allowedUnsignedInt" : 2,
"usedUnsignedInt" : 1
}
]
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/medical-service-moh",
"code" : "L9266",
"display" : "בדיקת רופא כירורג שד במרפאה"
}
]
},
"excluded" : false,
"name" : "בדיקת רופא - התמחות x",
"description" : "התמחות x",
"benefit" : [
{
"type" : {
"text" : "benefit"
},
"allowedUnsignedInt" : 3,
"usedUnsignedInt" : 2
}
]
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/medical-service-moh",
"code" : "99242",
"display" : "בדיקת רופא מומחה במרפאה, למעט בדיקות להן קוד מיוחד"
}
]
},
"excluded" : false,
"name" : "בדיקת רופא - התמחות y",
"description" : "התמחות y",
"benefit" : [
{
"type" : {
"text" : "benefit"
},
"allowedUnsignedInt" : 4,
"usedUnsignedInt" : 2
}
]
}
]
}
]
}
},
{
"fullUrl" : "urn:uuid:1f8407ea-c10d-481e-9cef-829bc2560b6f",
"resource" : {
"resourceType" : "DocumentReference",
"id" : "Inline-Instance-for-3820-1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"DocumentReference_Inline-Instance-for-3820-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: DocumentReference Inline-Instance-for-3820-1</b></p><a name=\"Inline-Instance-for-3820-1\"> </a><a name=\"hcInline-Instance-for-3820-1\"> </a><a name=\"Inline-Instance-for-3820-1-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 \r\n\r\nThis 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: \r\n\r\nNote 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.\r\n\r\nThis 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>"
},
"identifier" : [
{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuid:cb512709-9276-4afd-9271-4990e5ef2889"
}
],
"status" : "current",
"type" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "64291-8",
"display" : "Health insurance-related form"
}
],
"text" : "מסמך התחייבות מאושרת"
},
"subject" : {
"type" : "Patient",
"identifier" : {
"system" : "http://fhir.leumit.co.il/identifier/magnetic-card",
"value" : "1-123456-123456-789"
}
},
"date" : "2023-07-04T05:02:03.001Z",
"authenticator" : {
"type" : "Organization",
"identifier" : {
"system" : "http://fhir.health.gov.il/identifier/legal-entity",
"value" : "580039899"
},
"display" : "לאומית"
},
"description" : "מסמך אישור התחייבות לקבלת שירות בבית החולים",
"content" : [
{
"attachment" : {
"contentType" : "application/pdf",
"url" : "http://example.org/xds/mhd/Binary/07a6483f-732b-461e-86b6-edb665c45510"
}
}
],
"context" : {
"related" : [
{
"reference" : "Coverage/3819",
"type" : "Coverage"
}
]
}
}
},
{
"fullUrl" : "http://hapi-fhir.outburn.co.il/fhir/Coverage/3819",
"resource" : {
"resourceType" : "Coverage",
"id" : "3819",
"text" : {
"status" : "generated",
"div" : "<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>"
},
"identifier" : [
{
"system" : "http://fhir.leumit.co.il/identifier/obligation-num",
"value" : "1-1222223"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/coverage-type",
"code" : "OBL",
"display" : "התחייבות"
}
]
},
"beneficiary" : {
"identifier" : {
"system" : "http://fhir.leumit.co.il/identifier/magnetic-card",
"value" : "1-123456-123456-789"
}
},
"period" : {
"start" : "2023-09-01",
"end" : "2023-10-01"
},
"payor" : [
{
"identifier" : {
"system" : "http://fhir.health.gov.il/identifier/legal-entity",
"value" : "580039899"
},
"display" : "לאומית"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/coverage-class",
"code" : "OBL-BASKET"
}
]
},
"value" : "התחייבות במסגרת הסל"
}
],
"costToBeneficiary" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
"code" : "deductible",
"display" : "Deductible"
}
],
"text" : "גובה השתתפות עצמית"
},
"valueMoney" : {
"value" : 200,
"currency" : "ILS"
}
}
]
}
}
]
}