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" : "cancellation-request-multiple-codes",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2023-07-20T12:21:34.190+00:00",
"source" : "#XilFlMo7DOtpxLzY"
},
"type" : "collection",
"entry" : [
{
"fullUrl" : "urn:uuid:3f003001-01cb-4f76-ada7-6d0bc6d04f62",
"resource" : {
"resourceType" : "CoverageEligibilityRequest",
"id" : "Inline-Instance-for-3822-1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityRequest_Inline-Instance-for-3822-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityRequest Inline-Instance-for-3822-1</b></p><a name=\"Inline-Instance-for-3822-1\"> </a><a name=\"hcInline-Instance-for-3822-1\"> </a><a name=\"Inline-Instance-for-3822-1-en-US\"> </a><p><b>identifier</b>: <code>http://fhir.tlvmc.gov.il/identifier/preauth-req-no</code>/3773</p><p><b>status</b>: Cancelled</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>serviced</b>: 2023-07-02</p><p><b>created</b>: 2023-07-18 07:51:20+0000</p><p><b>provider</b>: בי"ח איכילוב (Identifier: Israeli Legal Entity/500106919)</p><p><b>insurer</b>: מאוחדת (Identifier: Israeli Legal Entity/5899584495)</p><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Information</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>בקשת ההתחייבות המבוטלת (Identifier: <code>http://fhir.tlvmc.gov.il/identifier/preauth-req-no</code>/3772)</td></tr></table><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>quantity</b>: 2</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>210</td><td>Israeli new shekel</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>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>242</td><td>Israeli new shekel</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>quantity</b>: 2</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>136</td><td>Israeli new shekel</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>quantity</b>: 2</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>80</td><td>Israeli new shekel</td></tr></table></blockquote></div>"
},
"identifier" : [
{
"system" : "http://fhir.tlvmc.gov.il/identifier/preauth-req-no",
"value" : "3773"
}
],
"status" : "cancelled",
"purpose" : [
"validation"
],
"patient" : {
"identifier" : {
"system" : "http://fhir.leumit.co.il/identifier/magnetic-card",
"value" : "1-123456-123456-789"
}
},
"servicedDate" : "2023-07-02",
"created" : "2023-07-18T07:51:20.001Z",
"provider" : {
"type" : "Organization",
"identifier" : {
"system" : "http://fhir.health.gov.il/identifier/legal-entity",
"value" : "500106919"
},
"display" : "בי\"ח איכילוב"
},
"insurer" : {
"identifier" : {
"system" : "http://fhir.health.gov.il/identifier/legal-entity",
"value" : "5899584495"
},
"display" : "מאוחדת"
},
"supportingInfo" : [
{
"sequence" : 1,
"information" : {
"type" : "CoverageEligibilityRequest",
"identifier" : {
"system" : "http://fhir.tlvmc.gov.il/identifier/preauth-req-no",
"value" : "3772"
},
"display" : "בקשת ההתחייבות המבוטלת"
}
}
],
"item" : [
{
"productOrService" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/medical-service-moh",
"code" : "L9258",
"display" : "בדיקת רופא ילדים במרפאה"
}
]
},
"quantity" : {
"value" : 2
},
"unitPrice" : {
"value" : 210,
"currency" : "ILS"
}
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/medical-service-moh",
"code" : "L9261",
"display" : "בדיקת רופא כירורג בית החזה במרפאה"
}
]
},
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 242,
"currency" : "ILS"
}
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/medical-service-moh",
"code" : "L9266",
"display" : "בדיקת רופא כירורג שד במרפאה"
}
]
},
"quantity" : {
"value" : 2
},
"unitPrice" : {
"value" : 136,
"currency" : "ILS"
}
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://fhir.health.gov.il/cs/medical-service-moh",
"code" : "99242",
"display" : "בדיקת רופא מומחה במרפאה, למעט בדיקות להן קוד מיוחד"
}
]
},
"quantity" : {
"value" : 2
},
"unitPrice" : {
"value" : 80,
"currency" : "ILS"
}
}
]
}
}
]
}