電子病歷交換單張實作指引(EMR-IG)
0.1.0 - ci-build

This page is part of the 電子病歷交換單張實作指引(EMR-IG) (v0.1.0: Releases) 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

Example Bundle: 調劑單張 Bundle example

Document Details

Generated Narrative: Bundle 調劑單張

Document Subject

Unable to resolve subject '->甄○康(official) Female, DoB: 1985-01-02 ( Medical record number: Z199999829 (use: official, ))'

Document Content

Social history Narrative

Vital signs, weight, height, head circumference, oxygen saturation and BMI panel

Diagnosis Narrative

Medication prescribed Narrative

Signature of person collecting or coordinating collection of assessment information Provider

Additional Resources Included in Document

Entry 1 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Composition/com-ds

Resource Composition:

Generated Narrative: Composition com-ds

status: Final

type: Medication dispensed

encounter: Encounter: status = finished; class = 西醫一般案件 (casetype#01); serviceType = 家醫科; period = 2023-02-23 --> (ongoing)

date: 2024-02-19 14:30:00+0100

author:

title: 調劑單張

custodian: Organization 洪文武藥局

Entry 2 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Patient/pat-ds

Resource Patient:

Generated Narrative: Patient pat-ds

甄○康(official) Female, DoB: 1985-01-02 ( Medical record number: Z199999829 (use: official, ))

Person Age39 a (Details: UCUM codea = 'a')

Entry 3 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Organization/org-ds

Resource Organization:

Generated Narrative: Organization org-ds

identifier: Provider number/3531020884

name: 洪文武診所

Contacts

-TelecomAddress
*ph: 02-29765731(Work)新北市三重區集美街162號1樓(work)

Entry 4 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Organization/org-dis-ds

Resource Organization:

Generated Narrative: Organization org-dis-ds

identifier: Provider number/3531020884

name: 洪文武藥局

Contacts

-TelecomAddress
*ph: 02-29765731(Work)新北市三重區集美街162號1樓(work)

Entry 5 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Practitioner/pra-ds

Resource Practitioner:

Generated Narrative: Practitioner pra-ds

identifier: https://www.fda.gov.tw//A0429 (use: official, )

name: 洪文武(Official)

telecom: ph: 02-29765731(Work)

Entry 6 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Practitioner/pra-dis-ds

Resource Practitioner:

Generated Narrative: Practitioner pra-dis-ds

name: 洪藥師(Official)

telecom: ph: 02-29765731(Work)

Qualifications

-IdentifierCode
*https://www.mohw.gov.tw//A1*****8028 (use: official, )Pharmacist

Entry 7 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Encounter/enc-ds

Resource Encounter:

Generated Narrative: Encounter enc-ds

Not done yet

Entry 8 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Condition/con-ds

Resource Condition:

Generated Narrative: Condition con-ds

clinicalStatus: Active

category: Problem List Item

code: 霍亂

subject: 甄○康(official) Female, DoB: 1985-01-02 ( Medical record number: Z199999829 (use: official, ))

note: 001

Entry 9 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Observation/obs-ds

Resource Observation:

Generated Narrative: Observation obs-ds

status: Final

category: Vital Signs

code: Body weight

subject: 甄○康(official) Female, DoB: 1985-01-02 ( Medical record number: Z199999829 (use: official, ))

encounter: Encounter: status = finished; class = 西醫一般案件 (casetype#01); serviceType = 家醫科; period = 2023-02-23 --> (ongoing)

effective: 2023-12-21

performer: Practitioner 洪藥師(official)

value: 50 kg (Details: UCUM codekg = 'kg')

Entry 10 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Coverage/cov-ds

Resource Coverage:

Generated Narrative: Coverage cov-ds

status: Active

type: 普通疾病

beneficiary: 甄○康(official) Female, DoB: 1985-01-02 ( Medical record number: Z199999829 (use: official, ))

Entry 11 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/ChargeItem/cha-ds

Resource ChargeItem:

Generated Narrative: ChargeItem cha-ds

status: Billed

code: 藥事服務代碼

subject: 甄○康(official) Female, DoB: 1985-01-02 ( Medical record number: Z199999829 (use: official, ))

Entry 12 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Medication/med-01-ds

Resource Medication:

Generated Narrative: Medication med-01-ds

identifier: 1

code: YEN KUANG EYE DROPS

ingredient

Entry 13 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/MedicationRequest/med-req-01-ds

Resource MedicationRequest:

Generated Narrative: MedicationRequest med-req-01-ds

identifier: http://www.moi.gov.tw//Med000001, 7

status: Active

intent: Order

category: 一般處方箋：處方用藥，一次給予7日(含)以下之用藥量, 自行調劑或檢驗（查）或物理治療

subject: 甄○康(official) Female, DoB: 1985-01-02 ( Medical record number: Z199999829 (use: official, ))

encounter: Encounter: status = finished; class = 西醫一般案件 (casetype#01); serviceType = 家醫科; period = 2023-02-23 --> (ongoing)

authoredOn: 2024-01-12 00:00:00+0800

insurance: Coverage: status = active; type = 普通疾病

note: A, 否

DosageInstructions

-Method
*Use

DispenseRequests

-ValidityPeriodNumberOfRepeatsAllowed
*2024-01-12 00:00:00+0800 --> 2024-01-19 00:00:00+08001

Entry 14 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/MedicationDispense/med-dis-01-ds

Resource MedicationDispense:

Generated Narrative: MedicationDispense med-dis-01-ds

identifier: 3, 7

status: preparation

subject: 甄○康(official) Female, DoB: 1985-01-02 ( Medical record number: Z199999829 (use: official, ))

quantity: 6 顆

daysSupply: 10 Day (Details: UCUM coded = 'd')

note: A, 否

dosageInstruction

Substitutions

-WasSubstitutedReason
*true不可替代時始需註明

Entry 15 - fullUrl = https://twcore.mohw.gov.tw/ig/emr/Media/media-ds

Resource DocumentReference:

Generated Narrative: DocumentReference media-ds