Appointment request module

1. claim:ClaimModule

[Detail] Medical appointment request module. A series of medical care actions performed once by the same doctor is placed in a single module. A separate module is used if the utilized health insurance differs.

[Omission] Not allowed

1.1. claim:information

[Detail] Request header information

[Omission] Not allowed

[Attribute]

Attribute name	Data type	Omission	Table used	Explanation
claim:status	string	#REQUIRED	Claim008	Status of appointment request module appoint: appointment status regist: registration status perform: performance status
claim:oderTime	dateTime	#IMPLIED	0	Order issuance date/time CCYY-MM-DDThh:mm:ss or CCYY-MM-DD
claim:appointTime	dateTime	#IMPLIED	0	Expected performance date/time CCYY-MM-DDThh:mm:ss or CCYY-MM-DD
claim:registTime	dateTime	#IMPLIED	0	Registration date/time CCYY-MM-DDThh:mm:ss or CCYY-MM-DD
claim:performTime	dateTime	#IMPLIED	0	Performance date/time CCYY-MM-DDThh:mm:ss or CCYY-MM-DD
claim:admitFlag	boolean	#REQUIRED	0	Inpatient/outpatient classification. Admission flag. true: inpatient; false: outpatient
claim:timeClass	string	#IMPLIED	Claim001	Time classification
claim:insuranceUid	string	#IMPLIED	0	Utilized insurance. Enter uid of Health Insurance Section of related insurance.
claim:defaultTableId	string	#IMPLIED	0	Common medical request code system name. Name of medical request code system that becomes default in same module.

1.1.1. claim:appoint

[Detail] Appointment information

[Omission] Omission allowed

1.1.1.1. claim:appName

[Detail] Appointment

[Omission] Omission allowed

[Repetition setting] Repeated. Repeated if there are multiple appointment items.

[Attribute]

Attribute name	Data type	Omission	Table used	Explanation
claim:appCode	string	#IMPLIED	0	Appointment code
claim:appCodeId	string	#IMPLIED	0	Appointment code table

Comment: The appointment code may require various items depending on the facility; thus, an independent code table is created and entries are made along with the table being used. For example, Claim009 code is indicated.

1.1.1.2. claim:memo

[Detail] Appointment memo

[Data type] string

[Omission] Omission allowed

1.1.2. claim:patientDepartment

[Detail] Medical-care-giving department. Department that actually performed the medical care. This is not the department to which the consulting physician belongs.

[Omission] Omission allowed

1.1.2.1. mmlDp:Department

[Detail] Medical department information format. Refer to the MML common format (medical department information format).

1.1.3. claim:patientWard

[Detail] Medical-care-giving ward. Ward that actually performed the medical care. This is not the department to which the consulting physician belongs.

[Omission] Omission allowed

1.1.3.1. mmlDp:Department

[Detail] Medical department information format. Refer to the MML common format (medical department information format).

1.1.4. mmlHi:insuranceClass

[Detail] Health insurance class. Refer to the MML Health insurance information module for the structure.

1.2. claim:bundle

[Detail] Medical-care-bundling section. Includes single tests, single prescriptions, and other single medical care actions. Normally corresponds to a series of medical care item groups that are bundled via "*" of the medical insurance invoice.

[Omission] Not allowed

[Repetition setting] Repeated. Repeated when there are multiple medical care actions that the same doctor performs once. For example, if a doctor writes a prescription and performs a laboratory test during a single outpatient examination, two claim:bundle items are generated.

[Attribute]

Attribute name	Data type	Omission	Table used	Explanation
claim:classCode	string	#IMPLIED	0	Medical care action classification code. Enter medical care classification code of primary claim:Item action.
claim:classCodeId	string	#IMPLIED	0	Medical care action classification code table

Comment: The medical care action classification code depends largely on the medical request code that is used; thus, a table is not particularly established in the CLAIM specifications. The CLAIM table list at the end of this specification, for example, shows the Claim002 table and Claim007 table (point column/tabulation destination code list of medical insurance invoice computer processing system, edited by Social Insurance Medical Fee Payment Fund).

1.2.1. claim:className

[Detail] Name of medical care action classification

[Data type] string

[Omission] Omission allowed

1.2.2. claim:administration

[Detail] Administration

[Data type] string

[Omission] Omission allowed

[Attribute]

Attribute name	Data type	Omission	Table used	Explanation
claim:adminCode	string	#IMPLIED	Claim006	Administration code
claim:adminCodeId	string	#IMPLIED	0	Administration code table. Entered as Claim006.

1.2.3. claim:admMemo

[Detail] Administration comment

[Data type] string

[Omission] Omission allowed

[Example] Nonuniform dosages: morning-afternoon-evening 2-1-1
< claim:admMemo > Nonuniform dosages: morning-afternoon-evening 2-1-1

1.2.4. claim:bundleNumber

[Detail] Number of times or number of days. Regarded as 1 if omitted.

[Data type] integer

[Omission] Omission allowed

1.2.5. claim:item

[Detail] Medical care item section. Includes smallest medical care item units (invoice details), such as BUN, Alinamin, and Doppler addition.

[Omission] Not allowed

[Repetition setting] Repeated. Repeated if there are multiple medical care items.

[Attribute]

Attribute name	Data type	Omission	Table used	Explanation
claim:subclassCode	string	#IMPLIED	Claim003	Medical care subclass code. Procedure, material, and pharmaceutical classifications.
claim:subclassCodeId	string	#IMPLIED	0	Medical care subclass code table. Entered as Claim003.
claim:code	string	#REQUIRED	0	Medical request code
claim:tableId	string	#IMPLIED	0	Name of medical request code system. Can omit if same as claim:defaultTableId.
claim:aliasCode	string	#IMPLIED	0	Alias medical request code
claim:aliasTableId	string	#IMPLIED	0	Name of alias medical request code system

Comment: Differentiation between claim:code (medical request code) and claim:aliasCode (name of alias medical request code system)

Codes that are used for clinical computations with the clinical accounting system must be set up as a claim:code. If a code is added for a purpose other than clinical computation, it is set up as a supplementary code to the claim:aliasCode. For example, for pharmaceuticals it is conceivable that a local code for the clinical accounting system used at the implementing facility will be set as the claim:code, a code that is common throughout the nation will be set up as the claim:aliasCode, and the latter will be used for linking with the pharmaceutical information system.

1.2.5.1. claim:name

[Detail] Name of medical request

[Data type] string

1.2.5.2. claim:number

[Detail] Number. Includes requested quantity of pharmaceuticals, quantity of materials used, etc.

[Data type] decimal

[Omission] Omission allowed

[Repetition setting] Repeated. As with the material unit cost and material quantity, repeated for multiple items.

[Attribute]

Attribute name	Data type	Omission	Table used	Explanation
claim:numberCode	string	#REQUIRED	Claim004	Number code
claim:numberCodeId	string	#REQUIRED	0	Number code table. Entered as Claim004.
claim:unit	string	#IMPLIED	0	Unit

1.2.5.3. claim:duration

[Detail] Prescribed duration. Time required for anesthesia, for instance, is entered.

[Data type] timePeriod Form: PTnHnM

[Omission] Omission allowed

[Example] 5 hours, 25 minutes
<claim:duration>PT5H25M</claim:duration>

1.2.5.4. claim:location

[Detail] Location. Location of photograph, surgery, or treatment is entered. No particular code is established.

[Omission] Omission allowed

[Repetition setting] Repeated. Repeated if there are multiple locations.

1.2.5.5. claim:film

[Detail] Film section

[Omission] Omission allowed

[Repetition setting] Repeated. Repeated if there are multiple film sizes.

1.2.5.5.1. claim:filmSize

[Detail] Film size

[Data type] string

[Omission] Not allowed

[Attribute]

Attribute name	Data type	Omission	Table used	Explanation
claim:sizeCode	string	#IMPLIED	Claim005	Film size code
claim:sizeCodeId	string	#IMPLIED	0	Film size code table. Entered as Claim005.
claim:filmDivision	string	#IMPLIED	0	Film division. Entry format is not established.

1.2.5.5.2. claim:filmNumber

[Detail] Film number

[Data type] integer

[Omission] Not allowed

[Example] Half size (for computer tomography): 3 films
<claim:film>
<claim:filmSize
claim:sizeCode="07"
claim:sizeCodeId="Claim005">
Half-size (for computer tomography)
</claim:filmSize>
<claim:filmNumber>3</claim:filmNumber>
</claim:film>

1.2.5.6. claim:event

[Detail] Related procedure. Includes the names of related procedures and test procedures. No particular entry format is established. Used for inserting related procedures in order to clarify the purpose of using requested pharmaceuticals and materials.

[Data type] string

[Omission] Omission allowed

[Attribute]

Attribute name	Data type	Omission	Table used	Explanation
claim:eventStart	date	#IMPLIED	0	Start date. Start date of related procedure.
claim:eventEnd	date	#IMPLIED	0	End date. End date of related procedure.

[Example] Coronary artery bypass surgery. Surgery date: January 4, 2000
<claim:event
claim:eventStart="2000-01-04">
Coronary artery bypass surgery
</claim:event>

1.2.5.7. claim:memo

[Detail] Memo. Item added to 1.2.3. claim:item (medical care item section). Any entry format is permissible.

[Data type] string

[Omission] Omission allowed

1.2.6. claim:memo

[Detail] Memo. Item added to 1.2. claim:bundle (medical-care-bundling section). Any entry format is permissible.

[Data type] string

[Omission] Omission allowed