Bộ Hướng dẫn Triển khai Core FHIR cho Việt Nam - Draft for Community Review (v0.8.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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: Ví dụ: Yêu cầu thanh toán BHYT ngoại trú (Khám / XN / Thuốc)

Bản thô xml | Tải xuống

<Claim xmlns="http://hl7.org/fhir">
  <id value="ExampleClaimOutpatient"/>
  <meta>
    <profile
             value="http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim"/>
  </meta>
  <language value="vi"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Claim ExampleClaimOutpatient</b></p><a name="ExampleClaimOutpatient"> </a><a name="hcExampleClaimOutpatient"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-vn-core-claim.html">Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile</a></p></div><blockquote><p><b>Tổng chi phí theo nhóm — Claim Cost Summary Extension</b></p><ul><li>totalMedication: <span title="Vietnamese Dong">₫3.200.000</span> (VND)</li><li>totalInsurance: <span title="Vietnamese Dong">₫3.360.000</span> (VND)</li><li>totalPatientCopay: <span title="Vietnamese Dong">₫840.000</span> (VND)</li><li>totalPatientSelfPay: <span title="Vietnamese Dong">₫0</span> (VND)</li></ul></blockquote><blockquote><p><b>Kỳ thanh toán — Claim Payment Period Extension</b></p><ul><li>year: 2026</li><li>month: 4</li></ul></blockquote><p><b>Phương thức thanh toán — Payment Method Extension</b>: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-payment-method-cs 1}">Phí dịch vụ (FFS)</span></p><p><b>identifier</b>: Mã liên kết hồ sơ BHYT/LK-2026-OUT-000315</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}">Professional</span></p><p><b>subType</b>: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-patient-visit-type-cs 1.1}">KCB đúng cơ sở nơi đăng ký KCB BHYT ban đầu</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href="Patient-ExamplePatientNguyenVanAn.html">Nguyễn Văn An</a></p><p><b>created</b>: 2026-04-19</p><p><b>provider</b>: <a href="Organization-ExampleOrganizationChoRay.html">Bệnh viện Chợ Rẫy</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><h3>Diagnoses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://hl7.org/fhir/sid/icd-10 K29.5}">Viêm dạ dày mạn</span></td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-diagnosistype principal}">Principal Diagnosis</span></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><a href="Coverage-ExampleCoverageBHYTNew.html">BHYT Nguyễn Văn An — DN 80%</a></td></tr></table><blockquote><p><b>item</b></p><p><b>Khoa thực hiện — Claim Item Department Extension</b>: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-department-cs K01}">Khoa Khám bệnh</span></p><blockquote><p><b>Thông tin chi phí BHYT — Insurance Cost Info Extension</b></p><ul><li>scope: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs 1}">Trong phạm vi hưởng BHYT</span></li><li>paymentRatio: 100</li><li>benefitLevel: 80</li></ul></blockquote><p><b>sequence</b>: 1</p><p><b>category</b>: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs 1}">Khám bệnh</span></p><p><b>productOrService</b>: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-examination-code-cs 02.05}">Khám chuyên khoa Nội tiêu hóa (tái khám theo giấy hẹn)</span></p><h3>Nets</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>150000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>Khoa thực hiện — Claim Item Department Extension</b>: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-department-cs K47}">Khoa Xét nghiệm</span></p><blockquote><p><b>Thông tin chi phí BHYT — Insurance Cost Info Extension</b></p><ul><li>scope: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs 1}">Trong phạm vi hưởng BHYT</span></li><li>paymentRatio: 100</li><li>benefitLevel: 80</li></ul></blockquote><p><b>sequence</b>: 2</p><p><b>category</b>: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs 3}">Xét nghiệm</span></p><p><b>productOrService</b>: <span title="Codes:{http://loinc.org 58410-2}">XN huyết học (CBC) + test hơi thở C13 chẩn đoán H. pylori</span></p><h3>Nets</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>850000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>Nguồn chi trả — Payment Source Extension</b>: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-payment-source-cs 1}">Bảo hiểm y tế</span></p><blockquote><p><b>Thông tin chi phí BHYT — Insurance Cost Info Extension</b></p><ul><li>scope: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs 1}">Trong phạm vi hưởng BHYT</span></li><li>paymentRatio: 100</li><li>benefitLevel: 80</li></ul></blockquote><p><b>sequence</b>: 3</p><p><b>category</b>: <span title="Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs 8}">Thuốc, dịch truyền</span></p><p><b>productOrService</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/data-absent-reason unknown}">Phác đồ diệt H. pylori (Esomeprazole + Amoxicillin + Clarithromycin, 14 ngày) + biệt dược bổ trợ</span></p><h3>Nets</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>3200000</td><td>Vietnamese đồng</td></tr></table></blockquote><h3>Totals</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>4200000</td><td>Vietnamese đồng</td></tr></table></div>
  </text>
  <extension
             url="http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary">
    <extension url="totalMedication">
      <valueMoney>
        <value value="3200000"/>
        <currency value="VND"/>
      </valueMoney>
    </extension>
    <extension url="totalInsurance">
      <valueMoney>
        <value value="3360000"/>
        <currency value="VND"/>
      </valueMoney>
    </extension>
    <extension url="totalPatientCopay">
      <valueMoney>
        <value value="840000"/>
        <currency value="VND"/>
      </valueMoney>
    </extension>
    <extension url="totalPatientSelfPay">
      <valueMoney>
        <value value="0"/>
        <currency value="VND"/>
      </valueMoney>
    </extension>
  </extension>
  <extension
             url="http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period">
    <extension url="year">
      <valueInteger value="2026"/>
    </extension>
    <extension url="month">
      <valueInteger value="4"/>
    </extension>
  </extension>
  <extension
             url="http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method">
    <valueCodeableConcept>
      <coding>
        <system
                value="http://fhir.hl7.org.vn/core/CodeSystem/vn-payment-method-cs"/>
        <code value="1"/>
        <display value="Phí dịch vụ (FFS)"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <identifier>
    <type>
      <coding>
        <system
                value="http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs"/>
        <code value="MA_LK"/>
        <display value="Mã liên kết hồ sơ BHYT"/>
      </coding>
    </type>
    <system value="http://fhir.hl7.org.vn/core/sid/ma-lk"/>
    <value value="LK-2026-OUT-000315"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
      <display value="Professional"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system
              value="http://fhir.hl7.org.vn/core/CodeSystem/vn-patient-visit-type-cs"/>
      <code value="1.1"/>
      <display value="KCB đúng cơ sở nơi đăng ký KCB BHYT ban đầu"/>
    </coding>
  </subType>
  <use value="claim"/>
  <patient>🔗 
    <reference value="Patient/ExamplePatientNguyenVanAn"/>
    <display value="Nguyễn Văn An"/>
  </patient>
  <created value="2026-04-19"/>
  <provider>🔗 
    <reference value="Organization/ExampleOrganizationChoRay"/>
    <display value="Bệnh viện Chợ Rẫy"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="normal"/>
      <display value="Normal"/>
    </coding>
  </priority>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/sid/icd-10"/>
        <code value="K29.5"/>
        <display value="Chronic gastritis, unspecified"/>
      </coding>
      <text value="Viêm dạ dày mạn"/>
    </diagnosisCodeableConcept>
    <type>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/ex-diagnosistype"/>
        <code value="principal"/>
        <display value="Principal Diagnosis"/>
      </coding>
    </type>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>🔗 
      <reference value="Coverage/ExampleCoverageBHYTNew"/>
      <display value="BHYT Nguyễn Văn An — DN 80%"/>
    </coverage>
  </insurance>
  <item>
    <extension
               url="http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://fhir.hl7.org.vn/core/CodeSystem/vn-department-cs"/>
          <code value="K01"/>
          <display value="Khoa Khám bệnh"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info">
      <extension url="scope">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs"/>
            <code value="1"/>
            <display value="Trong phạm vi hưởng BHYT"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="paymentRatio">
        <valueDecimal value="100"/>
      </extension>
      <extension url="benefitLevel">
        <valueDecimal value="80"/>
      </extension>
    </extension>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs"/>
        <code value="1"/>
        <display value="Khám bệnh"/>
      </coding>
    </category>
    <productOrService>
      <coding>
        <system
                value="http://fhir.hl7.org.vn/core/CodeSystem/vn-examination-code-cs"/>
        <code value="02.05"/>
        <display value="Nội tiêu hóa"/>
      </coding>
      <text value="Khám chuyên khoa Nội tiêu hóa (tái khám theo giấy hẹn)"/>
    </productOrService>
    <net>
      <value value="150000"/>
      <currency value="VND"/>
    </net>
  </item>
  <item>
    <extension
               url="http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://fhir.hl7.org.vn/core/CodeSystem/vn-department-cs"/>
          <code value="K47"/>
          <display value="Khoa Xét nghiệm"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info">
      <extension url="scope">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs"/>
            <code value="1"/>
            <display value="Trong phạm vi hưởng BHYT"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="paymentRatio">
        <valueDecimal value="100"/>
      </extension>
      <extension url="benefitLevel">
        <valueDecimal value="80"/>
      </extension>
    </extension>
    <sequence value="2"/>
    <category>
      <coding>
        <system
                value="http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs"/>
        <code value="3"/>
        <display value="Xét nghiệm"/>
      </coding>
    </category>
    <productOrService>
      <coding>
        <system value="http://loinc.org"/>
        <code value="58410-2"/>
        <display value="CBC panel - Blood by Automated count"/>
      </coding>
      <text
            value="XN huyết học (CBC) + test hơi thở C13 chẩn đoán H. pylori"/>
    </productOrService>
    <net>
      <value value="850000"/>
      <currency value="VND"/>
    </net>
  </item>
  <item>
    <extension
               url="http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://fhir.hl7.org.vn/core/CodeSystem/vn-payment-source-cs"/>
          <code value="1"/>
          <display value="Bảo hiểm y tế"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info">
      <extension url="scope">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs"/>
            <code value="1"/>
            <display value="Trong phạm vi hưởng BHYT"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="paymentRatio">
        <valueDecimal value="100"/>
      </extension>
      <extension url="benefitLevel">
        <valueDecimal value="80"/>
      </extension>
    </extension>
    <sequence value="3"/>
    <category>
      <coding>
        <system
                value="http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs"/>
        <code value="8"/>
        <display value="Thuốc, dịch truyền"/>
      </coding>
    </category>
    <productOrService>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/data-absent-reason"/>
        <code value="unknown"/>
        <display value="Unknown"/>
      </coding>
      <text
            value="Phác đồ diệt H. pylori (Esomeprazole + Amoxicillin + Clarithromycin, 14 ngày) + biệt dược bổ trợ"/>
    </productOrService>
    <net>
      <value value="3200000"/>
      <currency value="VND"/>
    </net>
  </item>
  <total>
    <value value="4200000"/>
    <currency value="VND"/>
  </total>
</Claim>