Hướng dẫn triển khai FHIR cốt lõi Việt Nam — VN Core FHIR Implementation Guide
0.10.0 - Draft for Community Review
Hướng dẫn triển khai FHIR cốt lõi Việt Nam — VN Core FHIR Implementation Guide - Draft for Community Review (v0.10.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| URL chính thức: http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim-appeal-task | Phiên bản: 0.10.0 | ||||
| Computable Name: VNCoreClaimAppealTask | |||||
| Định danh khác: OID:2.25.161089673617632664299011809196868855799.42.34 | |||||
Theo dõi một kiến nghị của cơ sở khám bệnh, chữa bệnh đề nghị xem xét lại việc TỪ CHỐI THANH TOÁN hoặc việc THU HỒI chi phí khám bệnh, chữa bệnh bảo hiểm y tế.
Căn cứ pháp lý. NĐ 188/2025/NĐ-CP Điều 51 khoản 3: cơ sở khám bệnh, chữa bệnh "có quyền kiến nghị cơ quan bảo hiểm xã hội xem xét lại việc từ chối thanh toán … hoặc kiến nghị cơ quan có thẩm quyền xem xét, giải quyết theo quy định của pháp luật". Điều 52 khoản 4 lặp lại quyền đó cho việc thu hồi. Điều 53 quy định trách nhiệm các bên và nói tới kết quả giải quyết cuối cùng.
Vì sao profile riêng chứ không mở rộng VNCoreTask. VNCoreTask đã khoá focus vào
VNCoreServiceRequest hoặc VNCoreMedicationRequest — hai luồng chuyển người bệnh và cấp phát
thuốc. Kiến nghị chi phí nhắm vào ClaimResponse hoặc PaymentReconciliation, không nằm trong tập
đó; kế thừa sẽ buộc phải nới focus của profile cha và làm loãng chính ràng buộc khiến nó hữu ích.
Vì sao dùng Task mà không phải resource khác. Đây là quyết định ánh xạ CỤC BỘ của VN Core:
nghị định quy định quyền và trách nhiệm, không chỉ định resource FHIR nào. Task được chọn vì
quy trình này là một công việc có vòng đời, có bên yêu cầu, bên thực hiện và kết quả — đúng ngữ
nghĩa Task. Không nên hiểu là nghị định yêu cầu dùng Task.
Ranh giới. Profile theo dõi TIẾN TRÌNH kiến nghị; nó không phán xét kiến nghị đúng hay sai, và
không thay thế biên bản giám định hay văn bản thu hồi — hai chứng từ đó nằm ở DocumentReference
được focus hoặc input trỏ tới.
Usages:
You can also check for usages in the FHIR IG Statistics
Mô tả profile, differential, snapshot và các biểu diễn liên quan.
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
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C | 0..* | Task | A task to be performed Constraints: inv-1, vn-claim-appeal-outcome-required, vn-claim-appeal-state-coherent, vn-claim-appeal-decision-chronology | ||||||
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?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||||
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1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||
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SO | 1..1 | Coding | Giai đoạn kiến nghị — phân biệt đang ở cơ quan BHXH hay đã chuyển cơ quan có thẩm quyền URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage Binding: Giai đoạn kiến nghị chi phí BHYT — BHYT Cost Appeal Stage ValueSet (required)
| ||||||
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?! | 0..* | Extension | Extensions that cannot be ignored | ||||||
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?!SOΣ | 1..1 | code | Vòng đời kỹ thuật: requested | in-progress | completed | cancelled Binding: TaskStatus (required): The current status of the task.
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SOΣ | 1..1 | code | unknown | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: TaskIntent (required): Distinguishes whether the task is a proposal, plan or full order. Fixed Value: order
| ||||||
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SOΣ | 1..1 | CodeableConcept | Loại công việc — kiến nghị xem xét lại Binding: TaskCode (example): Codes to identify what the task involves. These will typically be specific to a particular workflow.
| ||||||
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SΣ | 1..1 | string | Plain text representation of the concept | ||||||
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SOΣ | 1..1 | Reference(Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile | Đối soát và phân bổ khoản thanh toán BHYT — VN Core BHYT Payment Reconciliation | DocumentReference) | Quyết định bị kiến nghị: kết quả giám định hoặc đối soát thanh toán/thu hồi
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SOΣ | 0..1 | Reference(Resource) | Người bệnh liên quan nếu kiến nghị gắn với một hồ sơ cụ thể
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SOΣ | 0..1 | Period | Khoảng thời gian xem xét kiến nghị — `end` là thời điểm ra quyết định
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SOC | 1..1 | dateTime | Thời điểm nêu kiến nghị
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SOΣ | 1..1 | Reference(Cơ sở khám bệnh, chữa bệnh VN Core — VN Core KCB Organization Profile | Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ sở khám bệnh, chữa bệnh nêu kiến nghị
| ||||||
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SOΣ | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan giải quyết: cơ quan bảo hiểm xã hội hoặc cơ quan có thẩm quyền
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SO | 0..1 | CodeableConcept | Lý do kiến nghị Binding Description: (example): Indicates why the task is needed. E.g. Suspended because patient admitted to hospital.
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SO | 0..* | BackboneElement | Tài liệu kèm theo: biên bản giám định, văn bản thu hồi, chứng từ bổ sung
| ||||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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1..1 | CodeableConcept | Label for the input Binding Description: (example): Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Comparison source", "Applicable consent", "Concomitent Medications", etc. | |||||||
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1..1 | Content to use in performing the task | ||||||||
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base64Binary | |||||||||
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boolean | |||||||||
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canonical(Any) | |||||||||
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code | |||||||||
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date | |||||||||
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dateTime | |||||||||
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decimal | |||||||||
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id | |||||||||
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instant | |||||||||
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integer | |||||||||
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markdown | |||||||||
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oid | |||||||||
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positiveInt | |||||||||
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string | |||||||||
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time | |||||||||
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unsignedInt | |||||||||
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uri | |||||||||
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url | |||||||||
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uuid | |||||||||
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Address | |||||||||
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Age | |||||||||
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Annotation | |||||||||
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Attachment | |||||||||
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CodeableConcept | |||||||||
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Coding | |||||||||
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ContactPoint | |||||||||
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Count | |||||||||
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Distance | |||||||||
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Duration | |||||||||
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HumanName | |||||||||
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Identifier | |||||||||
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Money | |||||||||
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Period | |||||||||
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Quantity | |||||||||
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Range | |||||||||
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Ratio | |||||||||
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Reference(Any) | |||||||||
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SampledData | |||||||||
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Signature | |||||||||
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Timing | |||||||||
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ContactDetail | |||||||||
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Contributor | |||||||||
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DataRequirement | |||||||||
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Expression | |||||||||
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ParameterDefinition | |||||||||
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RelatedArtifact | |||||||||
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TriggerDefinition | |||||||||
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UsageContext | |||||||||
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Dosage | |||||||||
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Meta | |||||||||
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SO | 0..* | BackboneElement | Kết quả giải quyết — bắt buộc khi kiến nghị đã kết thúc
| ||||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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1..1 | CodeableConcept | Label for output Binding Description: (example): Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Identified issues", "Preliminary results", "Filler order", "Final results", etc. | |||||||
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1..1 | Result of output | ||||||||
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base64Binary | |||||||||
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boolean | |||||||||
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canonical(Any) | |||||||||
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code | |||||||||
![]() ![]() ![]() ![]() |
date | |||||||||
![]() ![]() ![]() ![]() |
dateTime | |||||||||
![]() ![]() ![]() ![]() |
decimal | |||||||||
![]() ![]() ![]() ![]() |
id | |||||||||
![]() ![]() ![]() ![]() |
instant | |||||||||
![]() ![]() ![]() ![]() |
integer | |||||||||
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markdown | |||||||||
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oid | |||||||||
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positiveInt | |||||||||
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string | |||||||||
![]() ![]() ![]() ![]() |
time | |||||||||
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unsignedInt | |||||||||
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uri | |||||||||
![]() ![]() ![]() ![]() |
url | |||||||||
![]() ![]() ![]() ![]() |
uuid | |||||||||
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Address | |||||||||
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Age | |||||||||
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Annotation | |||||||||
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Attachment | |||||||||
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CodeableConcept | |||||||||
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Coding | |||||||||
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ContactPoint | |||||||||
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Count | |||||||||
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Distance | |||||||||
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Duration | |||||||||
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HumanName | |||||||||
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Identifier | |||||||||
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Money | |||||||||
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Period | |||||||||
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Quantity | |||||||||
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Range | |||||||||
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Ratio | |||||||||
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Reference(Any) | |||||||||
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SampledData | |||||||||
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Signature | |||||||||
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Timing | |||||||||
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ContactDetail | |||||||||
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Contributor | |||||||||
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DataRequirement | |||||||||
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Expression | |||||||||
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ParameterDefinition | |||||||||
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RelatedArtifact | |||||||||
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TriggerDefinition | |||||||||
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UsageContext | |||||||||
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Dosage | |||||||||
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Meta | |||||||||
Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter)![]() |
|---|---|---|
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Documentation for this format | ||
| Path | Status | Usage | ValueSet | Version | Source |
| Task.status | Base | required | TaskStatus | 📍4.0.1 | FHIR Std. |
| Task.intent | Base | required | TaskIntent | 📍4.0.1 | FHIR Std. |
| Task.code | Base | example | Task Codes | 📍4.0.1 | FHIR Std. |
| Task.reasonCode | Base | example | Not State | Unknown | |
| Task.input.type | Base | example | Not State | Unknown | |
| Task.output.type | Base | example | Not State | Unknown |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | Task | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Task | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Task | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Task | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Task | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
| inv-1 | error | Task | Last modified date must be greater than or equal to authored-on date. |
lastModified.exists().not() or authoredOn.exists().not() or lastModified >= authoredOn
|
| vn-claim-appeal-decision-chronology | error | Task | Kiến nghị đã kết thúc phải ghi thời điểm ra quyết định, và thời điểm ấy không được sớm hơn ngày nêu kiến nghị. A concluded appeal SHALL carry executionPeriod.end, which SHALL NOT precede authoredOn. |
extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed' or code = 'withdrawn')).exists() implies (executionPeriod.end.exists() and executionPeriod.end >= authoredOn)
|
| vn-claim-appeal-outcome-required | error | Task | Kiến nghị ở giai đoạn giữ nguyên hoặc chấp nhận phải mang kết quả giải quyết, và NGƯỢC LẠI: output chỉ được xuất hiện khi kiến nghị đã có kết quả cuối (siết P1 #7 — output trước khi kết thúc là kết quả tiền chế). An appeal that is upheld or reversed SHALL carry its resolution output, and output SHALL only be present at a terminal result stage. |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or output.exists()) and (output.empty() or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
| vn-claim-appeal-state-coherent | error | Task | Ma trận trạng thái Task ↔ giai đoạn kiến nghị: upheld/reversed chỉ đi với completed; withdrawn chỉ đi với cancelled; completed đòi giai đoạn là kết quả cuối. Task.status and appealStage SHALL follow the full coherence matrix (upheld/reversed ⇔ completed; withdrawn ⇒ cancelled). |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or status = 'completed') and (extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and code = 'withdrawn').empty() or status = 'cancelled') and (status != 'completed' or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter)![]() |
|---|---|---|
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Documentation for this format | ||
| Id | Grade | Path(s) | Description | Expression |
| vn-claim-appeal-decision-chronology | error | Task | Kiến nghị đã kết thúc phải ghi thời điểm ra quyết định, và thời điểm ấy không được sớm hơn ngày nêu kiến nghị. A concluded appeal SHALL carry executionPeriod.end, which SHALL NOT precede authoredOn. |
extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed' or code = 'withdrawn')).exists() implies (executionPeriod.end.exists() and executionPeriod.end >= authoredOn)
|
| vn-claim-appeal-outcome-required | error | Task | Kiến nghị ở giai đoạn giữ nguyên hoặc chấp nhận phải mang kết quả giải quyết, và NGƯỢC LẠI: output chỉ được xuất hiện khi kiến nghị đã có kết quả cuối (siết P1 #7 — output trước khi kết thúc là kết quả tiền chế). An appeal that is upheld or reversed SHALL carry its resolution output, and output SHALL only be present at a terminal result stage. |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or output.exists()) and (output.empty() or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
| vn-claim-appeal-state-coherent | error | Task | Ma trận trạng thái Task ↔ giai đoạn kiến nghị: upheld/reversed chỉ đi với completed; withdrawn chỉ đi với cancelled; completed đòi giai đoạn là kết quả cuối. Task.status and appealStage SHALL follow the full coherence matrix (upheld/reversed ⇔ completed; withdrawn ⇒ cancelled). |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or status = 'completed') and (extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and code = 'withdrawn').empty() or status = 'cancelled') and (status != 'completed' or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
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C | 0..* | Task | A task to be performed Constraints: inv-1, vn-claim-appeal-outcome-required, vn-claim-appeal-state-coherent, vn-claim-appeal-decision-chronology | ||||||
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Σ | 0..1 | id | Logical id of this artifact | ||||||
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Σ | 0..1 | Meta | Metadata about the resource | ||||||
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?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||||
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0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||||
![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||||
![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||||
![]() ![]() |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||
![]() ![]() ![]() |
SO | 1..1 | Coding | Giai đoạn kiến nghị — phân biệt đang ở cơ quan BHXH hay đã chuyển cơ quan có thẩm quyền URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage Binding: Giai đoạn kiến nghị chi phí BHYT — BHYT Cost Appeal Stage ValueSet (required)
| ||||||
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?! | 0..* | Extension | Extensions that cannot be ignored | ||||||
![]() ![]() |
0..* | Identifier | Task Instance Identifier | |||||||
![]() ![]() |
Σ | 0..1 | canonical(ActivityDefinition) | Formal definition of task | ||||||
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Σ | 0..1 | uri | Formal definition of task | ||||||
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Σ | 0..* | Reference(Resource) | Request fulfilled by this task | ||||||
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Σ | 0..1 | Identifier | Requisition or grouper id | ||||||
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Σ | 0..* | Reference(Task) | Composite task | ||||||
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?!SOΣ | 1..1 | code | Vòng đời kỹ thuật: requested | in-progress | completed | cancelled Binding: TaskStatus (required): The current status of the task.
| ||||||
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Σ | 0..1 | CodeableConcept | Reason for current status Binding Description: (example): Codes to identify the reason for current status. These will typically be specific to a particular workflow. | ||||||
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Σ | 0..1 | CodeableConcept | E.g. "Specimen collected", "IV prepped" Binding Description: (example): The domain-specific business-contextual sub-state of the task. For example: "Blood drawn", "IV inserted", "Awaiting physician signature", etc. | ||||||
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SOΣ | 1..1 | code | unknown | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: TaskIntent (required): Distinguishes whether the task is a proposal, plan or full order. Fixed Value: order
| ||||||
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0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): The task's priority. | |||||||
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SOΣ | 1..1 | CodeableConcept | Loại công việc — kiến nghị xem xét lại Binding: TaskCode (example): Codes to identify what the task involves. These will typically be specific to a particular workflow.
| ||||||
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0..1 | string | Unique id for inter-element referencing | |||||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||
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Σ | 0..* | Coding | Code defined by a terminology system | ||||||
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SΣ | 1..1 | string | Plain text representation of the concept | ||||||
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Σ | 0..1 | string | Human-readable explanation of task | ||||||
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SOΣ | 1..1 | Reference(Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile | Đối soát và phân bổ khoản thanh toán BHYT — VN Core BHYT Payment Reconciliation | DocumentReference) | Quyết định bị kiến nghị: kết quả giám định hoặc đối soát thanh toán/thu hồi
| ||||||
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SOΣ | 0..1 | Reference(Resource) | Người bệnh liên quan nếu kiến nghị gắn với một hồ sơ cụ thể
| ||||||
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Σ | 0..1 | Reference(Encounter) | Healthcare event during which this task originated | ||||||
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SOΣ | 0..1 | Period | Khoảng thời gian xem xét kiến nghị — `end` là thời điểm ra quyết định
| ||||||
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SOC | 1..1 | dateTime | Thời điểm nêu kiến nghị
| ||||||
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ΣC | 0..1 | dateTime | Task Last Modified Date | ||||||
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SOΣ | 1..1 | Reference(Cơ sở khám bệnh, chữa bệnh VN Core — VN Core KCB Organization Profile | Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ sở khám bệnh, chữa bệnh nêu kiến nghị
| ||||||
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0..* | CodeableConcept | Requested performer Binding: ProcedurePerformerRoleCodes (preferred): The type(s) of task performers allowed. | |||||||
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SOΣ | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan giải quyết: cơ quan bảo hiểm xã hội hoặc cơ quan có thẩm quyền
| ||||||
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Σ | 0..1 | Reference(Location) | Where task occurs | ||||||
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SO | 0..1 | CodeableConcept | Lý do kiến nghị Binding Description: (example): Indicates why the task is needed. E.g. Suspended because patient admitted to hospital.
| ||||||
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0..1 | Reference(Resource) | Why task is needed | |||||||
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0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage | |||||||
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0..* | Annotation | Comments made about the task | |||||||
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0..* | Reference(Provenance) | Key events in history of the Task | |||||||
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0..1 | BackboneElement | Constraints on fulfillment tasks | |||||||
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0..1 | string | Unique id for inter-element referencing | |||||||
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0..* | Extension | Additional content defined by implementations | |||||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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0..1 | positiveInt | How many times to repeat | |||||||
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0..1 | Period | When fulfillment sought | |||||||
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0..* | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Group | Organization) | For whom is fulfillment sought? | |||||||
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SO | 0..* | BackboneElement | Tài liệu kèm theo: biên bản giám định, văn bản thu hồi, chứng từ bổ sung
| ||||||
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0..1 | string | Unique id for inter-element referencing | |||||||
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0..* | Extension | Additional content defined by implementations | |||||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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1..1 | CodeableConcept | Label for the input Binding Description: (example): Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Comparison source", "Applicable consent", "Concomitent Medications", etc. | |||||||
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1..1 | Content to use in performing the task | ||||||||
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base64Binary | |||||||||
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boolean | |||||||||
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canonical(Any) | |||||||||
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code | |||||||||
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date | |||||||||
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dateTime | |||||||||
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decimal | |||||||||
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id | |||||||||
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instant | |||||||||
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integer | |||||||||
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markdown | |||||||||
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oid | |||||||||
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positiveInt | |||||||||
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string | |||||||||
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time | |||||||||
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unsignedInt | |||||||||
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uri | |||||||||
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url | |||||||||
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uuid | |||||||||
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Address | |||||||||
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Age | |||||||||
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Annotation | |||||||||
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Attachment | |||||||||
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CodeableConcept | |||||||||
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Coding | |||||||||
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ContactPoint | |||||||||
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Count | |||||||||
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Distance | |||||||||
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Duration | |||||||||
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HumanName | |||||||||
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Identifier | |||||||||
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Money | |||||||||
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Period | |||||||||
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Quantity | |||||||||
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Range | |||||||||
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Ratio | |||||||||
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Reference(Any) | |||||||||
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SampledData | |||||||||
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Signature | |||||||||
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Timing | |||||||||
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ContactDetail | |||||||||
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Contributor | |||||||||
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DataRequirement | |||||||||
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Expression | |||||||||
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ParameterDefinition | |||||||||
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RelatedArtifact | |||||||||
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TriggerDefinition | |||||||||
![]() ![]() ![]() ![]() |
UsageContext | |||||||||
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Dosage | |||||||||
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Meta | |||||||||
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SO | 0..* | BackboneElement | Kết quả giải quyết — bắt buộc khi kiến nghị đã kết thúc
| ||||||
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0..1 | string | Unique id for inter-element referencing | |||||||
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0..* | Extension | Additional content defined by implementations | |||||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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1..1 | CodeableConcept | Label for output Binding Description: (example): Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Identified issues", "Preliminary results", "Filler order", "Final results", etc. | |||||||
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1..1 | Result of output | ||||||||
![]() ![]() ![]() ![]() |
base64Binary | |||||||||
![]() ![]() ![]() ![]() |
boolean | |||||||||
![]() ![]() ![]() ![]() |
canonical(Any) | |||||||||
![]() ![]() ![]() ![]() |
code | |||||||||
![]() ![]() ![]() ![]() |
date | |||||||||
![]() ![]() ![]() ![]() |
dateTime | |||||||||
![]() ![]() ![]() ![]() |
decimal | |||||||||
![]() ![]() ![]() ![]() |
id | |||||||||
![]() ![]() ![]() ![]() |
instant | |||||||||
![]() ![]() ![]() ![]() |
integer | |||||||||
![]() ![]() ![]() ![]() |
markdown | |||||||||
![]() ![]() ![]() ![]() |
oid | |||||||||
![]() ![]() ![]() ![]() |
positiveInt | |||||||||
![]() ![]() ![]() ![]() |
string | |||||||||
![]() ![]() ![]() ![]() |
time | |||||||||
![]() ![]() ![]() ![]() |
unsignedInt | |||||||||
![]() ![]() ![]() ![]() |
uri | |||||||||
![]() ![]() ![]() ![]() |
url | |||||||||
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uuid | |||||||||
![]() ![]() ![]() ![]() |
Address | |||||||||
![]() ![]() ![]() ![]() |
Age | |||||||||
![]() ![]() ![]() ![]() |
Annotation | |||||||||
![]() ![]() ![]() ![]() |
Attachment | |||||||||
![]() ![]() ![]() ![]() |
CodeableConcept | |||||||||
![]() ![]() ![]() ![]() |
Coding | |||||||||
![]() ![]() ![]() ![]() |
ContactPoint | |||||||||
![]() ![]() ![]() ![]() |
Count | |||||||||
![]() ![]() ![]() ![]() |
Distance | |||||||||
![]() ![]() ![]() ![]() |
Duration | |||||||||
![]() ![]() ![]() ![]() |
HumanName | |||||||||
![]() ![]() ![]() ![]() |
Identifier | |||||||||
![]() ![]() ![]() ![]() |
Money | |||||||||
![]() ![]() ![]() ![]() |
Period | |||||||||
![]() ![]() ![]() ![]() |
Quantity | |||||||||
![]() ![]() ![]() ![]() |
Range | |||||||||
![]() ![]() ![]() ![]() |
Ratio | |||||||||
![]() ![]() ![]() ![]() |
Reference(Any) | |||||||||
![]() ![]() ![]() ![]() |
SampledData | |||||||||
![]() ![]() ![]() ![]() |
Signature | |||||||||
![]() ![]() ![]() ![]() |
Timing | |||||||||
![]() ![]() ![]() ![]() |
ContactDetail | |||||||||
![]() ![]() ![]() ![]() |
Contributor | |||||||||
![]() ![]() ![]() ![]() |
DataRequirement | |||||||||
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Expression | |||||||||
![]() ![]() ![]() ![]() |
ParameterDefinition | |||||||||
![]() ![]() ![]() ![]() |
RelatedArtifact | |||||||||
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TriggerDefinition | |||||||||
![]() ![]() ![]() ![]() |
UsageContext | |||||||||
![]() ![]() ![]() ![]() |
Dosage | |||||||||
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Meta | |||||||||
Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter)![]() |
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Documentation for this format | ||
| Path | Status | Usage | ValueSet | Version | Source |
| Task.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| Task.status | Base | required | TaskStatus | 📍4.0.1 | FHIR Std. |
| Task.statusReason | Base | example | Not State | Unknown | |
| Task.businessStatus | Base | example | Not State | Unknown | |
| Task.intent | Base | required | TaskIntent | 📍4.0.1 | FHIR Std. |
| Task.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std. |
| Task.code | Base | example | Task Codes | 📍4.0.1 | FHIR Std. |
| Task.performerType | Base | preferred | Procedure Performer Role Codes | 📍4.0.1 | FHIR Std. |
| Task.reasonCode | Base | example | Not State | Unknown | |
| Task.input.type | Base | example | Not State | Unknown | |
| Task.output.type | Base | example | Not State | Unknown |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | Task | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Task | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Task | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Task | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Task | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
| inv-1 | error | Task | Last modified date must be greater than or equal to authored-on date. |
lastModified.exists().not() or authoredOn.exists().not() or lastModified >= authoredOn
|
| vn-claim-appeal-decision-chronology | error | Task | Kiến nghị đã kết thúc phải ghi thời điểm ra quyết định, và thời điểm ấy không được sớm hơn ngày nêu kiến nghị. A concluded appeal SHALL carry executionPeriod.end, which SHALL NOT precede authoredOn. |
extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed' or code = 'withdrawn')).exists() implies (executionPeriod.end.exists() and executionPeriod.end >= authoredOn)
|
| vn-claim-appeal-outcome-required | error | Task | Kiến nghị ở giai đoạn giữ nguyên hoặc chấp nhận phải mang kết quả giải quyết, và NGƯỢC LẠI: output chỉ được xuất hiện khi kiến nghị đã có kết quả cuối (siết P1 #7 — output trước khi kết thúc là kết quả tiền chế). An appeal that is upheld or reversed SHALL carry its resolution output, and output SHALL only be present at a terminal result stage. |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or output.exists()) and (output.empty() or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
| vn-claim-appeal-state-coherent | error | Task | Ma trận trạng thái Task ↔ giai đoạn kiến nghị: upheld/reversed chỉ đi với completed; withdrawn chỉ đi với cancelled; completed đòi giai đoạn là kết quả cuối. Task.status and appealStage SHALL follow the full coherence matrix (upheld/reversed ⇔ completed; withdrawn ⇒ cancelled). |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or status = 'completed') and (extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and code = 'withdrawn').empty() or status = 'cancelled') and (status != 'completed' or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter)![]() |
|---|---|---|
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Documentation for this format | ||
Summary
Mandatory: 7 elements
Must-Support: 14 elements
Fixed: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Dạng xem phần tử chính
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
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C | 0..* | Task | A task to be performed Constraints: inv-1, vn-claim-appeal-outcome-required, vn-claim-appeal-state-coherent, vn-claim-appeal-decision-chronology | ||||||
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?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||||
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1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||
![]() ![]() ![]() |
SO | 1..1 | Coding | Giai đoạn kiến nghị — phân biệt đang ở cơ quan BHXH hay đã chuyển cơ quan có thẩm quyền URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage Binding: Giai đoạn kiến nghị chi phí BHYT — BHYT Cost Appeal Stage ValueSet (required)
| ||||||
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?! | 0..* | Extension | Extensions that cannot be ignored | ||||||
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?!SOΣ | 1..1 | code | Vòng đời kỹ thuật: requested | in-progress | completed | cancelled Binding: TaskStatus (required): The current status of the task.
| ||||||
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SOΣ | 1..1 | code | unknown | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: TaskIntent (required): Distinguishes whether the task is a proposal, plan or full order. Fixed Value: order
| ||||||
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SOΣ | 1..1 | CodeableConcept | Loại công việc — kiến nghị xem xét lại Binding: TaskCode (example): Codes to identify what the task involves. These will typically be specific to a particular workflow.
| ||||||
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SΣ | 1..1 | string | Plain text representation of the concept | ||||||
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SOΣ | 1..1 | Reference(Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile | Đối soát và phân bổ khoản thanh toán BHYT — VN Core BHYT Payment Reconciliation | DocumentReference) | Quyết định bị kiến nghị: kết quả giám định hoặc đối soát thanh toán/thu hồi
| ||||||
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SOΣ | 0..1 | Reference(Resource) | Người bệnh liên quan nếu kiến nghị gắn với một hồ sơ cụ thể
| ||||||
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SOΣ | 0..1 | Period | Khoảng thời gian xem xét kiến nghị — `end` là thời điểm ra quyết định
| ||||||
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SOC | 1..1 | dateTime | Thời điểm nêu kiến nghị
| ||||||
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SOΣ | 1..1 | Reference(Cơ sở khám bệnh, chữa bệnh VN Core — VN Core KCB Organization Profile | Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ sở khám bệnh, chữa bệnh nêu kiến nghị
| ||||||
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SOΣ | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan giải quyết: cơ quan bảo hiểm xã hội hoặc cơ quan có thẩm quyền
| ||||||
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SO | 0..1 | CodeableConcept | Lý do kiến nghị Binding Description: (example): Indicates why the task is needed. E.g. Suspended because patient admitted to hospital.
| ||||||
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SO | 0..* | BackboneElement | Tài liệu kèm theo: biên bản giám định, văn bản thu hồi, chứng từ bổ sung
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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1..1 | CodeableConcept | Label for the input Binding Description: (example): Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Comparison source", "Applicable consent", "Concomitent Medications", etc. | |||||||
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1..1 | Content to use in performing the task | ||||||||
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base64Binary | |||||||||
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boolean | |||||||||
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canonical(Any) | |||||||||
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code | |||||||||
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date | |||||||||
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dateTime | |||||||||
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decimal | |||||||||
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id | |||||||||
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instant | |||||||||
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integer | |||||||||
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markdown | |||||||||
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oid | |||||||||
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positiveInt | |||||||||
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string | |||||||||
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time | |||||||||
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unsignedInt | |||||||||
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uri | |||||||||
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url | |||||||||
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uuid | |||||||||
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Address | |||||||||
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Age | |||||||||
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Annotation | |||||||||
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Attachment | |||||||||
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CodeableConcept | |||||||||
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Coding | |||||||||
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ContactPoint | |||||||||
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Count | |||||||||
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Distance | |||||||||
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Duration | |||||||||
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HumanName | |||||||||
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Identifier | |||||||||
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Money | |||||||||
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Period | |||||||||
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Quantity | |||||||||
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Range | |||||||||
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Ratio | |||||||||
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Reference(Any) | |||||||||
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SampledData | |||||||||
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Signature | |||||||||
![]() ![]() ![]() ![]() |
Timing | |||||||||
![]() ![]() ![]() ![]() |
ContactDetail | |||||||||
![]() ![]() ![]() ![]() |
Contributor | |||||||||
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DataRequirement | |||||||||
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Expression | |||||||||
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ParameterDefinition | |||||||||
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RelatedArtifact | |||||||||
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TriggerDefinition | |||||||||
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UsageContext | |||||||||
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Dosage | |||||||||
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Meta | |||||||||
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SO | 0..* | BackboneElement | Kết quả giải quyết — bắt buộc khi kiến nghị đã kết thúc
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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1..1 | CodeableConcept | Label for output Binding Description: (example): Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Identified issues", "Preliminary results", "Filler order", "Final results", etc. | |||||||
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1..1 | Result of output | ||||||||
![]() ![]() ![]() ![]() |
base64Binary | |||||||||
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boolean | |||||||||
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canonical(Any) | |||||||||
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code | |||||||||
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date | |||||||||
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dateTime | |||||||||
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decimal | |||||||||
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id | |||||||||
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instant | |||||||||
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integer | |||||||||
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markdown | |||||||||
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oid | |||||||||
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positiveInt | |||||||||
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string | |||||||||
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time | |||||||||
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unsignedInt | |||||||||
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uri | |||||||||
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url | |||||||||
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uuid | |||||||||
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Address | |||||||||
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Age | |||||||||
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Annotation | |||||||||
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Attachment | |||||||||
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CodeableConcept | |||||||||
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Coding | |||||||||
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ContactPoint | |||||||||
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Count | |||||||||
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Distance | |||||||||
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Duration | |||||||||
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HumanName | |||||||||
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Identifier | |||||||||
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Money | |||||||||
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Period | |||||||||
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Quantity | |||||||||
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Range | |||||||||
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Ratio | |||||||||
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Reference(Any) | |||||||||
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SampledData | |||||||||
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Signature | |||||||||
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Timing | |||||||||
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ContactDetail | |||||||||
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Contributor | |||||||||
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DataRequirement | |||||||||
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Expression | |||||||||
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ParameterDefinition | |||||||||
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RelatedArtifact | |||||||||
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TriggerDefinition | |||||||||
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UsageContext | |||||||||
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Dosage | |||||||||
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Meta | |||||||||
Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter)![]() |
|---|---|---|
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Documentation for this format | ||
| Path | Status | Usage | ValueSet | Version | Source |
| Task.status | Base | required | TaskStatus | 📍4.0.1 | FHIR Std. |
| Task.intent | Base | required | TaskIntent | 📍4.0.1 | FHIR Std. |
| Task.code | Base | example | Task Codes | 📍4.0.1 | FHIR Std. |
| Task.reasonCode | Base | example | Not State | Unknown | |
| Task.input.type | Base | example | Not State | Unknown | |
| Task.output.type | Base | example | Not State | Unknown |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | Task | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Task | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Task | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Task | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Task | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
| inv-1 | error | Task | Last modified date must be greater than or equal to authored-on date. |
lastModified.exists().not() or authoredOn.exists().not() or lastModified >= authoredOn
|
| vn-claim-appeal-decision-chronology | error | Task | Kiến nghị đã kết thúc phải ghi thời điểm ra quyết định, và thời điểm ấy không được sớm hơn ngày nêu kiến nghị. A concluded appeal SHALL carry executionPeriod.end, which SHALL NOT precede authoredOn. |
extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed' or code = 'withdrawn')).exists() implies (executionPeriod.end.exists() and executionPeriod.end >= authoredOn)
|
| vn-claim-appeal-outcome-required | error | Task | Kiến nghị ở giai đoạn giữ nguyên hoặc chấp nhận phải mang kết quả giải quyết, và NGƯỢC LẠI: output chỉ được xuất hiện khi kiến nghị đã có kết quả cuối (siết P1 #7 — output trước khi kết thúc là kết quả tiền chế). An appeal that is upheld or reversed SHALL carry its resolution output, and output SHALL only be present at a terminal result stage. |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or output.exists()) and (output.empty() or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
| vn-claim-appeal-state-coherent | error | Task | Ma trận trạng thái Task ↔ giai đoạn kiến nghị: upheld/reversed chỉ đi với completed; withdrawn chỉ đi với cancelled; completed đòi giai đoạn là kết quả cuối. Task.status and appealStage SHALL follow the full coherence matrix (upheld/reversed ⇔ completed; withdrawn ⇒ cancelled). |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or status = 'completed') and (extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and code = 'withdrawn').empty() or status = 'cancelled') and (status != 'completed' or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
Dạng xem Differential
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
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C | 0..* | Task | A task to be performed Constraints: vn-claim-appeal-outcome-required, vn-claim-appeal-state-coherent, vn-claim-appeal-decision-chronology | ||||||
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1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||
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SO | 1..1 | Coding | Giai đoạn kiến nghị — phân biệt đang ở cơ quan BHXH hay đã chuyển cơ quan có thẩm quyền URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage Binding: Giai đoạn kiến nghị chi phí BHYT — BHYT Cost Appeal Stage ValueSet (required)
| ||||||
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SO | 1..1 | code | Vòng đời kỹ thuật: requested | in-progress | completed | cancelled
| ||||||
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SO | 1..1 | code | unknown | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Fixed Value: order
| ||||||
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SO | 1..1 | CodeableConcept | Loại công việc — kiến nghị xem xét lại
| ||||||
![]() ![]() ![]() |
S | 1..1 | string | Plain text representation of the concept | ||||||
![]() ![]() |
SO | 1..1 | Reference(Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile | Đối soát và phân bổ khoản thanh toán BHYT — VN Core BHYT Payment Reconciliation | DocumentReference) | Quyết định bị kiến nghị: kết quả giám định hoặc đối soát thanh toán/thu hồi
| ||||||
![]() ![]() |
SO | 0..1 | Reference(Resource) | Người bệnh liên quan nếu kiến nghị gắn với một hồ sơ cụ thể
| ||||||
![]() ![]() |
SO | 0..1 | Period | Khoảng thời gian xem xét kiến nghị — `end` là thời điểm ra quyết định
| ||||||
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SO | 1..1 | dateTime | Thời điểm nêu kiến nghị
| ||||||
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SO | 1..1 | Reference(Cơ sở khám bệnh, chữa bệnh VN Core — VN Core KCB Organization Profile | Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ sở khám bệnh, chữa bệnh nêu kiến nghị
| ||||||
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SO | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan giải quyết: cơ quan bảo hiểm xã hội hoặc cơ quan có thẩm quyền
| ||||||
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SO | 0..1 | CodeableConcept | Lý do kiến nghị
| ||||||
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SO | 0..* | BackboneElement | Tài liệu kèm theo: biên bản giám định, văn bản thu hồi, chứng từ bổ sung
| ||||||
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SO | 0..* | BackboneElement | Kết quả giải quyết — bắt buộc khi kiến nghị đã kết thúc
| ||||||
Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter)![]() |
|---|---|---|
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Documentation for this format | ||
| Id | Grade | Path(s) | Description | Expression |
| vn-claim-appeal-decision-chronology | error | Task | Kiến nghị đã kết thúc phải ghi thời điểm ra quyết định, và thời điểm ấy không được sớm hơn ngày nêu kiến nghị. A concluded appeal SHALL carry executionPeriod.end, which SHALL NOT precede authoredOn. |
extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed' or code = 'withdrawn')).exists() implies (executionPeriod.end.exists() and executionPeriod.end >= authoredOn)
|
| vn-claim-appeal-outcome-required | error | Task | Kiến nghị ở giai đoạn giữ nguyên hoặc chấp nhận phải mang kết quả giải quyết, và NGƯỢC LẠI: output chỉ được xuất hiện khi kiến nghị đã có kết quả cuối (siết P1 #7 — output trước khi kết thúc là kết quả tiền chế). An appeal that is upheld or reversed SHALL carry its resolution output, and output SHALL only be present at a terminal result stage. |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or output.exists()) and (output.empty() or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
| vn-claim-appeal-state-coherent | error | Task | Ma trận trạng thái Task ↔ giai đoạn kiến nghị: upheld/reversed chỉ đi với completed; withdrawn chỉ đi với cancelled; completed đòi giai đoạn là kết quả cuối. Task.status and appealStage SHALL follow the full coherence matrix (upheld/reversed ⇔ completed; withdrawn ⇒ cancelled). |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or status = 'completed') and (extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and code = 'withdrawn').empty() or status = 'cancelled') and (status != 'completed' or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
|
Dạng xem SnapshotView
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
![]() |
C | 0..* | Task | A task to be performed Constraints: inv-1, vn-claim-appeal-outcome-required, vn-claim-appeal-state-coherent, vn-claim-appeal-decision-chronology | ||||||
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||||
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Σ | 0..1 | Meta | Metadata about the resource | ||||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||||
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0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||||
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0..* | Resource | Contained, inline Resources | |||||||
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1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||
![]() ![]() ![]() |
SO | 1..1 | Coding | Giai đoạn kiến nghị — phân biệt đang ở cơ quan BHXH hay đã chuyển cơ quan có thẩm quyền URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage Binding: Giai đoạn kiến nghị chi phí BHYT — BHYT Cost Appeal Stage ValueSet (required)
| ||||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||||
![]() ![]() |
0..* | Identifier | Task Instance Identifier | |||||||
![]() ![]() |
Σ | 0..1 | canonical(ActivityDefinition) | Formal definition of task | ||||||
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Σ | 0..1 | uri | Formal definition of task | ||||||
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Σ | 0..* | Reference(Resource) | Request fulfilled by this task | ||||||
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Σ | 0..1 | Identifier | Requisition or grouper id | ||||||
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Σ | 0..* | Reference(Task) | Composite task | ||||||
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?!SOΣ | 1..1 | code | Vòng đời kỹ thuật: requested | in-progress | completed | cancelled Binding: TaskStatus (required): The current status of the task.
| ||||||
![]() ![]() |
Σ | 0..1 | CodeableConcept | Reason for current status Binding Description: (example): Codes to identify the reason for current status. These will typically be specific to a particular workflow. | ||||||
![]() ![]() |
Σ | 0..1 | CodeableConcept | E.g. "Specimen collected", "IV prepped" Binding Description: (example): The domain-specific business-contextual sub-state of the task. For example: "Blood drawn", "IV inserted", "Awaiting physician signature", etc. | ||||||
![]() ![]() |
SOΣ | 1..1 | code | unknown | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: TaskIntent (required): Distinguishes whether the task is a proposal, plan or full order. Fixed Value: order
| ||||||
![]() ![]() |
0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): The task's priority. | |||||||
![]() ![]() |
SOΣ | 1..1 | CodeableConcept | Loại công việc — kiến nghị xem xét lại Binding: TaskCode (example): Codes to identify what the task involves. These will typically be specific to a particular workflow.
| ||||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||
![]() ![]() ![]() |
Σ | 0..* | Coding | Code defined by a terminology system | ||||||
![]() ![]() ![]() |
SΣ | 1..1 | string | Plain text representation of the concept | ||||||
![]() ![]() |
Σ | 0..1 | string | Human-readable explanation of task | ||||||
![]() ![]() |
SOΣ | 1..1 | Reference(Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile | Đối soát và phân bổ khoản thanh toán BHYT — VN Core BHYT Payment Reconciliation | DocumentReference) | Quyết định bị kiến nghị: kết quả giám định hoặc đối soát thanh toán/thu hồi
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SOΣ | 0..1 | Reference(Resource) | Người bệnh liên quan nếu kiến nghị gắn với một hồ sơ cụ thể
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Σ | 0..1 | Reference(Encounter) | Healthcare event during which this task originated | ||||||
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SOΣ | 0..1 | Period | Khoảng thời gian xem xét kiến nghị — `end` là thời điểm ra quyết định
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SOC | 1..1 | dateTime | Thời điểm nêu kiến nghị
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ΣC | 0..1 | dateTime | Task Last Modified Date | ||||||
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SOΣ | 1..1 | Reference(Cơ sở khám bệnh, chữa bệnh VN Core — VN Core KCB Organization Profile | Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ sở khám bệnh, chữa bệnh nêu kiến nghị
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0..* | CodeableConcept | Requested performer Binding: ProcedurePerformerRoleCodes (preferred): The type(s) of task performers allowed. | |||||||
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SOΣ | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan giải quyết: cơ quan bảo hiểm xã hội hoặc cơ quan có thẩm quyền
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Σ | 0..1 | Reference(Location) | Where task occurs | ||||||
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SO | 0..1 | CodeableConcept | Lý do kiến nghị Binding Description: (example): Indicates why the task is needed. E.g. Suspended because patient admitted to hospital.
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0..1 | Reference(Resource) | Why task is needed | |||||||
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0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage | |||||||
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0..* | Annotation | Comments made about the task | |||||||
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0..* | Reference(Provenance) | Key events in history of the Task | |||||||
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0..1 | BackboneElement | Constraints on fulfillment tasks | |||||||
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0..1 | string | Unique id for inter-element referencing | |||||||
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0..* | Extension | Additional content defined by implementations | |||||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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0..1 | positiveInt | How many times to repeat | |||||||
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0..1 | Period | When fulfillment sought | |||||||
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0..* | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Group | Organization) | For whom is fulfillment sought? | |||||||
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SO | 0..* | BackboneElement | Tài liệu kèm theo: biên bản giám định, văn bản thu hồi, chứng từ bổ sung
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0..1 | string | Unique id for inter-element referencing | |||||||
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0..* | Extension | Additional content defined by implementations | |||||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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1..1 | CodeableConcept | Label for the input Binding Description: (example): Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Comparison source", "Applicable consent", "Concomitent Medications", etc. | |||||||
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1..1 | Content to use in performing the task | ||||||||
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base64Binary | |||||||||
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boolean | |||||||||
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canonical(Any) | |||||||||
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code | |||||||||
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date | |||||||||
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dateTime | |||||||||
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decimal | |||||||||
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id | |||||||||
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instant | |||||||||
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integer | |||||||||
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markdown | |||||||||
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oid | |||||||||
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positiveInt | |||||||||
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string | |||||||||
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time | |||||||||
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unsignedInt | |||||||||
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uri | |||||||||
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url | |||||||||
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uuid | |||||||||
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Address | |||||||||
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Age | |||||||||
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Annotation | |||||||||
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Attachment | |||||||||
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CodeableConcept | |||||||||
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Coding | |||||||||
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ContactPoint | |||||||||
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Count | |||||||||
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Distance | |||||||||
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Duration | |||||||||
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HumanName | |||||||||
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Identifier | |||||||||
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Money | |||||||||
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Period | |||||||||
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Quantity | |||||||||
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Range | |||||||||
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Ratio | |||||||||
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Reference(Any) | |||||||||
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SampledData | |||||||||
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Signature | |||||||||
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Timing | |||||||||
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ContactDetail | |||||||||
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Contributor | |||||||||
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DataRequirement | |||||||||
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Expression | |||||||||
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ParameterDefinition | |||||||||
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RelatedArtifact | |||||||||
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TriggerDefinition | |||||||||
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UsageContext | |||||||||
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Dosage | |||||||||
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Meta | |||||||||
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SO | 0..* | BackboneElement | Kết quả giải quyết — bắt buộc khi kiến nghị đã kết thúc
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0..1 | string | Unique id for inter-element referencing | |||||||
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0..* | Extension | Additional content defined by implementations | |||||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||||
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1..1 | CodeableConcept | Label for output Binding Description: (example): Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Identified issues", "Preliminary results", "Filler order", "Final results", etc. | |||||||
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1..1 | Result of output | ||||||||
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base64Binary | |||||||||
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boolean | |||||||||
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canonical(Any) | |||||||||
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code | |||||||||
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date | |||||||||
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dateTime | |||||||||
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decimal | |||||||||
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id | |||||||||
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instant | |||||||||
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integer | |||||||||
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markdown | |||||||||
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oid | |||||||||
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positiveInt | |||||||||
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string | |||||||||
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time | |||||||||
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unsignedInt | |||||||||
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uri | |||||||||
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url | |||||||||
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uuid | |||||||||
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Address | |||||||||
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Age | |||||||||
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Annotation | |||||||||
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Attachment | |||||||||
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CodeableConcept | |||||||||
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Coding | |||||||||
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ContactPoint | |||||||||
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Count | |||||||||
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Distance | |||||||||
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Duration | |||||||||
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HumanName | |||||||||
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Identifier | |||||||||
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Money | |||||||||
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Period | |||||||||
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Quantity | |||||||||
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Range | |||||||||
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Ratio | |||||||||
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Reference(Any) | |||||||||
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SampledData | |||||||||
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Signature | |||||||||
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Timing | |||||||||
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ContactDetail | |||||||||
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Contributor | |||||||||
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DataRequirement | |||||||||
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Expression | |||||||||
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ParameterDefinition | |||||||||
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RelatedArtifact | |||||||||
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TriggerDefinition | |||||||||
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UsageContext | |||||||||
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Dosage | |||||||||
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Meta | |||||||||
Documentation for this format | ||||||||||
| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter)![]() |
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Documentation for this format | ||
| Path | Status | Usage | ValueSet | Version | Source |
| Task.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| Task.status | Base | required | TaskStatus | 📍4.0.1 | FHIR Std. |
| Task.statusReason | Base | example | Not State | Unknown | |
| Task.businessStatus | Base | example | Not State | Unknown | |
| Task.intent | Base | required | TaskIntent | 📍4.0.1 | FHIR Std. |
| Task.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std. |
| Task.code | Base | example | Task Codes | 📍4.0.1 | FHIR Std. |
| Task.performerType | Base | preferred | Procedure Performer Role Codes | 📍4.0.1 | FHIR Std. |
| Task.reasonCode | Base | example | Not State | Unknown | |
| Task.input.type | Base | example | Not State | Unknown | |
| Task.output.type | Base | example | Not State | Unknown |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | Task | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
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| dom-3 | error | Task | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
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| dom-4 | error | Task | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
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| dom-5 | error | Task | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
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| dom-6 | best practice | Task | A resource should have narrative for robust management |
text.`div`.exists()
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| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
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| inv-1 | error | Task | Last modified date must be greater than or equal to authored-on date. |
lastModified.exists().not() or authoredOn.exists().not() or lastModified >= authoredOn
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| vn-claim-appeal-decision-chronology | error | Task | Kiến nghị đã kết thúc phải ghi thời điểm ra quyết định, và thời điểm ấy không được sớm hơn ngày nêu kiến nghị. A concluded appeal SHALL carry executionPeriod.end, which SHALL NOT precede authoredOn. |
extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed' or code = 'withdrawn')).exists() implies (executionPeriod.end.exists() and executionPeriod.end >= authoredOn)
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| vn-claim-appeal-outcome-required | error | Task | Kiến nghị ở giai đoạn giữ nguyên hoặc chấp nhận phải mang kết quả giải quyết, và NGƯỢC LẠI: output chỉ được xuất hiện khi kiến nghị đã có kết quả cuối (siết P1 #7 — output trước khi kết thúc là kết quả tiền chế). An appeal that is upheld or reversed SHALL carry its resolution output, and output SHALL only be present at a terminal result stage. |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or output.exists()) and (output.empty() or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
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| vn-claim-appeal-state-coherent | error | Task | Ma trận trạng thái Task ↔ giai đoạn kiến nghị: upheld/reversed chỉ đi với completed; withdrawn chỉ đi với cancelled; completed đòi giai đoạn là kết quả cuối. Task.status and appealStage SHALL follow the full coherence matrix (upheld/reversed ⇔ completed; withdrawn ⇒ cancelled). |
(extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).empty() or status = 'completed') and (extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and code = 'withdrawn').empty() or status = 'cancelled') and (status != 'completed' or extension.where(url = 'http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-appeal-stage').value.ofType(Coding).where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-claim-appeal-stage-cs' and (code = 'upheld' or code = 'reversed')).exists())
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| Name | Bên giám định BHYT (Adjudicator) | Bên gửi hồ sơ BHYT (Submitter)![]() |
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Documentation for this format | ||
Summary
Mandatory: 7 elements
Must-Support: 14 elements
Fixed: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Biểu diễn khác của hồ sơ: CSV, Excel, Schematron