LinkId Text Cardinality Type Flags Description & Constraints OrderReferralForm Questionnaire order Auftrag 1..1 group Definition: Bundle order.title Titel 1..1 string Definition: Composition.title order.type Typ 1..1 coding Definition: Composition.type Value Set: DocumentEntry.typeCode order.category Kategorie 1..1 coding Definition: Composition.category Value Set: DocumentEntry.classCode order.placerOrderIdentifier Auftragsnummer des Auftraggebers 0..1 string Definition: ServiceRequest.identifier:placerOrderIdentifier.value order.placerOrderIdentifierDomain Identifier Domain der Auftragsnummer des Auftraggebers 0..1 string Definition: ServiceRequest.identifier:placerOrderIdentifier.system order.fillerOrderIdentifier Auftragsnummer des Auftragsempfängers 0..1 string Definition: ServiceRequest.identifier:fillerOrderIdentifier.value order.fillerOrderIdentifierDomain Identifier Domain der Auftragsnummer des Auftragsempfängers 0..1 string Definition: ServiceRequest.identifier:fillerOrderIdentifier.system order.precedentDocumentIdentifier Identifier des Vorgängerdokuments 0..1 string Definition: Composition.extension:precedentDocument order.notificationContactDocument Dringender Benachrichtigungskontakt für dieses Dokument 0..1 group Definition: Composition.extension:urgentNoficationContactForThisDocument order.notificationContactDocument.practitioner Zu benachrichtigende Person 0..1 group Definition: PractitionerRole.practitioner order.notificationContactDocument.practitioner.title Titel 0..1 string Definition: Practitioner.name.prefix order.notificationContactDocument.practitioner.familyName Name 0..1 string Definition: Practitioner.name.family order.notificationContactDocument.practitioner.givenName Vorname 0..1 string Definition: Practitioner.name.given order.notificationContactDocument.practitioner.phone Telefon 0..1 string Definition: Practitioner.telecom.value order.notificationContactDocument.practitioner.email E-Mail 0..1 string Definition: Practitioner.telecom.value order.notificationContactDocumentResponse Dringender Benachrichtigungskontakt für die Antwort auf dieses Dokument 0..1 group Definition: Composition.extension:urgentNoficationContactForTheResponseToThisDocument order.notificationContactDocumentResponse.practitioner Zu benachrichtigende Person 0..1 group Definition: PractitionerRole.practitioner order.notificationContactDocumentResponse.practitioner.title Titel 0..1 string Definition: Practitioner.name.prefix order.notificationContactDocumentResponse.practitioner.familyName Name 0..1 string Definition: Practitioner.name.family order.notificationContactDocumentResponse.practitioner.givenName Vorname 0..1 string Definition: Practitioner.name.given order.notificationContactDocumentResponse.practitioner.phone Telefon 0..1 string Definition: Practitioner.telecom.value order.notificationContactDocumentResponse.practitioner.email E-Mail 0..1 string Definition: Practitioner.telecom.value order.priority Auftragspriorität 0..1 coding Definition: ServiceRequest.priority Options: 4 options receiver Empfänger 0..1 group Definition: Composition.extension:receiver receiver.practitioner Empfangende Person 0..1 group Definition: PractitionerRole.practitioner receiver.practitioner.title Titel 0..1 string Definition: Practitioner.name.prefix receiver.practitioner.familyName Name 0..1 string Definition: Practitioner.name.family receiver.practitioner.givenName Vorname 0..1 string Definition: Practitioner.name.given receiver.practitioner.gln GLN 0..1 string Definition: Practitioner.identifier:GLN.value receiver.practitioner.phone Telefon 0..1 string Definition: Practitioner.telecom.value receiver.practitioner.email E-Mail 0..1 string Definition: Practitioner.telecom.value receiver.organization Empfangende Organisation 0..1 group Definition: PractitionerRole.organization receiver.organization.name Name der Organisation 0..1 string Definition: Organization.name receiver.organization.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string Definition: Organization.address.line receiver.organization.postalCode PLZ 0..1 string Definition: Organization.address.postalCode receiver.organization.city Ort 0..1 string Definition: Organization.address.city receiver.organization.country Land 0..1 string Definition: Organization.address.country patient Patient 0..1 group Definition: Composition.subject patient.familyName Name 0..1 string Definition: Patient.name.family patient.maidenName Ledigname 0..1 string Definition: Patient.name.family patient.givenName Vorname 0..1 string Definition: Patient.name.given patient.localPid Lokale Patienten-ID 0..1 string Definition: Patient.identifier:LocalPid.value patient.localPidDomain Lokale Patienten-ID Domain 0..1 string Definition: Patient.identifier:LocalPid.system patient.birthDate Geburtsdatum 0..1 date Definition: Patient.birthDate patient.gender Geschlecht 0..1 coding Definition: Patient.gender Options: 3 options patient.phone Telefon 0..* string Definition: Patient.telecom.value patient.email E-Mail 0..1 string Definition: Patient.telecom.value patient.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string Definition: Patient.address.line patient.postalCode PLZ 0..1 string Definition: Patient.address.postalCode patient.city Ort 0..1 string Definition: Patient.address.city patient.country Land 0..1 string Definition: Patient.address.country patient.contactperson Kontaktperson 0..1 group Definition: Patient.contact patient.contactperson.relationship Beziehung 0..1 string Definition: Patient.contact.relationship.text patient.contactperson.familyName Name 0..1 string Definition: Patient.contact.name.family patient.contactperson.givenName Vorname 0..1 string Definition: Patient.contact.name.given patient.contactperson.phone Telefon 0..* string Definition: Patient.contact.telecom.value patient.contactperson.email E-Mail 0..1 string Definition: Patient.contact.telecom.value requestedEncounter Patientenaufnahme 0..1 group Definition: ServiceRequest.extension:requestedEncounterDetails requestedEncounter.class Voraussichtlich: Ambulant / Stationär / Notfall 0..1 coding Definition: Encounter.class Options: 3 options requestedEncounter.desiredAccommodation Zimmerkategorie 0..1 coding Definition: Encounter.extension:desiredAccommodation Options: 3 options coverage Kostenträger 0..1 group Definition: ServiceRequest.insurance coverage.beneficiary Begünstigter (Patient) 0..1 group Definition: Coverage.beneficiary coverage.beneficiary.ahvn13 AHV-Nr. des Patienten 0..1 string Definition: Patient.identifier:AHVN13 coverage.kvg Krankenkasse (nach KVG) 0..1 group Definition: Coverage.type coverage.kvg.name Name der Versicherung 0..1 string Definition: Coverage.payor coverage.kvg.insuranceCardNumber Kennnummer der Versichertenkarte 0..1 string Definition: Coverage.identifier coverage.uvg Unfallversicherung (nach UVG) 0..1 group Definition: Coverage.type coverage.uvg.name Name der Versicherung 0..1 string Definition: Coverage.payor coverage.uvg.claimNumber Schadennummer 0..1 string Definition: Coverage.identifier coverage.vvg Zusatzversicherung (nach VVG) 0..1 group Definition: Coverage.type coverage.vvg.name Name der Versicherung 0..1 string Definition: Coverage.payor coverage.vvg.insuranceCardNumber Kennnummer der Versichertenkarte 0..1 string Definition: Coverage.identifier coverage.iv Invalidenversicherung (IV) 0..1 group Definition: Coverage.type coverage.iv.verfuegungsnummer IV-Verfügungsnummer 0..1 string Definition: Coverage.identifier coverage.mv Militärversicherung (MV) 0..1 group Definition: Coverage.type coverage.mv.versichertennummer MV-Versichertennummer 0..1 string Definition: Coverage.identifier coverage.self Selbstzahler 0..1 group Definition: Coverage.type coverage.self.familyName Name 0..1 string Definition: Coverage.payor coverage.self.givenName Vorname 0..1 string Definition: Coverage.payor coverage.other Anderer Kostenträger 0..1 group Definition: Coverage.type coverage.other.name Name des Kostenträgers 0..1 string Definition: Coverage.payor coverage.other.id Beliebige ID 0..1 string Definition: Coverage.identifier coverage.other.id.note Bemerkung zur ID 0..1 string Definition: Coverage.identifier.type.text sender Absender 1..1 group sender.author Verantwortlicher 1..1 group Definition: Composition.author sender.author.practitioner Verantwortliche Person 0..1 group Definition: PractitionerRole.practitioner sender.author.practitioner.title Titel 0..1 string Definition: Practitioner.name.prefix sender.author.practitioner.familyName Name 0..1 string Definition: Practitioner.name.family sender.author.practitioner.givenName Vorname 0..1 string Definition: Practitioner.name.given sender.author.practitioner.gln GLN 0..1 string Definition: Practitioner.identifier:GLN.value sender.author.practitioner.phone Telefon 0..1 string Definition: Practitioner.telecom.value sender.author.practitioner.email E-Mail 0..1 string Definition: Practitioner.telecom.value sender.author.organization Verantwortliche Organisation 0..1 group Definition: PractitionerRole.organization sender.author.organization.name Name der Organisation 0..1 string Definition: Organization.name sender.author.organization.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string Definition: Organization.address.line sender.author.organization.postalCode PLZ 0..1 string Definition: Organization.address.postalCode sender.author.organization.city Ort 0..1 string Definition: Organization.address.city sender.author.organization.country Land 0..1 string Definition: Organization.address.country sender.dataenterer Erfasser 0..1 group Definition: Composition.extension:dataEnterer sender.dataenterer.practitioner Erfassende Person 0..1 group Definition: PractitionerRole.practitioner sender.dataenterer.practitioner.familyName Name 0..1 string Definition: Practitioner.name.family sender.dataenterer.practitioner.givenName Vorname 0..1 string Definition: Practitioner.name.given sender.dataenterer.practitioner.phone Telefon 0..1 string Definition: Practitioner.telecom.value sender.dataenterer.practitioner.email E-Mail 0..1 string Definition: Practitioner.telecom.value receiverCopies Kopieempfänger 0..1 group Definition: Composition.extension:copyReceiver receiverCopy Kopieempfangende Organisation oder Person 0..* group receiverCopy.organization.name Name der Organisation 0..1 string Definition: Organization.name receiverCopy.title Titel 0..1 string Definition: HumanName.prefix receiverCopy.familyName Name 0..1 string Definition: HumanName.family receiverCopy.givenName Vorname 0..1 string Definition: HumanName.given receiverCopy.phone Telefon 0..1 string Definition: ContactPoint.value receiverCopy.email E-Mail 0..1 string Definition: ContactPoint.value receiverCopy.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string Definition: Address.line receiverCopy.postalCode PLZ 0..1 string Definition: Address.postalCode receiverCopy.city Ort 0..1 string Definition: Address.city receiverCopy.country Land 0..1 string Definition: Address.country appointment Ort und Zeit der Durchführung der angeforderten Leistung 0..* group Definition: ServiceRequest.extension:locationAndTime appointment.location Ort der Durchführung 1..1 group Definition: Appointment.participant.actor appointment.location.name Name 1..1 string Definition: Location.name appointment.location.phone Telefon 0..1 string Definition: Location.telecom.value appointment.location.email E-Mail 0..1 string Definition: Location.telecom.value appointment.location.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string Definition: Location.address.line appointment.location.postalCode PLZ 0..1 string Definition: Location.address.postalCode appointment.location.city Ort 0..1 string Definition: Location.address.city appointment.location.country Land 0..1 string Definition: Location.address.country appointment.requestedPeriod Datum und Zeit, wann der Termin bevorzugt geplant werden soll 0..1 group Definition: Appointment.requestedPeriod appointment.requestedPeriod.start Von 0..1 dateTime Definition: Appointment.requestedPeriod.start appointment.requestedPeriod.end Bis 0..1 dateTime Definition: Appointment.requestedPeriod.end appointment.status Status 1..1 coding Definition: Appointment.status Options: 3 options appointment.patientInstruction Patienteninformation für diesen Termin 0..1 string Definition: Appointment.patientInstruction note Bemerkungen 0..* group note.text Kommentar 1..1 string Definition: ServiceRequest.note.text Documentation for this format
The Bundle that is to be used to pre-populate the form
Identifier Domain der Auftragsnummer des Auftraggebers
Identifier Domain der Auftragsnummer des Auftragsempfängers
Dringender Benachrichtigungskontakt für dieses Dokument
Dringender Benachrichtigungskontakt für die Antwort auf dieses Dokument
Die Anfrage sollte dringend bearbeitet werden - höhere Priorität als normal.
Die Anfrage sollte so schnell wie möglich bearbeitet werden - höhere Priorität als dringend.
Die Anfrage sollte sofort bearbeitet werden - höchstmögliche Priorität. Z.B. bei einem Notfall.
Voraussichtlich: Ambulant / Stationär / Notfall
Kopieempfangende Organisation oder Person
Ort und Zeit der Durchführung der angeforderten Leistung
Datum und Zeit, wann der Termin bevorzugt geplant werden soll
Vom Patienten bestätigt, aber vom Leistungserbringer noch nicht (ausstehend)
Vom Patienten und Leistungserbringer bestätigt (gebucht)