診所門診病摘實作指引
1.0.1 - CI Build
診所門診病摘實作指引
1.0.1 - CI Build
This page is part of the 診所門診病摘實作指引 (v1.0.1: Releases) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
病歷表單版本：1
臨床狀態：Final (CompositionStatus#final)
種類：Outpatient Note ( LOINC#34108-1)
病人：Patient/PatientTCMCR-min "陳美真"
就醫事件：Encounter/EncounterTCMCR-min
文件產生時間：2023-09-10T10:30:00
醫事機構代碼：OrganizationTCMCR-min "3214567890"
醫事機構名稱：OrganizationTCMCR-min "捷達世中醫診所"
文件標題：中醫門診單
文件敏感性：normal ( v3 Code System Confidentiality#N)
病摘小節內容：
section[PatientInformation]：
section[educationlevel]： Observation/ObservationEducationLevelTCMCR-min
section[occupation]： Observation/ObservationOccupationTCMCR-min
section[bloodtype]： Observation/ObservationBloodtypeTCMCR-minsection[AllergyIntolerance]： Allergyintolerance/AllergyIntoleranceTCMCR-min
section[ConditionPastMedicalHistory]： Condition/ConditionPastMedicalHistoryTCMCR-min
section[ConditionMajorIllness]： Observation/ObservationMajorIllnessTCMCR-min
section[Medication]：
section[medication]： Medication/MedicationTCMCR-min
section[medication]： Medication/MedicationTCMCR-pro
section[medicationrequest]： MedicationRequest/MedicationRequestTCMCR-min
section[medicationrequest]： MedicationRequest/MedicationRequestTCMCR-prosection[ConditionDiagnosis]：
section[conditiondiagnosis]： Condition/ConditionDiagnosisTCMCR-min
section[practitioner]： Practitioner/PractitionerClinEMR-pro
section[careplan]： CarePlan/CarePlanTCMCR-min
section[observationtonguecondition]： Observation/ObservationTongueConditionTCMCR-min
section[observationpulsecondition]： Observation/ObservationPulseConditionTCMCR-min
section[observationmanifestation]： Observation/ObservationManifestationTCMCR-min
section[observationtherapeuticdiscipline]： Observation/ObservationTherapeuticDisciplineTCMCR-minsection[ConditionChiefComplaint]： Condition/ConditionChiefComplaintTCMCR-min
section[ObservationVitalSign]： Observation/ObservationVitalSignTCMCR-min
section[Procedure]： Procedure/ProcedureTCMCR-min
section[Procedure]： Procedure/ProcedureTCMCR-minn
section[Procedure]： Procedure/ProcedureTCMCR-prosection[ObservationLabResults]：
section[observation]： Observation/ObservationTCMCR-min
section[observation]： Observation/ObservationTCMCR-pro
section[servicerequest]： ServiceRequest/ServiceRequestTCMCR-min
section[servicerequest]： ServiceRequest/ServiceRequestTCMCR-min
section[diagnosticreport]： DiagnosticReport/DiagnosticReportTCMCR-min
section[organizationinspection]： Organization/OrganizationInspectionClinEMR-minsection[DocumentReference]： DocumentReference/DocumentReferenceTCMCR-min