{
"description": null,
"_filename": "example/Questionnaire-apply-catastrophic-illness.json",
"package_name": "tw.gov.mohw.nhi.ci",
"date": "2025-11-07",
"meta": {
"profile": [ "https://nhicore.nhi.gov.tw/ci/StructureDefinition/Questionnaire-twci" ]
},
"publisher": "衛生福利部中央健康保險署",
"name": "CatastrophicIllnessForm",
"item": [ {
"item": [ {
"text": "hosp.applMode|申報方式",
"type": "choice",
"linkId": "1.1",
"required": true,
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/nhi-apply-mode"
}, {
"text": "hosp.applType|申報類別",
"type": "choice",
"linkId": "1.2",
"required": true,
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/nhi-apply-type"
}, {
"text": "hosp.applDate|申請日期",
"type": "date",
"linkId": "1.3",
"required": true
}, {
"text": "hosp.medCertBookDate|開立診斷書申請日期",
"type": "date",
"linkId": "1.4",
"required": true
}, {
"text": "hosp.hospId|醫事機構代碼",
"type": "choice",
"linkId": "1.5",
"required": true,
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/nhi-organization"
}, {
"text": "hosp.acptNo|受理編號",
"type": "string",
"linkId": "1.6"
}, {
"text": "hosp.acptNum|受理次數",
"type": "integer",
"linkId": "1.7"
} ],
"text": "hosp|院所資訊",
"type": "group",
"linkId": "1",
"required": true
}, {
"text": "patient|病人資訊",
"type": "reference",
"linkId": "2",
"required": true
}, {
"item": [ {
"text": "doctor.diagPrsnId|醫師身分證號",
"type": "string",
"linkId": "3.1"
}, {
"text": "doctor.diagPrsnName|診斷醫師姓名",
"type": "string",
"linkId": "3.2",
"required": true
} ],
"text": "doctor|醫師資訊",
"type": "group",
"linkId": "3",
"required": true
}, {
"item": [ {
"text": "diagnosis.icd10cmCode|主診斷代碼",
"type": "choice",
"linkId": "4.1",
"required": true,
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/nhi-diag-code-icd"
}, {
"item": [ {
"text": "diagnosis.examinationReport.reportType|報告類型。當LOINC無法具體描述檢體種類（例如：`47526-9`時），請填寫及補充說明檢體種類。",
"type": "choice",
"linkId": "4.2.1",
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/loinc-report-type"
}, {
"text": "diagnosis.examinationReport.speType|檢體種類",
"type": "string",
"linkId": "4.2.2"
}, {
"text": "diagnosis.examinationReport.reportResultString|報告結果-文數字",
"type": "string",
"linkId": "4.2.3"
}, {
"text": "diagnosis.examinationReport.reportResultPdf|檢查報告檔案，請填寫完整檔案路徑。填寫格式：「file://檔名.副檔名」。",
"type": "string",
"linkId": "4.2.4"
}, {
"text": "diagnosis.examinationReport.reportResultPdfTitle|檢查報告名稱",
"type": "string",
"linkId": "4.2.5"
}, {
"text": "diagnosis.examinationReport.reportDate|報告日期，YYYY-MM-DD。",
"type": "date",
"linkId": "4.2.6"
} ],
"text": "diagnosis.examinationReport|檢查報告",
"type": "group",
"linkId": "4.2",
"repeats": true
}, {
"item": [ {
"text": "diagnosis.medrec.medrec|病歷資料",
"type": "string",
"linkId": "4.3.1"
}, {
"text": "diagnosis.medrec.medrecTitle|病歷資料名稱",
"type": "string",
"linkId": "4.3.2"
} ],
"text": "diagnosis.medrec|病歷資料",
"type": "group",
"linkId": "4.3",
"repeats": true
}, {
"item": [ {
"text": "diagnosis.imageStudy.imgItem|影像報告",
"type": "choice",
"linkId": "4.4.1",
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/icd-10-pcs-2023-image"
}, {
"text": "diagnosis.imageStudy.imgResult|影像報告結果",
"type": "string",
"linkId": "4.4.2"
}, {
"text": "diagnosis.imageStudy.imgDate|影像報告日期",
"type": "date",
"linkId": "4.4.3"
}, {
"text": "diagnosis.imageStudy.imgBodySite|影像檢查的身體部位",
"type": "choice",
"linkId": "4.4.4",
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/body-site"
}, {
"item": [ {
"text": "diagnosis.imageStudy.imgDicom.studyUid|整項影像檢查的識別碼",
"type": "string",
"linkId": "4.4.5.1"
}, {
"item": [ {
"text": "diagnosis.imageStudy.imgDicom.series.uid|此系列的DICOM系列實例UID",
"type": "string",
"linkId": "4.4.5.2.1"
}, {
"text": "diagnosis.imageStudy.imgDicom.series.modality|此系列實例所使用的成像儀器",
"type": "choice",
"linkId": "4.4.5.2.2"
}, {
"item": [ {
"text": "diagnosis.imageStudy.imgDicom.series.instance.uid|DICOM影像",
"type": "string",
"linkId": "4.4.5.2.3.1"
}, {
"text": "diagnosis.imageStudy.imgDicom.series.instance.sopClass|DICOM class 類型",
"type": "choice",
"linkId": "4.4.5.2.3.2"
} ],
"text": "diagnosis.imageStudy.imgDicom.series.instance|系列中的一個SOP實例",
"type": "group",
"linkId": "4.4.5.2.3",
"repeats": true
} ],
"text": "diagnosis.imageStudy.imgDicom.series|每項影像檢查有一個或多個系列(series)的實例",
"type": "group",
"linkId": "4.4.5.2",
"repeats": true
} ],
"text": "diagnosis.imageStudy.imgDicom|DICOM影像",
"type": "group",
"linkId": "4.4.5",
"repeats": true
}, {
"item": [ {
"text": "diagnosis.imageStudy.imgNonDicom.imgNonDicom|非DICOM影像",
"type": "string",
"linkId": "4.4.6.1"
}, {
"text": "diagnosis.imageStudy.imgNonDicom.imgNonDicomMimeType|非DICOM影像MimeType",
"type": "choice",
"linkId": "4.4.6.2",
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/media-mimetypes"
} ],
"text": "diagnosis.imageStudy.imgNonDicom|非DICOM影像",
"type": "group",
"linkId": "4.4.6",
"repeats": true
} ],
"text": "diagnosis.imageStudy|影像報告",
"type": "group",
"linkId": "4.4",
"repeats": true
} ],
"text": "diagnosis|疾病資訊",
"type": "group",
"linkId": "4"
}, {
"text": "ci|重大傷病",
"type": "reference",
"linkId": "5",
"required": true
}, {
"item": [ {
"text": "cancerStage.cancerStage|癌症期別，醫院自行填入癌症期別(1~4)，若為不適用者填9(不適用)。",
"type": "choice",
"linkId": "6.1",
"required": true,
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/cancer-stage"
}, {
"text": "cancerStage.assessScore|癌症分期分數或結果",
"type": "string",
"linkId": "6.2"
}, {
"text": "cancerStage.assessDate|癌症分期量表評估日期，YYYY-MM-DD，西元年月日，民國前為負數。",
"type": "date",
"linkId": "6.3"
} ],
"text": "cancerStage|癌症期別",
"type": "group",
"linkId": "6",
"required": true
}, {
"item": [ {
"text": "illness.oriCancerCode|原發癌症診斷碼，最長為7碼。",
"type": "choice",
"linkId": "7.1",
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/nhi-primary-cancer-icd"
}, {
"text": "illness.oriCancerDxDate|癌症最初診斷日期，西元年月日；不得大於系統日。",
"type": "date",
"linkId": "7.2"
}, {
"text": "illness.oriCancerAjcc|癌症最初診斷AJCC分期(病理分期或未接受治療前的臨床分期)，依期別填入；若不是用此分類而用其他分類，則填寫9。",
"type": "choice",
"linkId": "7.3",
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/nhi-cancerstaging"
}, {
"text": "illness.oriCancerAjcc1|癌症最初診斷AJCC分期_補充說明欄位，若前述欄位為9，則請於此欄位描述其他系統之其他分期為何。",
"type": "string",
"linkId": "7.4"
}, {
"text": "illness.cancerStatus|目前癌症狀態",
"type": "choice",
"linkId": "7.5",
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/nhi-cancerstage-status"
}, {
"text": "illness.cancerTreatment|後續治療評估，可複選。",
"type": "choice",
"linkId": "7.6",
"repeats": true,
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/nhi-cancer-treatment"
}, {
"text": "illness.cancerTreatmentPlan|後續治療計劃，可複選。",
"type": "choice",
"linkId": "7.7",
"repeats": true,
"answerValueSet": "https://nhicore.nhi.gov.tw/ci/ValueSet/nhi-cancer-treatment-plan"
}, {
"text": "illness.cancerTreatmentText|補充說明。",
"type": "string",
"linkId": "7.8"
} ],
"text": "illness|惡性腫瘤重大傷病換發評估表",
"type": "group",
"linkId": "7"
} ],
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": "Catastrophic-Illness-Form",
"package_version": "1.0.1",
"status": "active",
"id": "da0f4497-ffa8-4ce2-9648-63ae21d679b7",
"kind": null,
"url": "https://nhicore.nhi.gov.tw/ci/Questionnaire/apply-catastrophic-illness",
"version": "1.0.1",
"contact": [ {
"name": "衛生福利部中央健康保險署",
"telecom": [ {
"value": "https://www.nhi.gov.tw",
"system": "url"
} ]
} ]
}