電子カルテ情報共有サービス2文書５情報+患者サマリー FHIR実装ガイド JP-CLINS（CLinical Information Sharing ImplementationGuide） v1.4.1
1.4.1 - release
Japan
電子カルテ情報共有サービス2文書５情報+患者サマリー FHIR実装ガイド JP-CLINS（CLinical Information Sharing ImplementationGuide） v1.4.1 - Local Development build (v1.4.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
{
"resourceType" : "Condition",
"id" : "Example-JP-Condition-eCS-02",
"meta" : {
"lastUpdated" : "2023-04-01T10:00:00+09:00",
"profile" : [
🔗 "http://jpfhir.jp/fhir/eCS/StructureDefinition/JP_Condition_eCS"
],
"tag" : [
{
"system" : "http://jpfhir.jp/fhir/clins/CodeSystem/JP_ehrshrs_indication",
"code" : "LTS",
"display" : "長期保存"
},
{
"system" : "http://jpfhir.jp/fhir/clins/CodeSystem/JP_ehrshrs_indication",
"code" : "UNINFORMED",
"display" : "未告知"
}
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Condition </b><a name=\"Example-JP-Condition-eCS-02\"> </a><a name=\"hcExample-JP-Condition-eCS-02\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">ResourceCondition "Example-JP-Condition-eCS-02" Updated"2023-04-01 10:00:00+0900" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-JP-Condition-eCS.html\">eCS/CLINS:JP_Condition_eCS</a></p><p style=\"margin-bottom: 0px\">Tags: <span title=\"{http://jpfhir.jp/fhir/clins/CodeSystem/JP_ehrshrs_indication http://jpfhir.jp/fhir/clins/CodeSystem/JP_ehrshrs_indication}\">http://jpfhir.jp/fhir/clins/CodeSystem/JP_ehrshrs_indication</span>, <span title=\"{http://jpfhir.jp/fhir/clins/CodeSystem/JP_ehrshrs_indication http://jpfhir.jp/fhir/clins/CodeSystem/JP_ehrshrs_indication}\">http://jpfhir.jp/fhir/clins/CodeSystem/JP_ehrshrs_indication</span></p></div><p><b>JP eCS InstitutionNumber Extension</b>: <code>http://jpfhir.jp/fhir/core/IdSystem/insurance-medical-institution-no</code>/1318814790</p><p><b>JP eCS Department Extension</b>: 循環器診療科 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"urn:oid:1.2.392.200250.2.2.2\">JP Core Department SS-MIX CodeSystem</a>#08 "循環器科")</span></p><p><b>JP eCS Disgnostic Type Extension</b>: 主病名 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/CodeSystem/ex-diagnosistype\">Example Diagnosis Type Codes</a>#principal)</span></p><p><b>identifier</b>: <code>http://jpfhir.jp/fhir/core/IdSystem/resourceInstance-identifier</code>/202934702</p><p><b>clinicalStatus</b>: Active <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-condition-clinical.html\">Condition Clinical Status Codes</a>#active)</span></p><p><b>verificationStatus</b>: Confirmed <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-condition-ver-status.html\">ConditionVerificationStatus</a>#confirmed)</span></p><p><b>category</b>: Encounter Diagnosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-condition-category.html\">Condition Category Codes</a>#encounter-diagnosis)</span></p><p><b>code</b>: 胃癌 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"urn:oid:1.2.392.200119.4.101.2\">MEDIS病名管理番号 propertyなし</a>#20054178; <a href=\"http://jpfhir.jp/fhir/core/mhlw/CodeSystem/ICD10-2013-full\">MHLW 厚労省ICD102013版</a>#C169 "胃，部位不明")</span></p><p><b>subject</b>: <span><code>http://jpfhir.jp/fhir/clins/Idsystem/JP_Insurance_memberID</code>/00012345:あいう:１８７:05</span></p><p><b>encounter</b>: <a name=\"hcExample-Contained-JP-Encounter-AMB\"> </a></p><blockquote><p/><p><a name=\"Example-Contained-JP-Encounter-AMB\"> </a></p><p><a name=\"hcExample-Contained-JP-Encounter-AMB\"> </a></p><p><b>identifier</b>: <code>http://jpfhir.jp/fhir/core/IdSystem/resourceInstance-identifier</code>/192844</p><p><b>status</b>: finished</p><p><b>class</b>: 外来 (Details: ActCode code AMB = ' ambulatory ', stated as ' 外来 ')</p></blockquote><p><b>onset</b>: 2020-04-10</p><p><b>recordedDate</b>: 2020-04-18</p><p><b>recorder</b>: <span>: 消化器内科\u3000田中太郎</span></p><p><b>note</b>: Conditionリソース 必須要素と推奨要素を記述した データ作成例、主病名、未告知、長期保存、病名管理コードとICD10分類の両方でコーディング\u3000患者参照を被保険者番号のしている例</p><hr/><blockquote><p><b>Generated Narrative: Encounter #Example-Contained-JP-Encounter-AMB</b><a name=\"Example-Contained-JP-Encounter-AMB\"> </a><a name=\"hcExample-Contained-JP-Encounter-AMB\"> </a></p><p><b>identifier</b>: <code>http://jpfhir.jp/fhir/core/IdSystem/resourceInstance-identifier</code>/192844</p><p><b>status</b>: finished</p><p><b>class</b>: 外来 (Details: ActCode code AMB = ' ambulatory ', stated as ' 外来 ')</p></blockquote></div>"
},
"contained" : [
{
"resourceType" : "Encounter",
"id" : "Example-Contained-JP-Encounter-AMB",
"meta" : {
"profile" : [
🔗 "http://jpfhir.jp/fhir/core/StructureDefinition/JP_Encounter"
]
},
"language" : "ja",
"identifier" : [
{
"system" : "http://jpfhir.jp/fhir/core/IdSystem/resourceInstance-identifier",
"value" : "192844"
}
],
"status" : "finished",
"class" : {
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "AMB",
"display" : "外来"
}
}
],
"extension" : [
{
"url" : "http://jpfhir.jp/fhir/clins/Extension/StructureDefinition/JP_eCS_InstitutionNumber",
"valueIdentifier" : {
"system" : "http://jpfhir.jp/fhir/core/IdSystem/insurance-medical-institution-no",
"value" : "1318814790"
}
},
{
"url" : "http://jpfhir.jp/fhir/eCS/Extension/StructureDefinition/JP_eCS_Department",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "urn:oid:1.2.392.200250.2.2.2",
"code" : "08",
"display" : "循環器科"
}
],
"text" : "循環器診療科"
}
},
{
"url" : "http://jpfhir.jp/fhir/eCS/Extension/StructureDefinition/JP_eCS_DiagnosisType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code" : "principal",
"display" : "主病名"
}
]
}
}
],
"identifier" : [
{
"system" : "http://jpfhir.jp/fhir/core/IdSystem/resourceInstance-identifier",
"value" : "202934702"
}
],
"clinicalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code" : "active",
"display" : "Active"
}
]
},
"verificationStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code" : "confirmed",
"display" : "Confirmed"
}
]
},
"category" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/condition-category",
"code" : "encounter-diagnosis"
}
]
}
],
"code" : {
"coding" : [
{
"system" : "urn:oid:1.2.392.200119.4.101.2",
"code" : "20054178",
"display" : "胃癌"
},
{
"system" : "http://jpfhir.jp/fhir/core/mhlw/CodeSystem/ICD10-2013-full",
"code" : "C169",
"display" : "胃，部位不明"
}
],
"text" : "胃癌"
},
"subject" : {
"identifier" : {
"system" : "http://jpfhir.jp/fhir/clins/Idsystem/JP_Insurance_memberID",
"value" : "00012345:あいう:１８７:05"
}
},
"encounter" : {
"reference" : "#Example-Contained-JP-Encounter-AMB"
},
"onsetDateTime" : "2020-04-10",
"recordedDate" : "2020-04-18",
"recorder" : {
"display" : "消化器内科\u3000田中太郎"
},
"note" : [
{
"text" : "Conditionリソース 必須要素と推奨要素を記述した データ作成例、主病名、未告知、長期保存、病名管理コードとICD10分類の両方でコーディング\u3000患者参照を被保険者番号のしている例"
}
]
}