臺灣牙醫實作指引 (Taiwan Dental Implementation Guide)
0.0.1 - ballot

臺灣牙醫實作指引 (Taiwan Dental Implementation Guide) - Local Development build (v0.0.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Example Binary: 牙醫－牙周炎病人自費同意書範例

This content is an example of the 牙周炎病人自費同意書 (TW Periodontal Self-Pay Consent) 之邏輯模型 Logical Model and is not a FHIR Resource

    {
      "resourceType": "http://dental-ig.fhir.tw/StructureDefinition/TWDentalPeriodontalSelfPayConsent",
      "patientName": {
        "text": "王小明",
        "family": "王",
        "given": [
          "小明"
        ]
      },
      "birthDate": "1980-01-01",
      "medicalRecordNumber": {
        "system": "https://dental-ig.fhir.tw/identifier/medical-record",
        "value": "MR-001"
      },
      "organizationName": "幸福牙醫診所",
      "consentDescription": "本同意書說明牙周炎治療中使用之自費項目，包含材料費用及相關注意事項。",
      "selfPayReasons": [
        {
          "coding": [
            {
              "system": "https://dental-ig.fhir.tw/CodeSystem/selfpay-reason",
              "code": "UPGRADE"
            }
          ],
          "text": "材料升級"
        },
        {
          "coding": [
            {
              "system": "https://dental-ig.fhir.tw/CodeSystem/selfpay-reason",
              "code": "ADVANCED"
            }
          ],
          "text": "進階治療技術"
        }
      ],
      "selfPayOtherReason": "患者要求使用較新材料",
      "selfPayItems": [
        {
          "itemName": "進口生醫材料",
          "unitPrice": {
            "value": 2500,
            "currency": "TWD"
          },
          "quantity": 2,
          "amount": {
            "value": 5000,
            "currency": "TWD"
          }
        },
        {
          "itemName": "特殊手術器械使用費",
          "unitPrice": {
            "value": 1500,
            "currency": "TWD"
          },
          "quantity": 1,
          "amount": {
            "value": 1500,
            "currency": "TWD"
          }
        }
      ],
      "notes": [
        "1. 自費項目費用不包含在健保給付範圍內",
        "2. 治療效果因個人體質而異",
        "3. 如有任何問題請立即聯絡診所"
      ],
      "consentPersonName": {
        "text": "王大明",
        "family": "王",
        "given": [
          "大明"
        ]
      },
      "consentPersonId": "A123456789",
      "consentRelation": "父子",
      "contactPhone": "02-12345678",
      "contactMobile": "0912345678",
      "contactAddress": "台北市信義區信義路五段123號",
      "consentSignature": {
        "type": [
          {
            "system": "urn:iso-astm:E1762-95:2013",
            "code": "1.2.840.10065.1.12.1.1",
            "display": "Author's Signature"
          }
        ],
        "who": {
          "reference": "Patient/Dental-patient-example"
        },
        "when": "2024-01-01T14:00:00+08:00"
      },
      "consentDate": "2024-01-01"
    }