MedMij:V2020.02/BgLZ-AddendaInhoudelijkeGegevens: verschil tussen versies
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| Regel 1: | Regel 1: | ||
__NOINDEX__ | __NOINDEX__ | ||
| − | |||
__NUMBEREDHEADINGS__ | __NUMBEREDHEADINGS__ | ||
{{DISPLAYTITLE:Beschikbaarstellen Basisgegevens Langdurige Zorg: addenda inhoudelijke gegevens kwalificatie}} | {{DISPLAYTITLE:Beschikbaarstellen Basisgegevens Langdurige Zorg: addenda inhoudelijke gegevens kwalificatie}} | ||
| Regel 142: | Regel 141: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Wilsverklaring | |colspan="2"|Wilsverklaring | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-wilsverklaring-01|Wilsverklaring: bglz-1-1-wilsverklaring-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|<span id="bglz-1-1-wilsverklaring-01" title="Intern ID = bglz-1-1-wilsverklaring-01">Wilsverklaring bglz-1-1-wilsverklaring-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| Regel 159: | Regel 158: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Contactpersoon | |colspan="2"|Contactpersoon | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-contactpersoon-01|Contactpersoon: bglz-1-1-contactpersoon-01]] |
|} | |} | ||
=== Contactpersonen=== | === Contactpersonen=== | ||
| Regel 170: | Regel 169: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-contactpersoon-01" title="Intern ID = bglz-1-1-contactpersoon-01">Contactpersoon bglz-1-1-contactpersoon-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="22"| | |rowspan="22"| | ||
| Regel 236: | Regel 235: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1-1-probleem-01" title="Intern ID = bglz-1-1-probleem-01">Probleem bglz-1-1-probleem-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| Regel 255: | Regel 254: | ||
|style="background-color: white;"|Niet bekend met neurologische klachten | |style="background-color: white;"|Niet bekend met neurologische klachten | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1-1-probleem-02" title="Intern ID = bglz-1-1-probleem-02">Probleem bglz-1-1-probleem-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| Regel 271: | Regel 270: | ||
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1-1-probleem-03" title="Intern ID = bglz-1-1-probleem-03">Probleem bglz-1-1-probleem-03</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| Regel 287: | Regel 286: | ||
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1-1-probleem-04" title="Intern ID = bglz-1-1-probleem-04">Probleem bglz-1-1-probleem-04</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| Regel 303: | Regel 302: | ||
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1-1-probleem-05" title="Intern ID = bglz-1-1-probleem-05">Probleem bglz-1-1-probleem-05</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| Regel 319: | Regel 318: | ||
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1-1-probleem-06" title="Intern ID = bglz-1-1-probleem-06">Probleem bglz-1-1-probleem-06</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| Regel 335: | Regel 334: | ||
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1-1-probleem-07" title="Intern ID = bglz-1-1-probleem-07">Probleem bglz-1-1-probleem-07</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| Regel 351: | Regel 350: | ||
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1-1-probleem-08" title="Intern ID = bglz-1-1-probleem-08">Probleem bglz-1-1-probleem-08</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| Regel 456: | Regel 455: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test datum tijd | |colspan="2"|Test datum tijd | ||
| − | |style="background-color: white;"|T om 15 | + | |style="background-color: white;"|T om 15:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test uitslag | |colspan="2"|Test uitslag | ||
| Regel 478: | Regel 477: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test datum tijd | |colspan="2"|Test datum tijd | ||
| − | |style="background-color: white;"|T om 15 | + | |style="background-color: white;"|T om 15:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test uitslag | |colspan="2"|Test uitslag | ||
| Regel 504: | Regel 503: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test datum tijd | |colspan="2"|Test datum tijd | ||
| − | |style="background-color: white;"|T om 15 | + | |style="background-color: white;"|T om 15:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test uitslag | |colspan="2"|Test uitslag | ||
| Regel 530: | Regel 529: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test datum tijd | |colspan="2"|Test datum tijd | ||
| − | |style="background-color: white;"|T om 15 | + | |style="background-color: white;"|T om 15:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test uitslag | |colspan="2"|Test uitslag | ||
| Regel 568: | Regel 567: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Probleem | |colspan="2"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-probleem-01|Probleem: bglz-1-1-probleem-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verrichting type | |colspan="3"|Verrichting type | ||
| Regel 578: | Regel 577: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgaanbieder | |colspan="2"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgaanbieder-01|Zorgaanbieder: bglz-1-1-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Uitvoerder | |colspan="4"|Uitvoerder | ||
| Regel 585: | Regel 584: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-02|Zorgverlener: bglz-1-1-zorgverlener-02]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Aanvrager | |colspan="4"|Aanvrager | ||
| Regel 592: | Regel 591: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-02|Zorgverlener: bglz-1-1-zorgverlener-02]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Verrichting | |colspan="5"|Verrichting | ||
| Regel 609: | Regel 608: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Probleem | |colspan="2"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-probleem-01|Probleem: bglz-1-1-probleem-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verrichting type | |colspan="3"|Verrichting type | ||
| Regel 619: | Regel 618: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgaanbieder | |colspan="2"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgaanbieder-01|Zorgaanbieder: bglz-1-1-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Uitvoerder | |colspan="4"|Uitvoerder | ||
| Regel 626: | Regel 625: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-02|Zorgverlener: bglz-1-1-zorgverlener-02]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Aanvrager | |colspan="4"|Aanvrager | ||
| Regel 633: | Regel 632: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-02|Zorgverlener: bglz-1-1-zorgverlener-02]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Verrichting | |colspan="5"|Verrichting | ||
| Regel 647: | Regel 646: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Probleem | |colspan="2"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-probleem-05|Probleem: bglz-1-1-probleem-05]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verrichting type | |colspan="3"|Verrichting type | ||
| Regel 657: | Regel 656: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgaanbieder | |colspan="2"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgaanbieder-01|Zorgaanbieder: bglz-1-1-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Uitvoerder | |colspan="4"|Uitvoerder | ||
| Regel 664: | Regel 663: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-04|Zorgverlener: bglz-1-1-zorgverlener-04]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Aanvrager | |colspan="4"|Aanvrager | ||
| Regel 671: | Regel 670: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-02|Zorgverlener: bglz-1-1-zorgverlener-02]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Verrichting | |colspan="5"|Verrichting | ||
| Regel 685: | Regel 684: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Probleem | |colspan="2"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-probleem-06|Probleem: bglz-1-1-probleem-06]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verrichting type | |colspan="3"|Verrichting type | ||
| Regel 695: | Regel 694: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgaanbieder | |colspan="2"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgaanbieder-01|Zorgaanbieder: bglz-1-1-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Uitvoerder | |colspan="4"|Uitvoerder | ||
| Regel 702: | Regel 701: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-05|Zorgverlener: bglz-1-1-zorgverlener-05]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Aanvrager | |colspan="4"|Aanvrager | ||
| Regel 709: | Regel 708: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-02|Zorgverlener: bglz-1-1-zorgverlener-02]] |
|} | |} | ||
=== Verpleegkundig zorgplan=== | === Verpleegkundig zorgplan=== | ||
| Regel 724: | Regel 723: | ||
|rowspan="83"| | |rowspan="83"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-verpleegkundigeinterventie-01" title="Intern ID = bglz-1-1-verpleegkundigeinterventie-01">Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="16"| | |rowspan="16"| | ||
| Regel 736: | Regel 735: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Probleem | |colspan="3"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-probleem-03|Probleem: bglz-1-1-probleem-03]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Behandeldoel | |colspan="5"|Behandeldoel | ||
| Regel 761: | Regel 760: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-03|Zorgverlener: bglz-1-1-zorgverlener-03]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-verpleegkundigeinterventie-02" title="Intern ID = bglz-1-1-verpleegkundigeinterventie-02">Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="16"| | |rowspan="16"| | ||
| Regel 775: | Regel 774: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Probleem | |colspan="3"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-probleem-04|Probleem: bglz-1-1-probleem-04]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Behandeldoel | |colspan="5"|Behandeldoel | ||
| Regel 800: | Regel 799: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-03|Zorgverlener: bglz-1-1-zorgverlener-03]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-verpleegkundigeinterventie-03" title="Intern ID = bglz-1-1-verpleegkundigeinterventie-03">Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-03</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="15"| | |rowspan="15"| | ||
| Regel 814: | Regel 813: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Probleem | |colspan="3"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-probleem-05|Probleem: bglz-1-1-probleem-05]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Behandeldoel | |colspan="5"|Behandeldoel | ||
| Regel 836: | Regel 835: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-03|Zorgverlener: bglz-1-1-zorgverlener-03]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-verpleegkundigeinterventie-04" title="Intern ID = bglz-1-1-verpleegkundigeinterventie-04">Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-04</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="15"| | |rowspan="15"| | ||
| Regel 850: | Regel 849: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Probleem | |colspan="3"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-probleem-07|Probleem: bglz-1-1-probleem-07]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Behandeldoel | |colspan="5"|Behandeldoel | ||
| Regel 872: | Regel 871: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-03|Zorgverlener: bglz-1-1-zorgverlener-03]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-verpleegkundigeinterventie-05" title="Intern ID = bglz-1-1-verpleegkundigeinterventie-05">Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-05</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="15"| | |rowspan="15"| | ||
| Regel 886: | Regel 885: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Probleem | |colspan="3"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-probleem-08|Probleem: bglz-1-1-probleem-08]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Behandeldoel | |colspan="5"|Behandeldoel | ||
| Regel 908: | Regel 907: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgverlener-03|Zorgverlener: bglz-1-1-zorgverlener-03]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Uitkomsten | |colspan="7"|Uitkomsten | ||
| Regel 926: | Regel 925: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verpleegkundige interventie | |colspan="3"|Verpleegkundige interventie | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-verpleegkundigeinterventie-01|Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Uitkomst van zorg | |colspan="6"|Uitkomst van zorg | ||
| Regel 940: | Regel 939: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verpleegkundige interventie | |colspan="3"|Verpleegkundige interventie | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-verpleegkundigeinterventie-02|Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-02]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Uitkomst van zorg | |colspan="6"|Uitkomst van zorg | ||
| Regel 954: | Regel 953: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verpleegkundige interventie | |colspan="3"|Verpleegkundige interventie | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-verpleegkundigeinterventie-03|Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-03]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Uitkomst van zorg | |colspan="6"|Uitkomst van zorg | ||
| Regel 968: | Regel 967: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verpleegkundige interventie | |colspan="3"|Verpleegkundige interventie | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-verpleegkundigeinterventie-04|Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-04]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Uitkomst van zorg | |colspan="6"|Uitkomst van zorg | ||
| Regel 982: | Regel 981: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verpleegkundige interventie | |colspan="3"|Verpleegkundige interventie | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-verpleegkundigeinterventie-05|Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-05]] |
|} | |} | ||
=== Zorgsetting=== | === Zorgsetting=== | ||
| Regel 997: | Regel 996: | ||
|rowspan="12"| | |rowspan="12"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-zorgverlener-01" title="Intern ID = bglz-1-1-zorgverlener-01">Zorgverlener bglz-1-1-zorgverlener-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="10"| | |rowspan="10"| | ||
| Regel 1.028: | Regel 1.027: | ||
|rowspan="15"| | |rowspan="15"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-zorgverlener-02" title="Intern ID = bglz-1-1-zorgverlener-02">Zorgverlener bglz-1-1-zorgverlener-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="13"| | |rowspan="13"| | ||
| Regel 1.057: | Regel 1.056: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Zorgaanbieder | |colspan="3"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgaanbieder-01|Zorgaanbieder: bglz-1-1-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Zorgverleners rol | |colspan="4"|Zorgverleners rol | ||
| Regel 1.066: | Regel 1.065: | ||
|rowspan="40"| | |rowspan="40"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-zorgverlener-03" title="Intern ID = bglz-1-1-zorgverlener-03">Zorgverlener bglz-1-1-zorgverlener-03</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="12"| | |rowspan="12"| | ||
| Regel 1.095: | Regel 1.094: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Zorgaanbieder | |colspan="3"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgaanbieder-01|Zorgaanbieder: bglz-1-1-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-zorgverlener-04" title="Intern ID = bglz-1-1-zorgverlener-04">Zorgverlener bglz-1-1-zorgverlener-04</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="12"| | |rowspan="12"| | ||
| Regel 1.126: | Regel 1.125: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Zorgaanbieder | |colspan="3"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgaanbieder-01|Zorgaanbieder: bglz-1-1-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1-1-zorgverlener-05" title="Intern ID = bglz-1-1-zorgverlener-05">Zorgverlener bglz-1-1-zorgverlener-05</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="12"| | |rowspan="12"| | ||
| Regel 1.157: | Regel 1.156: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Zorgaanbieder | |colspan="3"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-1-zorgaanbieder-01|Zorgaanbieder: bglz-1-1-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|<span id="bglz-1-1-zorgaanbieder-01" title="Intern ID = bglz-1-1-zorgaanbieder-01">Zorgaanbieder bglz-1-1-zorgaanbieder-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="24"| | |rowspan="24"| | ||
| Regel 1.425: | Regel 1.424: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1-3-probleem-01" title="Intern ID = bglz-1-3-probleem-01">Probleem bglz-1-3-probleem-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
| Regel 1.468: | Regel 1.467: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test datum tijd | |colspan="2"|Test datum tijd | ||
| − | |style="background-color: white;"|T om 15 | + | |style="background-color: white;"|T om 15:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test uitslag | |colspan="2"|Test uitslag | ||
| Regel 1.494: | Regel 1.493: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test datum tijd | |colspan="2"|Test datum tijd | ||
| − | |style="background-color: white;"|T + 1 maand om 16 | + | |style="background-color: white;"|T + 1 maand om 16:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test uitslag | |colspan="2"|Test uitslag | ||
| Regel 1.521: | Regel 1.520: | ||
|rowspan="26"| | |rowspan="26"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|<span id="bglz-1-3-verpleegkundigeinterventie-01" title="Intern ID = bglz-1-3-verpleegkundigeinterventie-01">Verpleegkundige interventie bglz-1-3-verpleegkundigeinterventie-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="24"| | |rowspan="24"| | ||
| Regel 1.533: | Regel 1.532: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Probleem | |colspan="4"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-3-probleem-01|Probleem: bglz-1-3-probleem-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Frequentie | |colspan="5"|Frequentie | ||
| Regel 1.596: | Regel 1.595: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Verpleegkundige interventie | |colspan="4"|Verpleegkundige interventie | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1-3-verpleegkundigeinterventie-01|Verpleegkundige interventie: bglz-1-3-verpleegkundigeinterventie-01]] |
|}<section end=BgLZ-3.0-LZB-1.3-v1 /> | |}<section end=BgLZ-3.0-LZB-1.3-v1 /> | ||
= Release notes = | = Release notes = | ||
| − | Je vindt de release notes bij [[MedMij: | + | Je vindt de release notes bij [[MedMij:Vprepub-2020.02/OntwerpLangdurigeZorg#Release_notes|Functioneel ontwerp]] |
==Scenario BgLZ-3.0-LZB-1.5-v1== | ==Scenario BgLZ-3.0-LZB-1.5-v1== | ||
| Regel 1.738: | Regel 1.737: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Wilsverklaring | |colspan="2"|Wilsverklaring | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-wilsverklaring-01|Wilsverklaring: bglz-1.5-wilsverklaring-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|<span id="bglz-1.5-wilsverklaring-01" title="Intern ID = bglz-1.5-wilsverklaring-01">Wilsverklaring bglz-1.5-wilsverklaring-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| Regel 1.755: | Regel 1.754: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Contactpersoon | |colspan="2"|Contactpersoon | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-contactpersoon-01|Contactpersoon: bglz-1.5-contactpersoon-01]] |
|} | |} | ||
=== Contactpersonen=== | === Contactpersonen=== | ||
| Regel 1.766: | Regel 1.765: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1.5-contactpersoon-01" title="Intern ID = bglz-1.5-contactpersoon-01">Contactpersoon bglz-1.5-contactpersoon-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="22"| | |rowspan="22"| | ||
| Regel 1.832: | Regel 1.831: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1.5-probleem-01" title="Intern ID = bglz-1.5-probleem-01">Probleem bglz-1.5-probleem-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| Regel 1.851: | Regel 1.850: | ||
|style="background-color: white;"|Niet bekend met neurologische klachten | |style="background-color: white;"|Niet bekend met neurologische klachten | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1.5-probleem-02" title="Intern ID = bglz-1.5-probleem-02">Probleem bglz-1.5-probleem-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| Regel 1.867: | Regel 1.866: | ||
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="bglz-1.5-probleem-06" title="Intern ID = bglz-1.5-probleem-06">Probleem bglz-1.5-probleem-06</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| Regel 1.875: | Regel 1.874: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Probleem naam | |colspan="2"|Probleem naam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|afasie (code = '87486003' in codeSystem 'SNOMED CT') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Probleem begin datum | |colspan="2"|Probleem begin datum | ||
| Regel 1.882: | Regel 1.881: | ||
|colspan="2"|Probleem status | |colspan="2"|Probleem status | ||
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| + | |} | ||
| + | === Allergieen=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="5" | Allergieen | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="4" width="25%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Allergie intolerantie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="12"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Veroorzakende stof |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|pinda (code = '762952008' in codeSystem 'SNOMED CT') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Allergie status |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actief (code = 'active' in codeSystem 'HL7 ActStatus') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Mate van kritiek zijn |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Fataal (code = '399166001' in codeSystem 'SNOMED CT') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Na het eten van pinda's als student ontstond er een klinisch beeld van anafylaxie waarop de HA epipen heeft moeten toedienen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Reactie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="2"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Symptoom |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Anafylaxie (code = '39579001' in codeSystem 'SNOMED CT') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Reactie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="3"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Symptoom |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Angio-oedeem (code = '41291007' in codeSystem 'SNOMED CT') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Reactie beschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Angio-oedeem van de tong, lippen en peri-orbitale regio met acute benauwdheid na het eten van pinda's. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Allergie intolerantie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="9"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Veroorzakende stof |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|nikkelsulfaat (code = '255848005' in codeSystem 'SNOMED CT') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Allergie status |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actief (code = 'active' in codeSystem 'HL7 ActStatus') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Mate van kritiek zijn |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Matig (code = '6736007' in codeSystem 'SNOMED CT') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Opgemerkt bij het dragen van nikkel bevattende sieraden. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Reactie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="3"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Symptoom |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Contactdermatitis (code = '40275004' in codeSystem 'SNOMED CT') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Reactie beschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Last van jeuk, roodheid en irritatie op de contactplek van nikkel bevattende sieraden. |
| + | |} | ||
| + | === Uitslagen=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="5" | Uitslagen | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="4" width="25%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Laboratorium uitslag | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="17"| |
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Laboratorium test |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="7"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Test code |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hemoglobine (code = '718-7' in codeSystem 'LOINC') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Test datum tijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T om 15:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Test uitslag |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|11.0 g/dl |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Referentie bovengrens |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|16.0 g/dl |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="2"|Referentie ondergrens |
| + | |style="background-color: white;"|12.0 g/dl | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Interpretatie vlaggen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onder referentiewaarde (code = '281300000' in codeSystem 'SNOMED CT') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Laboratorium test | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="6"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Test code |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hematocriet (code = '20570-8' in codeSystem 'LOINC') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Test datum tijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T om 15:00 uur |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="2"|Test uitslag |
| + | |style="background-color: white;"|47 % | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Referentie bovengrens |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|51 % |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="2"|Referentie ondergrens |
| + | |style="background-color: white;"|39 % | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Onderzoek |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|hemoglobine & hematocriet panel (code = '24360-0' in codeSystem 'LOINC') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Laboratorium uitslag | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="9"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Laboratorium test |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="7"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Test code |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|glucose 2 uur na maaltijd massa/volume serum of plasma (code = '1521-4' in codeSystem 'LOINC') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Test datum tijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T om 15:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Test uitslag |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|5.9 mg/dl |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Referentie bovengrens |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|7.8 mg/dl |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="2"|Referentie ondergrens |
| + | |style="background-color: white;"|3.5 mg/dl | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Interpretatie vlaggen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Boven referentiewaarde (code = '281302008' in codeSystem 'SNOMED CT') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Laboratorium uitslag | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | + | |rowspan="9"| | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |rowspan=" | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Laboratorium test | |colspan="4"|Laboratorium test | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="6"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test code | |colspan="2"|Test code | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|cholesterol:mol/volume:moment:serum of plasma:kwantitatief: (code = '14647-2' in codeSystem 'LOINC') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test datum tijd | |colspan="2"|Test datum tijd | ||
| − | |style="background-color: white;"|T om 15 | + | |style="background-color: white;"|T om 15:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Test uitslag | |colspan="2"|Test uitslag | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|5.5 mmol/l |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Referentie bovengrens | |colspan="2"|Referentie bovengrens | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1.8 mmol/l |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Interpretatie vlaggen | |colspan="2"|Interpretatie vlaggen | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Boven referentiewaarde (code = '281302008' in codeSystem 'SNOMED CT') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|Toelichting |
| + | |style="background-color: white;"|Volgens richtlijn herseninfarct: streven naar <1,8mmol/L | ||
| + | |} | ||
| + | === Verrichtingen=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="5" | Verrichtingen | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="4" width="25%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Verrichting | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="16"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Verrichting start datum |
| − | |style="background-color: white;"|T | + | |style="background-color: white;"|T |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Verrichting eind datum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Indicatie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="2"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#bglz-1.5-probleem-01|Probleem: bglz-1.5-probleem-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Verrichting type |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|computertomografie van hersenen (code = '34227000' in codeSystem 'SNOMED CT') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Locatie |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="2"|Zorgaanbieder |
| + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgaanbieder-01|Zorgaanbieder: bglz-1.5-zorgaanbieder-01]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Uitvoerder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="2"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Zorgverlener |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgverlener-02|Zorgverlener: bglz-1.5-zorgverlener-02]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Aanvrager | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="2"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Zorgverlener |
| − | |style="background-color: white;"|5. | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgverlener-02|Zorgverlener: bglz-1.5-zorgverlener-02]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Verrichting | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="16"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Verrichting start datum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Verrichting eind datum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5 | + | |colspan="4"|Indicatie |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="2"|Probleem | ||
| + | |style="background-color: white;"|Zie [[#bglz-1.5-probleem-01|Probleem: bglz-1.5-probleem-01]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|Verrichting type |
| + | |style="background-color: white;"|percutane trombolyse van intracraniële arterie (code = '230935003' in codeSystem 'SNOMED CT') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Locatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="2"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Zorgaanbieder |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgaanbieder-01|Zorgaanbieder: bglz-1.5-zorgaanbieder-01]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Uitvoerder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="2"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Zorgverlener |
| − | |style="background-color: white;"|5.5 | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgverlener-02|Zorgverlener: bglz-1.5-zorgverlener-02]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Aanvrager | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="2"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Zorgverlener |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgverlener-02|Zorgverlener: bglz-1.5-zorgverlener-02]] |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Verrichting | |colspan="5"|Verrichting | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="12"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verrichting start datum | |colspan="3"|Verrichting start datum | ||
|style="background-color: white;"|T | |style="background-color: white;"|T | ||
| − | |||
| − | |||
| − | |||
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| − | |||
| − | |||
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| − | |||
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| − | |||
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| − | |||
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| − | |||
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| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
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| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verrichting type | |colspan="3"|Verrichting type | ||
| Regel 2.253: | Regel 2.165: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgaanbieder | |colspan="2"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgaanbieder-01|Zorgaanbieder: bglz-1.5-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Uitvoerder | |colspan="4"|Uitvoerder | ||
| Regel 2.260: | Regel 2.172: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgverlener-04|Zorgverlener: bglz-1.5-zorgverlener-04]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Aanvrager | |colspan="4"|Aanvrager | ||
| Regel 2.267: | Regel 2.179: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgverlener-02|Zorgverlener: bglz-1.5-zorgverlener-02]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Verrichting | |colspan="5"|Verrichting | ||
| Regel 2.281: | Regel 2.193: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Probleem | |colspan="2"|Probleem | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-probleem-06|Probleem: bglz-1.5-probleem-06]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Verrichting type | |colspan="3"|Verrichting type | ||
| Regel 2.291: | Regel 2.203: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgaanbieder | |colspan="2"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgaanbieder-01|Zorgaanbieder: bglz-1.5-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Uitvoerder | |colspan="4"|Uitvoerder | ||
| Regel 2.298: | Regel 2.210: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgverlener-05|Zorgverlener: bglz-1.5-zorgverlener-05]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Aanvrager | |colspan="4"|Aanvrager | ||
| Regel 2.305: | Regel 2.217: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Zorgverlener | |colspan="2"|Zorgverlener | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgverlener-02|Zorgverlener: bglz-1.5-zorgverlener-02]] |
|} | |} | ||
=== Verpleegkundig zorgplan=== | === Verpleegkundig zorgplan=== | ||
| Regel 2.317: | Regel 2.229: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Verpleegkundig zorgplan ongestructureerd | |colspan="2"|Verpleegkundig zorgplan ongestructureerd | ||
| − | |style="background-color: white;"|<div>Verpleegkundig zorgplan in opgemaakte tekst. Onderstaande is een voorbeeld. | + | |style="background-color: white;"|<div>Verpleegkundig zorgplan in opgemaakte tekst. Onderstaande is een voorbeeld. Het hoeft niet letterlijk te worden overgenomen.</div><div> </div><div><table class="fr-tinymce-table" style="border: 1px solid black; min-width: 50%; cell-padding: 1em; cell-spacing: 1em;"><tr><th colspan="1" rowspan="1" style="width: 30%; text-align: left;">probleem</th><th colspan="1" rowspan="1" style="width: 20%; text-align: left;">behandeldoel</th><th colspan="1" rowspan="1" style="width: 50%; text-align: left;">interventie</th></tr><tr><td colspan="1" rowspan="1" valign="top">probleem met zichzelf wassen en afdrogen</td><td colspan="1" rowspan="1" valign="top">wassen onafhankelijk</td><td colspan="1" rowspan="1" valign="top">ondersteunen bij wassen en/of persoonlijke hygiëne <br/>1 x per dag</td></tr><tr><td colspan="1" rowspan="1" valign="top">probleem met zichzelf kleden</td><td colspan="1" rowspan="1" valign="top">kleden onafhankelijk</td><td colspan="1" rowspan="1" valign="top">ondersteunen bij aankleden <br/>2 x per dag</td></tr><tr><td colspan="1" rowspan="1" valign="top">probleem met lopen</td><td colspan="1" rowspan="1" valign="top">lopen met hulp</td><td colspan="1" rowspan="1" valign="top">patiënt mobiliseren</td></tr><tr><td colspan="1" rowspan="1" valign="top">risico op decubitus</td><td colspan="1" rowspan="1" valign="top">huid blijft intact</td><td colspan="1" rowspan="1" valign="top">wisselen van positie van patiënt</td></tr><tr><td colspan="1" rowspan="1" valign="top">overbelaste mantelzorg</td><td colspan="1" rowspan="1" valign="top">zorgtaken voor echtgenoot worden gecontinueerd</td><td colspan="1" rowspan="1" valign="top">ondersteuning voor verzorger</td></tr></table></div><div><table class="fr-tinymce-table"><tr><td colspan="1" rowspan="1"><table class="fr-tinymce-table" style="width: 604.84375px;"><tr><td colspan="2" rowspan="1"><table class="fr-tinymce-table" style="width: 598.84375px;"><tr><td colspan="1" rowspan="1"> </td></tr></table></td></tr></table></td></tr></table></div> |
|} | |} | ||
=== Zorgsetting=== | === Zorgsetting=== | ||
| Regel 2.332: | Regel 2.244: | ||
|rowspan="12"| | |rowspan="12"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1.5-zorgverlener-01" title="Intern ID = bglz-1.5-zorgverlener-01">Zorgverlener bglz-1.5-zorgverlener-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="10"| | |rowspan="10"| | ||
| Regel 2.363: | Regel 2.275: | ||
|rowspan="15"| | |rowspan="15"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1.5-zorgverlener-02" title="Intern ID = bglz-1.5-zorgverlener-02">Zorgverlener bglz-1.5-zorgverlener-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="13"| | |rowspan="13"| | ||
| Regel 2.392: | Regel 2.304: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Zorgaanbieder | |colspan="3"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgaanbieder-01|Zorgaanbieder: bglz-1.5-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Zorgverleners rol | |colspan="4"|Zorgverleners rol | ||
| Regel 2.401: | Regel 2.313: | ||
|rowspan="40"| | |rowspan="40"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1.5-zorgverlener-03" title="Intern ID = bglz-1.5-zorgverlener-03">Zorgverlener bglz-1.5-zorgverlener-03</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="12"| | |rowspan="12"| | ||
| Regel 2.430: | Regel 2.342: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Zorgaanbieder | |colspan="3"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgaanbieder-01|Zorgaanbieder: bglz-1.5-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1.5-zorgverlener-04" title="Intern ID = bglz-1.5-zorgverlener-04">Zorgverlener bglz-1.5-zorgverlener-04</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="12"| | |rowspan="12"| | ||
| Regel 2.461: | Regel 2.373: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Zorgaanbieder | |colspan="3"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgaanbieder-01|Zorgaanbieder: bglz-1.5-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="bglz-1.5-zorgverlener-05" title="Intern ID = bglz-1.5-zorgverlener-05">Zorgverlener bglz-1.5-zorgverlener-05</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="12"| | |rowspan="12"| | ||
| Regel 2.492: | Regel 2.404: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Zorgaanbieder | |colspan="3"|Zorgaanbieder | ||
| − | |style="background-color: white;"|Zie | + | |style="background-color: white;"|Zie [[#bglz-1.5-zorgaanbieder-01|Zorgaanbieder: bglz-1.5-zorgaanbieder-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|<span id="bglz-1.5-zorgaanbieder-01" title="Intern ID = bglz-1.5-zorgaanbieder-01">Zorgaanbieder bglz-1.5-zorgaanbieder-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="24"| | |rowspan="24"| | ||
| Regel 2.558: | Regel 2.470: | ||
|colspan="5"|Organisatie type | |colspan="5"|Organisatie type | ||
|style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '2.16.840.1.113883.2.4.15.1060') | |style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '2.16.840.1.113883.2.4.15.1060') | ||
| − | |}<section end=BgLZ-3.0-LZB-1.5- | + | |}<section end=BgLZ-3.0-LZB-1.5-v2 /> |
[[Categorie:Kwalificatie]] | [[Categorie:Kwalificatie]] | ||
Versie van 23 jun 2022 10:13
1 Addenda voor inhoudelijke gegevens
1.1 Scenario BgLZ-3.0-LZB-1.1-v1
1.1.1 Demografie en identificatie
| Demografie en identificatie | |||||
| Gegevenselement | Waarde | ||||
| Patient | |||||
| Naamgegevens | |||||
| Voornamen | Fiona | ||||
| Initialen | F. | ||||
| Naamgebruik | Eigen geslachtsnaam (code = 'NL1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.101.5.4') | ||||
| Geslachtsnaam | |||||
| Achternaam | XXX_Mutter | ||||
| Adresgegevens | |||||
| Straat | Knolweg | ||||
| Huisnummer | 1001 | ||||
| Postcode | 9999XX | ||||
| Woonplaats | Stitswerd | ||||
| Land | Nederland (code = '6030' in codeSystem '2.16.840.1.113883.2.4.4.16.34') | ||||
| Adres soort | Postadres (code = 'PST' in codeSystem 'HL7 AddressUse') | ||||
| Contactgegevens | |||||
| Telefoonnummers | |||||
| Telefoonnummer | +31634567891 | ||||
| Telecom type | Mobiel telefoonnummer (code = 'MC' in codeSystem 'HL7 AddressUse') | ||||
| Nummer soort | Telefoonnummer thuis (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Email adressen | |||||
| Email adres | fmutter@hotmail.com | ||||
| Email soort | Privé e-mailadres (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Identificatienummer | 999911673 (in identificerend systeem: BSN) | ||||
| Geboortedatum | 8 feb 1964 | ||||
| Geslacht | Vrouw (code = 'F' in codeSystem 'HL7 AdministrativeGender') | ||||
| Meerling indicator | Nee | ||||
1.1.2 Behandelrestricties
| Behandelrestricties | ||||
| Gegevenselement | Waarde | |||
| Behandel aanwijzing | ||||
| Verificatie | ||||
| Geverifieerd | Ja | |||
| Geverifieerd bij | Patiënt (code = '116154003' in codeSystem 'SNOMED CT') | |||
| Verificatie datum | T | |||
| Behandeling | Cardiopulmonaire resuscitatie (code = '89666000' in codeSystem 'SNOMED CT') | |||
| Behandeling toegestaan | Behandeling niet toegestaan en/of wenselijk (code = 'NEE' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4') | |||
| Begin datum | T | |||
| Wilsverklaring | ||||
| Wilsverklaring | Zie Wilsverklaring: bglz-1-1-wilsverklaring-01 | |||
| Wilsverklaring bglz-1-1-wilsverklaring-01 | ||||
| Wilsverklaring type | Niet reanimeren verklaring (code = 'NR' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.14.1') | |||
| Wilsverklaring datum | T | |||
| Vertegenwoordiger | ||||
| Contactpersoon | Zie Contactpersoon: bglz-1-1-contactpersoon-01 | |||
1.1.3 Contactpersonen
| Contactpersonen | |||||
| Gegevenselement | Waarde | ||||
| Contactpersoon bglz-1-1-contactpersoon-01 | |||||
| Naamgegevens | |||||
| Voornamen | Robert | ||||
| Initialen | R. | ||||
| Naamgebruik | Eigen geslachtsnaam (code = 'NL1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.101.5.4') | ||||
| Geslachtsnaam | |||||
| Achternaam | Prins | ||||
| Contactgegevens | |||||
| Telefoonnummers | |||||
| Telefoonnummer | 06-34567891 | ||||
| Telecom type | Mobiel telefoonnummer (code = 'MC' in codeSystem 'HL7 AddressUse') | ||||
| Nummer soort | Telefoonnummer thuis (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Email adressen | |||||
| Email adres | bprins@123net.nl | ||||
| Email soort | Privé e-mailadres (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Rol | Eerste relatie/contactpersoon (code = '1' in codeSystem '2.16.840.1.113883.2.4.3.11.22.472') | ||||
| Relatie | Zoon (code = 'SONC' in codeSystem 'HL7 RoleCode') | ||||
1.1.4 Klachten en diagnoses
| Klachten en diagnoses | |||
| Gegevenselement | Waarde | ||
| Probleem bglz-1-1-probleem-01 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | ischemisch cerebrovasculair accident (code = '422504002' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| Toelichting | Niet bekend met neurologische klachten | ||
| Probleem bglz-1-1-probleem-02 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | diabetes mellitus (code = '73211009' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T - 14 jaar | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| Probleem bglz-1-1-probleem-03 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | probleem met zichzelf wassen en afdrogen (code = '288552005' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| Probleem bglz-1-1-probleem-04 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | probleem met zichzelf kleden (code = '284972002' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| Probleem bglz-1-1-probleem-05 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | probleem met lopen (code = '228158008' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| Probleem bglz-1-1-probleem-06 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | afasie (code = '87486003' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| Probleem bglz-1-1-probleem-07 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | risico op decubitus (code = '285304000' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| Probleem bglz-1-1-probleem-08 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | overbelaste mantelzorg (code = '705044006' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
1.1.5 Allergieen
| Allergieen | ||||
| Gegevenselement | Waarde | |||
| Allergie intolerantie | ||||
| Veroorzakende stof | pinda (code = '762952008' in codeSystem 'SNOMED CT') | |||
| Allergie status | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||
| Mate van kritiek zijn | Fataal (code = '399166001' in codeSystem 'SNOMED CT') | |||
| Toelichting | Na het eten van pinda's als student ontstond er een klinisch beeld van anafylaxie waarop de HA epipen heeft moeten toedienen | |||
| Reactie | ||||
| Symptoom | Anafylaxie (code = '39579001' in codeSystem 'SNOMED CT') | |||
| Reactie | ||||
| Symptoom | Angio-oedeem (code = '41291007' in codeSystem 'SNOMED CT') | |||
| Reactie beschrijving | Angio-oedeem van de tong, lippen en peri-orbitale regio met acute benauwdheid na het eten van pinda's. | |||
| Allergie intolerantie | ||||
| Veroorzakende stof | nikkelsulfaat (code = '255848005' in codeSystem 'SNOMED CT') | |||
| Allergie status | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||
| Mate van kritiek zijn | Matig (code = '6736007' in codeSystem 'SNOMED CT') | |||
| Toelichting | Opgemerkt bij het dragen van nikkel bevattende sieraden. | |||
| Reactie | ||||
| Symptoom | Contactdermatitis (code = '40275004' in codeSystem 'SNOMED CT') | |||
| Reactie beschrijving | Last van jeuk, roodheid en irritatie op de contactplek van nikkel bevattende sieraden. | |||
1.1.6 Uitslagen
| Uitslagen | ||||
| Gegevenselement | Waarde | |||
| Laboratorium uitslag | ||||
| Laboratorium test | ||||
| Test code | Hemoglobine (code = '718-7' in codeSystem 'LOINC') | |||
| Test datum tijd | T om 15:00 uur | |||
| Test uitslag | 11.0 g/dl | |||
| Referentie bovengrens | 16.0 g/dl | |||
| Referentie ondergrens | 12.0 g/dl | |||
| Interpretatie vlaggen | Onder referentiewaarde (code = '281300000' in codeSystem 'SNOMED CT') | |||
| Laboratorium test | ||||
| Test code | Hematocriet (code = '20570-8' in codeSystem 'LOINC') | |||
| Test datum tijd | T om 15:00 uur | |||
| Test uitslag | 47 % | |||
| Referentie bovengrens | 51 % | |||
| Referentie ondergrens | 39 % | |||
| Onderzoek | hemoglobine & hematocriet panel (code = '24360-0' in codeSystem 'LOINC') | |||
| Laboratorium uitslag | ||||
| Laboratorium test | ||||
| Test code | glucose 2 uur na maaltijd massa/volume serum of plasma (code = '1521-4' in codeSystem 'LOINC') | |||
| Test datum tijd | T om 15:00 uur | |||
| Test uitslag | 5.9 mg/dl | |||
| Referentie bovengrens | 7.8 mg/dl | |||
| Referentie ondergrens | 3.5 mg/dl | |||
| Interpretatie vlaggen | Boven referentiewaarde (code = '281302008' in codeSystem 'SNOMED CT') | |||
| Laboratorium uitslag | ||||
| Laboratorium test | ||||
| Test code | cholesterol:mol/volume:moment:serum of plasma:kwantitatief: (code = '14647-2' in codeSystem 'LOINC') | |||
| Test datum tijd | T om 15:00 uur | |||
| Test uitslag | 5.5 mmol/l | |||
| Referentie bovengrens | 1.8 mmol/l | |||
| Interpretatie vlaggen | Boven referentiewaarde (code = '281302008' in codeSystem 'SNOMED CT') | |||
| Toelichting | Volgens richtlijn herseninfarct: streven naar <1,8mmol/L | |||
1.1.7 Verrichtingen
| Verrichtingen | ||||
| Gegevenselement | Waarde | |||
| Verrichting | ||||
| Verrichting start datum | T | |||
| Verrichting eind datum | T | |||
| Indicatie | ||||
| Probleem | Zie Probleem: bglz-1-1-probleem-01 | |||
| Verrichting type | computertomografie van hersenen (code = '34227000' in codeSystem 'SNOMED CT') | |||
| Locatie | ||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1-1-zorgaanbieder-01 | |||
| Uitvoerder | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-02 | |||
| Aanvrager | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-02 | |||
| Verrichting | ||||
| Verrichting start datum | T | |||
| Verrichting eind datum | T | |||
| Indicatie | ||||
| Probleem | Zie Probleem: bglz-1-1-probleem-01 | |||
| Verrichting type | percutane trombolyse van intracraniële arterie (code = '230935003' in codeSystem 'SNOMED CT') | |||
| Locatie | ||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1-1-zorgaanbieder-01 | |||
| Uitvoerder | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-02 | |||
| Aanvrager | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-02 | |||
| Verrichting | ||||
| Verrichting start datum | T | |||
| Indicatie | ||||
| Probleem | Zie Probleem: bglz-1-1-probleem-05 | |||
| Verrichting type | fysiotherapie (code = '91251008' in codeSystem 'SNOMED CT') | |||
| Locatie | ||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1-1-zorgaanbieder-01 | |||
| Uitvoerder | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-04 | |||
| Aanvrager | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-02 | |||
| Verrichting | ||||
| Verrichting start datum | T | |||
| Indicatie | ||||
| Probleem | Zie Probleem: bglz-1-1-probleem-06 | |||
| Verrichting type | logopedische behandeling (code = '5154007' in codeSystem 'SNOMED CT') | |||
| Locatie | ||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1-1-zorgaanbieder-01 | |||
| Uitvoerder | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-05 | |||
| Aanvrager | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-02 | |||
1.1.8 Verpleegkundig zorgplan
| Verpleegkundig zorgplan | ||||||
| Gegevenselement | Waarde | |||||
| Doelen en interventies | ||||||
| Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-01 | ||||||
| Interventie | ondersteunen bij wassen en/of persoonlijke hygiëne (code = '386420003' in codeSystem 'SNOMED CT') | |||||
| Indicatie | ||||||
| Probleem | Zie Probleem: bglz-1-1-probleem-03 | |||||
| Behandeldoel | ||||||
| Behandeldoel | ||||||
| Gewenst zorgresultaat | wassen onafhankelijk | |||||
| Frequentie | 1 per dag | |||||
| Uitvoerder | ||||||
| Zorgverlener | ||||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-03 | |||||
| Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-02 | ||||||
| Interventie | ondersteunen bij aankleden (code = '313332003' in codeSystem 'SNOMED CT') | |||||
| Indicatie | ||||||
| Probleem | Zie Probleem: bglz-1-1-probleem-04 | |||||
| Behandeldoel | ||||||
| Behandeldoel | ||||||
| Gewenst zorgresultaat | kleden onafhankelijk | |||||
| Frequentie | 2 per dag | |||||
| Uitvoerder | ||||||
| Zorgverlener | ||||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-03 | |||||
| Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-03 | ||||||
| Interventie | patiënt mobiliseren (code = '62013009' in codeSystem 'SNOMED CT') | |||||
| Indicatie | ||||||
| Probleem | Zie Probleem: bglz-1-1-probleem-05 | |||||
| Behandeldoel | ||||||
| Behandeldoel | ||||||
| Gewenst zorgresultaat | lopen met hulp | |||||
| Uitvoerder | ||||||
| Zorgverlener | ||||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-03 | |||||
| Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-04 | ||||||
| Interventie | wisselen van positie van patiënt (code = '225286008' in codeSystem 'SNOMED CT') | |||||
| Indicatie | ||||||
| Probleem | Zie Probleem: bglz-1-1-probleem-07 | |||||
| Behandeldoel | ||||||
| Behandeldoel | ||||||
| Gewenst zorgresultaat | huid blijft intact | |||||
| Uitvoerder | ||||||
| Zorgverlener | ||||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-03 | |||||
| Verpleegkundige interventie bglz-1-1-verpleegkundigeinterventie-05 | ||||||
| Interventie | ondersteuning voor verzorger (code = '386229000' in codeSystem 'SNOMED CT') | |||||
| Indicatie | ||||||
| Probleem | Zie Probleem: bglz-1-1-probleem-08 | |||||
| Behandeldoel | ||||||
| Behandeldoel | ||||||
| Gewenst zorgresultaat | zorgtaken voor echtgenoot worden gecontinueerd | |||||
| Uitvoerder | ||||||
| Zorgverlener | ||||||
| Zorgverlener | Zie Zorgverlener: bglz-1-1-zorgverlener-03 | |||||
| Uitkomsten | ||||||
| Uitkomst van zorg | ||||||
| Zorgresultaat | Wassen met hulp. | |||||
| Interventie | ||||||
| Verpleegkundige interventie | Zie Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-01 | |||||
| Uitkomst van zorg | ||||||
| Zorgresultaat | Kleden met hulp. | |||||
| Interventie | ||||||
| Verpleegkundige interventie | Zie Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-02 | |||||
| Uitkomst van zorg | ||||||
| Zorgresultaat | Lopen geheel afhankelijk. | |||||
| Interventie | ||||||
| Verpleegkundige interventie | Zie Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-03 | |||||
| Uitkomst van zorg | ||||||
| Zorgresultaat | Huid is intact zonder decubitus wonden. | |||||
| Interventie | ||||||
| Verpleegkundige interventie | Zie Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-04 | |||||
| Uitkomst van zorg | ||||||
| Zorgresultaat | Thuiszorg is aangevraagd voor continuering van zorgtaken en huishoudelijke hulp. | |||||
| Interventie | ||||||
| Verpleegkundige interventie | Zie Verpleegkundige interventie: bglz-1-1-verpleegkundigeinterventie-05 | |||||
1.1.9 Zorgsetting
| Zorgsetting | ||||||
| Gegevenselement | Waarde | |||||
| Huisarts | ||||||
| Zorgverlener bglz-1-1-zorgverlener-01 | ||||||
| Naamgegevens | ||||||
| Voornamen | Laura | |||||
| Initialen | L. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Lanen | |||||
| Specialisme | Huisarts (code = '01.015' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgverleners rol | Verwijzer (code = 'REF' in codeSystem 'HL7 ParticipationType') | |||||
| Hoofdbehandelaar | ||||||
| Zorgverlener bglz-1-1-zorgverlener-02 | ||||||
| Naamgegevens | ||||||
| Voornamen | Niels | |||||
| Initialen | N. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Helmond | |||||
| Specialisme | Neuroloog (code = '01.026' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgaanbieder | ||||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1-1-zorgaanbieder-01 | |||||
| Zorgverleners rol | Hoofdbehandelaar (code = 'RESP' in codeSystem 'HL7 ParticipationType') | |||||
| Overige behandelaars | ||||||
| Zorgverlener bglz-1-1-zorgverlener-03 | ||||||
| Naamgegevens | ||||||
| Voornamen | Petra Johanna | |||||
| Initialen | P.J. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Vreeswijk | |||||
| Specialisme | Verpleegkundige (code = '30.000' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgaanbieder | ||||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1-1-zorgaanbieder-01 | |||||
| Zorgverlener bglz-1-1-zorgverlener-04 | ||||||
| Naamgegevens | ||||||
| Voornamen | Thomas | |||||
| Initialen | T. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Janssen | |||||
| Specialisme | Fysiotherapeut (code = '04.000' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgaanbieder | ||||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1-1-zorgaanbieder-01 | |||||
| Zorgverlener bglz-1-1-zorgverlener-05 | ||||||
| Naamgegevens | ||||||
| Voornamen | Hilda | |||||
| Initialen | H. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Bruinsma | |||||
| Specialisme | Logopedist (code = '91.000' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgaanbieder | ||||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1-1-zorgaanbieder-01 | |||||
| Zorgaanbieder bglz-1-1-zorgaanbieder-01 | ||||||
| Organisatie naam | AA-zkh | |||||
| Organisatie locatie | Noord | |||||
| Afdeling specialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT (Vektis Zorgverlenersspecificatie (subberoepsgroep))') | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +31182435768 | |||||
| Telecom type | Vast telefoonnummer (code = 'LL' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.22.1') | |||||
| Nummer soort | Zakelijk telefoonnummer (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||
| Email adressen | ||||||
| Email adres | neurologie@AAZ.nl | |||||
| Email soort | Zakelijk e-mailadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||
| Adresgegevens | ||||||
| Straat | De Weststraat | |||||
| Huisnummer | 3 | |||||
| Postcode | 9999PK | |||||
| Woonplaats | Stitswerd | |||||
| Land | Nederland (code = '6030' in codeSystem '2.16.840.1.113883.2.4.4.16.34') | |||||
| Adres soort | Werkadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||
| Organisatie type | Algemeen ziekenhuis (code = 'V6' in codeSystem '2.16.840.1.113883.2.4.15.1060') | |||||
1.2 Scenario BgLZ-3.0-LZB-1.2-v1
1.2.1 Demografie en identificatie
| Demografie en identificatie | |||||
| Gegevenselement | Waarde | ||||
| Patient | |||||
| Naamgegevens | |||||
| Voornamen | Gea | ||||
| Initialen | G. | ||||
| Naamgebruik | Eigen geslachtsnaam (code = 'NL1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.101.5.4') | ||||
| Geslachtsnaam | |||||
| Achternaam | XXX_Valk | ||||
| Adresgegevens | |||||
| Straat | Knolweg | ||||
| Huisnummer | 1003 | ||||
| Postcode | 9999ZA | ||||
| Woonplaats | Stitswerd | ||||
| Land | Nederland (code = '6030' in codeSystem '2.16.840.1.113883.2.4.4.16.34') | ||||
| Adres soort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | ||||
| Contactgegevens | |||||
| Telefoonnummers | |||||
| Telefoonnummer | +31645678912 | ||||
| Telecom type | Mobiel telefoonnummer (code = 'MC' in codeSystem 'HL7 AddressUse') | ||||
| Nummer soort | Telefoonnummer thuis (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Email adressen | |||||
| Email adres | gvalk@hotmail.com | ||||
| Email soort | Privé e-mailadres (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Identificatienummer | 999911697 (in identificerend systeem: BSN) | ||||
| Geboortedatum | 8 feb 1964 | ||||
| Geslacht | Vrouw (code = 'F' in codeSystem 'HL7 AdministrativeGender') | ||||
| Meerling indicator | Ja | ||||
1.3 Scenario BgLZ-3.0-LZB-1.3-v1
1.3.1 Demografie en identificatie
| Demografie en identificatie | |||||
| Gegevenselement | Waarde | ||||
| Patient | |||||
| Naamgegevens | |||||
| Voornamen | Fiona | ||||
| Initialen | F. | ||||
| Naamgebruik | Eigen geslachtsnaam (code = 'NL1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.101.5.4') | ||||
| Geslachtsnaam | |||||
| Achternaam | XXX_Mutter | ||||
| Adresgegevens | |||||
| Straat | Knolweg | ||||
| Huisnummer | 1001 | ||||
| Postcode | 9999XX | ||||
| Woonplaats | Stitswerd | ||||
| Land | Nederland (code = '6030' in codeSystem '2.16.840.1.113883.2.4.4.16.34') | ||||
| Adres soort | Postadres (code = 'PST' in codeSystem 'HL7 AddressUse') | ||||
| Contactgegevens | |||||
| Telefoonnummers | |||||
| Telefoonnummer | +31634567891 | ||||
| Telecom type | Mobiel telefoonnummer (code = 'MC' in codeSystem 'HL7 AddressUse') | ||||
| Nummer soort | Telefoonnummer thuis (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Email adressen | |||||
| Email adres | fmutter@hotmail.com | ||||
| Email soort | Privé e-mailadres (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Identificatienummer | 999911673 (in identificerend systeem: BSN) | ||||
| Geboortedatum | 8 feb 1964 | ||||
| Geslacht | Vrouw (code = 'F' in codeSystem 'HL7 AdministrativeGender') | ||||
| Meerling indicator | Nee | ||||
1.3.2 Klachten en diagnoses
| Klachten en diagnoses | |||
| Gegevenselement | Waarde | ||
| Probleem bglz-1-3-probleem-01 | |||
| Probleem anatomische locatie | hiel (code = '76853006' in codeSystem 'SNOMED CT') | ||
| Probleem lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | ||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | decubitus (code = '399912005' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T + 1 maand | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
1.3.3 Uitslagen
| Uitslagen | ||||
| Gegevenselement | Waarde | |||
| Laboratorium uitslag | ||||
| Laboratorium test | ||||
| Test code | cholesterol:mol/volume:moment:serum of plasma:kwantitatief: (code = '14647-2' in codeSystem 'LOINC') | |||
| Test datum tijd | T om 15:00 uur | |||
| Test uitslag | 5.5 mmol/l | |||
| Referentie bovengrens | 1.8 mmol/l | |||
| Interpretatie vlaggen | Boven referentiewaarde (code = '281302008' in codeSystem 'SNOMED CT') | |||
| Toelichting | Volgens richtlijn herseninfarct: streven naar <1,8mmol/L | |||
| Laboratorium uitslag | ||||
| Laboratorium test | ||||
| Test code | cholesterol:mol/volume:moment:serum of plasma:kwantitatief: (code = '14647-2' in codeSystem 'LOINC') | |||
| Test datum tijd | T + 1 maand om 16:00 uur | |||
| Test uitslag | 1.7 mmol/l | |||
| Referentie bovengrens | 1.8 mmol/l | |||
| Interpretatie vlaggen | Onder referentiewaarde (code = '281300000' in codeSystem 'SNOMED CT') | |||
| Toelichting | Volgens richtlijn herseninfarct: streven naar <1,8mmol/L | |||
1.3.4 Verpleegkundig zorgplan
| Verpleegkundig zorgplan | |||||||
| Gegevenselement | Waarde | ||||||
| Doelen en interventies | |||||||
| Verpleegkundige interventie bglz-1-3-verpleegkundigeinterventie-01 | |||||||
| Interventie | aanleggen van verband op wond (code = '182531007' in codeSystem 'SNOMED CT') | ||||||
| Indicatie | |||||||
| Probleem | Zie Probleem: bglz-1-3-probleem-01 | ||||||
| Frequentie | 1 per dag | ||||||
| Medisch hulpmiddel | |||||||
| Medisch hulpmiddel | |||||||
| Product | |||||||
| Product type | schuimverband (code = '448416005' in codeSystem 'SNOMED CT') | ||||||
| Anatomische locatie | hiel (code = '76853006' in codeSystem 'SNOMED CT') | ||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | ||||||
| Medisch hulpmiddel | |||||||
| Medisch hulpmiddel | |||||||
| Product | |||||||
| Product type | huidvervangende wondbedekkers (code = '465239008' in codeSystem 'SNOMED CT') | ||||||
| Anatomische locatie | hiel (code = '76853006' in codeSystem 'SNOMED CT') | ||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | ||||||
| Uitkomsten | |||||||
| Uitkomst van zorg | |||||||
| Zorgresultaat | Decubituswond is verbeterd van categorie 2 naar 1. | ||||||
| Interventie | |||||||
| Verpleegkundige interventie | Zie Verpleegkundige interventie: bglz-1-3-verpleegkundigeinterventie-01 | ||||||
2 Release notes
Je vindt de release notes bij Functioneel ontwerp
2.1 Scenario BgLZ-3.0-LZB-1.5-v1
2.1.1 Demografie en identificatie
| Demografie en identificatie | |||||
| Gegevenselement | Waarde | ||||
| Patient | |||||
| Naamgegevens | |||||
| Voornamen | Fiona | ||||
| Initialen | F. | ||||
| Naamgebruik | Eigen geslachtsnaam (code = 'NL1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.101.5.4') | ||||
| Geslachtsnaam | |||||
| Achternaam | XXX_Mutter | ||||
| Adresgegevens | |||||
| Straat | Knolweg | ||||
| Huisnummer | 1001 | ||||
| Postcode | 9999XX | ||||
| Woonplaats | Stitswerd | ||||
| Land | Nederland (code = '6030' in codeSystem '2.16.840.1.113883.2.4.4.16.34') | ||||
| Adres soort | Postadres (code = 'PST' in codeSystem 'HL7 AddressUse') | ||||
| Contactgegevens | |||||
| Telefoonnummers | |||||
| Telefoonnummer | +31634567891 | ||||
| Telecom type | Mobiel telefoonnummer (code = 'MC' in codeSystem 'HL7 AddressUse') | ||||
| Nummer soort | Telefoonnummer thuis (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Email adressen | |||||
| Email adres | fmutter@hotmail.com | ||||
| Email soort | Privé e-mailadres (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Identificatienummer | 999911673 (in identificerend systeem: BSN) | ||||
| Geboortedatum | 8 feb 1964 | ||||
| Geslacht | Vrouw (code = 'F' in codeSystem 'HL7 AdministrativeGender') | ||||
| Meerling indicator | Nee | ||||
2.1.2 Behandelrestricties
| Behandelrestricties | ||||
| Gegevenselement | Waarde | |||
| Behandel aanwijzing | ||||
| Verificatie | ||||
| Geverifieerd | Ja | |||
| Geverifieerd bij | Patiënt (code = '116154003' in codeSystem 'SNOMED CT') | |||
| Verificatie datum | T | |||
| Behandeling | Cardiopulmonaire resuscitatie (code = '89666000' in codeSystem 'SNOMED CT') | |||
| Behandeling toegestaan | Behandeling niet toegestaan en/of wenselijk (code = 'NEE' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4') | |||
| Begin datum | T | |||
| Wilsverklaring | ||||
| Wilsverklaring | Zie Wilsverklaring: bglz-1.5-wilsverklaring-01 | |||
| Wilsverklaring bglz-1.5-wilsverklaring-01 | ||||
| Wilsverklaring type | Niet reanimeren verklaring (code = 'NR' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.14.1') | |||
| Wilsverklaring datum | T | |||
| Vertegenwoordiger | ||||
| Contactpersoon | Zie Contactpersoon: bglz-1.5-contactpersoon-01 | |||
2.1.3 Contactpersonen
| Contactpersonen | |||||
| Gegevenselement | Waarde | ||||
| Contactpersoon bglz-1.5-contactpersoon-01 | |||||
| Naamgegevens | |||||
| Voornamen | Robert | ||||
| Initialen | R. | ||||
| Naamgebruik | Eigen geslachtsnaam (code = 'NL1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.101.5.4') | ||||
| Geslachtsnaam | |||||
| Achternaam | Prins | ||||
| Contactgegevens | |||||
| Telefoonnummers | |||||
| Telefoonnummer | 06-34567891 | ||||
| Telecom type | Mobiel telefoonnummer (code = 'MC' in codeSystem 'HL7 AddressUse') | ||||
| Nummer soort | Telefoonnummer thuis (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Email adressen | |||||
| Email adres | bprins@123net.nl | ||||
| Email soort | Privé e-mailadres (code = 'HP' in codeSystem 'HL7 AddressUse') | ||||
| Rol | Eerste relatie/contactpersoon (code = '1' in codeSystem '2.16.840.1.113883.2.4.3.11.22.472') | ||||
| Relatie | Zoon (code = 'SONC' in codeSystem 'HL7 RoleCode') | ||||
2.1.4 Klachten en diagnoses
| Klachten en diagnoses | |||
| Gegevenselement | Waarde | ||
| Probleem bglz-1.5-probleem-01 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | ischemisch cerebrovasculair accident (code = '422504002' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| Toelichting | Niet bekend met neurologische klachten | ||
| Probleem bglz-1.5-probleem-02 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | diabetes mellitus (code = '73211009' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T - 14 jaar | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
| Probleem bglz-1.5-probleem-06 | |||
| Probleem type | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | ||
| Probleem naam | afasie (code = '87486003' in codeSystem 'SNOMED CT') | ||
| Probleem begin datum | T | ||
| Probleem status | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||
2.1.5 Allergieen
| Allergieen | ||||
| Gegevenselement | Waarde | |||
| Allergie intolerantie | ||||
| Veroorzakende stof | pinda (code = '762952008' in codeSystem 'SNOMED CT') | |||
| Allergie status | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||
| Mate van kritiek zijn | Fataal (code = '399166001' in codeSystem 'SNOMED CT') | |||
| Toelichting | Na het eten van pinda's als student ontstond er een klinisch beeld van anafylaxie waarop de HA epipen heeft moeten toedienen | |||
| Reactie | ||||
| Symptoom | Anafylaxie (code = '39579001' in codeSystem 'SNOMED CT') | |||
| Reactie | ||||
| Symptoom | Angio-oedeem (code = '41291007' in codeSystem 'SNOMED CT') | |||
| Reactie beschrijving | Angio-oedeem van de tong, lippen en peri-orbitale regio met acute benauwdheid na het eten van pinda's. | |||
| Allergie intolerantie | ||||
| Veroorzakende stof | nikkelsulfaat (code = '255848005' in codeSystem 'SNOMED CT') | |||
| Allergie status | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||
| Mate van kritiek zijn | Matig (code = '6736007' in codeSystem 'SNOMED CT') | |||
| Toelichting | Opgemerkt bij het dragen van nikkel bevattende sieraden. | |||
| Reactie | ||||
| Symptoom | Contactdermatitis (code = '40275004' in codeSystem 'SNOMED CT') | |||
| Reactie beschrijving | Last van jeuk, roodheid en irritatie op de contactplek van nikkel bevattende sieraden. | |||
2.1.6 Uitslagen
| Uitslagen | ||||
| Gegevenselement | Waarde | |||
| Laboratorium uitslag | ||||
| Laboratorium test | ||||
| Test code | Hemoglobine (code = '718-7' in codeSystem 'LOINC') | |||
| Test datum tijd | T om 15:00 uur | |||
| Test uitslag | 11.0 g/dl | |||
| Referentie bovengrens | 16.0 g/dl | |||
| Referentie ondergrens | 12.0 g/dl | |||
| Interpretatie vlaggen | Onder referentiewaarde (code = '281300000' in codeSystem 'SNOMED CT') | |||
| Laboratorium test | ||||
| Test code | Hematocriet (code = '20570-8' in codeSystem 'LOINC') | |||
| Test datum tijd | T om 15:00 uur | |||
| Test uitslag | 47 % | |||
| Referentie bovengrens | 51 % | |||
| Referentie ondergrens | 39 % | |||
| Onderzoek | hemoglobine & hematocriet panel (code = '24360-0' in codeSystem 'LOINC') | |||
| Laboratorium uitslag | ||||
| Laboratorium test | ||||
| Test code | glucose 2 uur na maaltijd massa/volume serum of plasma (code = '1521-4' in codeSystem 'LOINC') | |||
| Test datum tijd | T om 15:00 uur | |||
| Test uitslag | 5.9 mg/dl | |||
| Referentie bovengrens | 7.8 mg/dl | |||
| Referentie ondergrens | 3.5 mg/dl | |||
| Interpretatie vlaggen | Boven referentiewaarde (code = '281302008' in codeSystem 'SNOMED CT') | |||
| Laboratorium uitslag | ||||
| Laboratorium test | ||||
| Test code | cholesterol:mol/volume:moment:serum of plasma:kwantitatief: (code = '14647-2' in codeSystem 'LOINC') | |||
| Test datum tijd | T om 15:00 uur | |||
| Test uitslag | 5.5 mmol/l | |||
| Referentie bovengrens | 1.8 mmol/l | |||
| Interpretatie vlaggen | Boven referentiewaarde (code = '281302008' in codeSystem 'SNOMED CT') | |||
| Toelichting | Volgens richtlijn herseninfarct: streven naar <1,8mmol/L | |||
2.1.7 Verrichtingen
| Verrichtingen | ||||
| Gegevenselement | Waarde | |||
| Verrichting | ||||
| Verrichting start datum | T | |||
| Verrichting eind datum | T | |||
| Indicatie | ||||
| Probleem | Zie Probleem: bglz-1.5-probleem-01 | |||
| Verrichting type | computertomografie van hersenen (code = '34227000' in codeSystem 'SNOMED CT') | |||
| Locatie | ||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1.5-zorgaanbieder-01 | |||
| Uitvoerder | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1.5-zorgverlener-02 | |||
| Aanvrager | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1.5-zorgverlener-02 | |||
| Verrichting | ||||
| Verrichting start datum | T | |||
| Verrichting eind datum | T | |||
| Indicatie | ||||
| Probleem | Zie Probleem: bglz-1.5-probleem-01 | |||
| Verrichting type | percutane trombolyse van intracraniële arterie (code = '230935003' in codeSystem 'SNOMED CT') | |||
| Locatie | ||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1.5-zorgaanbieder-01 | |||
| Uitvoerder | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1.5-zorgverlener-02 | |||
| Aanvrager | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1.5-zorgverlener-02 | |||
| Verrichting | ||||
| Verrichting start datum | T | |||
| Verrichting type | fysiotherapie (code = '91251008' in codeSystem 'SNOMED CT') | |||
| Locatie | ||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1.5-zorgaanbieder-01 | |||
| Uitvoerder | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1.5-zorgverlener-04 | |||
| Aanvrager | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1.5-zorgverlener-02 | |||
| Verrichting | ||||
| Verrichting start datum | T | |||
| Indicatie | ||||
| Probleem | Zie Probleem: bglz-1.5-probleem-06 | |||
| Verrichting type | logopedische behandeling (code = '5154007' in codeSystem 'SNOMED CT') | |||
| Locatie | ||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1.5-zorgaanbieder-01 | |||
| Uitvoerder | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1.5-zorgverlener-05 | |||
| Aanvrager | ||||
| Zorgverlener | Zie Zorgverlener: bglz-1.5-zorgverlener-02 | |||
2.1.8 Verpleegkundig zorgplan
| Verpleegkundig zorgplan | ||||||||||||||||||||||||
| Gegevenselement | Waarde | |||||||||||||||||||||||
| Verpleegkundig zorgplan ongestructureerd | Verpleegkundig zorgplan in opgemaakte tekst. Onderstaande is een voorbeeld. Het hoeft niet letterlijk te worden overgenomen.
| |||||||||||||||||||||||
2.1.9 Zorgsetting
| Zorgsetting | ||||||
| Gegevenselement | Waarde | |||||
| Huisarts | ||||||
| Zorgverlener bglz-1.5-zorgverlener-01 | ||||||
| Naamgegevens | ||||||
| Voornamen | Laura | |||||
| Initialen | L. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Lanen | |||||
| Specialisme | Huisarts (code = '01.015' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgverleners rol | Verwijzer (code = 'REF' in codeSystem 'HL7 ParticipationType') | |||||
| Hoofdbehandelaar | ||||||
| Zorgverlener bglz-1.5-zorgverlener-02 | ||||||
| Naamgegevens | ||||||
| Voornamen | Niels | |||||
| Initialen | N. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Helmond | |||||
| Specialisme | Neuroloog (code = '01.026' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgaanbieder | ||||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1.5-zorgaanbieder-01 | |||||
| Zorgverleners rol | Hoofdbehandelaar (code = 'RESP' in codeSystem 'HL7 ParticipationType') | |||||
| Overige behandelaars | ||||||
| Zorgverlener bglz-1.5-zorgverlener-03 | ||||||
| Naamgegevens | ||||||
| Voornamen | Petra Johanna | |||||
| Initialen | P.J. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Vreeswijk | |||||
| Specialisme | Verpleegkundige (code = '30.000' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgaanbieder | ||||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1.5-zorgaanbieder-01 | |||||
| Zorgverlener bglz-1.5-zorgverlener-04 | ||||||
| Naamgegevens | ||||||
| Voornamen | Thomas | |||||
| Initialen | T. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Janssen | |||||
| Specialisme | Fysiotherapeut (code = '04.000' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgaanbieder | ||||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1.5-zorgaanbieder-01 | |||||
| Zorgverlener bglz-1.5-zorgverlener-05 | ||||||
| Naamgegevens | ||||||
| Voornamen | Hilda | |||||
| Initialen | H. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Bruinsma | |||||
| Specialisme | Logopedist (code = '91.000' in codeSystem 'RoleCodeNL - zorgverlenertype (personen)') | |||||
| Zorgaanbieder | ||||||
| Zorgaanbieder | Zie Zorgaanbieder: bglz-1.5-zorgaanbieder-01 | |||||
| Zorgaanbieder bglz-1.5-zorgaanbieder-01 | ||||||
| Organisatie naam | AA-zkh | |||||
| Organisatie locatie | Noord | |||||
| Afdeling specialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT (Vektis Zorgverlenersspecificatie (subberoepsgroep))') | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +31182435768 | |||||
| Telecom type | Vast telefoonnummer (code = 'LL' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.22.1') | |||||
| Nummer soort | Zakelijk telefoonnummer (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||
| Email adressen | ||||||
| Email adres | neurologie@AAZ.nl | |||||
| Email soort | Zakelijk e-mailadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||
| Adresgegevens | ||||||
| Straat | De Weststraat | |||||
| Huisnummer | 3 | |||||
| Postcode | 9999PK | |||||
| Woonplaats | Stitswerd | |||||
| Land | Nederland (code = '6030' in codeSystem '2.16.840.1.113883.2.4.4.16.34') | |||||
| Adres soort | Werkadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||
| Organisatie type | Algemeen ziekenhuis (code = 'V6' in codeSystem '2.16.840.1.113883.2.4.15.1060') | |||||