vpk:Vprepub-4.0 Testgegevens eOverdracht Aanmeldbericht addendum: verschil tussen versies

Uit informatiestandaarden
Naar navigatie springen Naar zoeken springen
(Tekst vervangen door " Deze wiki-pagina is in voorbereiding.")
Regel 1: Regel 1:
  
__NUMBEREDHEADINGS__
+
Deze wiki-pagina is in voorbereiding.
{{DISPLAYTITLE:e-overdracht: addendum inhoudelijke gegevens aanmeldbericht '''[dit laatste nog toe laten voegen]'''}}
 
 
 
=Addenda voor inhoudelijke gegevens=
 
<section begin=eovd-saa-tst-1.1-alle_zibs />
 
==Aanmeldbericht==
 
 
 
=== Administratieve gegevens===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="7" | Administratieve gegevens
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="6" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="6"|Datum overplaatsing
 
|style="background-color: white;"|T + 1 dag
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Persoonsgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="47"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patient
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="18"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Naamgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="6"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Voornamen
 
|style="background-color: white;"|Erik
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Initialen
 
|style="background-color: white;"|E
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Geslachtsnaam
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Achternaam
 
|style="background-color: white;"|XXX_Altenborg
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Adresgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="6"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Straat
 
|style="background-color: white;"|Knolweg
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Huisnummer
 
|style="background-color: white;"|1000
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Postcode
 
|style="background-color: white;"|9999XA
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Woonplaats
 
|style="background-color: white;"|Stitswerd
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Adres soort
 
|style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Identificatienummer
 
|style="background-color: white;"|999911612 (in identificerend systeem: BSN)
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Geboortedatum
 
|style="background-color: white;"|14 aug 1964
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Geslacht
 
|style="background-color: white;"|Man (code = 'M' in codeSystem 'HL7 AdministrativeGender')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Betaler
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verzekeraar
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Verzekering
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Eind datum tijd
 
|style="background-color: white;"|T + 1 jaar
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Verzekeringssoort
 
|style="background-color: white;"|Basis (code = 'B' in codeSystem '2.16.840.1.113883.2.4.3.11.60.101.5.1')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Contactpersoon
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="18"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Naamgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Voornamen
 
|style="background-color: white;"|Johanna
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Initialen
 
|style="background-color: white;"|J
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Roepnaam
 
|style="background-color: white;"|Hanna
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Geslachtsnaam
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Achternaam
 
|style="background-color: white;"|Bakker
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Contactgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Telefoonnummers
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Telefoonnummer
 
|style="background-color: white;"|+31645678912
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Email adressen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Email adres
 
|style="background-color: white;"|jbakker@123net.nl
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Relatie
 
|style="background-color: white;"|Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): achterneef
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Sturende organisatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="16"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Zorgaanbieder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="14"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Zorgaanbieder identificatienummer
 
|style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z)
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie naam
 
|style="background-color: white;"|AB-zkh
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie locatie
 
|style="background-color: white;"|Noord
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Afdeling specialisme
 
|style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Vektis Zorgverlenersspecificatie (subberoepsgroep)')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Contactgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Telefoonnummers
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Telefoonnummer
 
|style="background-color: white;"|+31182435770
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Email adressen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Email adres
 
|style="background-color: white;"|neurologie@ABZ.nl
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie type
 
|style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '2.16.840.1.113883.2.4.15.1060')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Ontvangende organisatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Zorgaanbieder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Afdeling specialisme
 
|style="background-color: white;"|Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT Vektis Zorgverlenersspecificatie (subberoepsgroep)')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie type
 
|style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '2.16.840.1.113883.2.4.15.1060')
 
|}
 
=== Algemene patienten context===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="5" | Algemene patienten context
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="4" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Juridische situatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|<span id="tst-1.1-juridischesituatie-01" title="Intern ID = tst-1.1-juridischesituatie-01">Juridische situatie tst-1.1-juridischesituatie-01</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Vertegenwoordiging
 
|style="background-color: white;"|Onder curatele stelling (code = '9' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Datum aanvang
 
|style="background-color: white;"|T - 1 jaar
 
|}
 
=== Medische context===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="5" | Medische context
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="4" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Medische diagnose
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="18"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="4"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|ischemisch cerebrovasculair (code = '422504002' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Toelichting
 
|style="background-color: white;"|niet bekend met neurologische klachten
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|neoplasma van colon (code = '126838000')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|oksel (code = '238600001' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|inverse psoriasis (code = '238600001')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Voorgeschiedenis
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|diabetes mellitus (code = '73211009')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Let op
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Alert
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Alert naam
 
|style="background-color: white;"|Drager MRSA (code = '432415000' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Alert
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Alert naam
 
|style="background-color: white;"|Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): ernstige claustrofobie
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Vrijheidsbeperking
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="9"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Vrijheidsbeperkende interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Wilsbekwaam
 
|style="background-color: white;"|Ja
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Juridische situatie
 
|style="background-color: white;"|Zie [[#tst-1.1-juridischesituatie-01|Juridische situatie: tst-1.1-juridischesituatie-01]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Soort interventie
 
|style="background-color: white;"|geforceerd toedienen van voeding bij patiënt (code = '37041007' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Reden van toepassen
 
|style="background-color: white;"|bevorderen van fysieke gezondheid (code = '121581000146106' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Instemming
 
|style="background-color: white;"|Instemming patiënt (code = '2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Begin
 
|style="background-color: white;"|T - 50 dagen
 
|}
 
=== Verpleegkundige context zorgplan===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="7" | Verpleegkundige context zorgplan
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="6" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Actuele patientproblemen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="64"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patientprobleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="15"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|<span id="tst-1.1-patientprobleem-01" title="Intern ID = tst-1.1-patientprobleem-01">Probleem tst-1.1-patientprobleem-01</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="4"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem naam
 
|style="background-color: white;"|probleem met zichzelf wassen (code = '288552005' in codeSystem 'Referentieset Nationale kernset patientproblemen')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Toelichting
 
|style="background-color: white;"|meneer kan niet buigen
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="8"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|ondersteunen bij wassen en/of persoonlijke hygiëne (code = '386420003' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#tst-1.1-patientprobleem-01|Probleem: tst-1.1-patientprobleem-01]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Uitvoerder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Zorgverlener
 
|style="background-color: white;"|Ja
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patientprobleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="11"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|<span id="tst-1.1-patientprobleem-02" title="Intern ID = tst-1.1-patientprobleem-02">Probleem tst-1.1-patientprobleem-02</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem naam
 
|style="background-color: white;"|probleem met zichzelf kleden (code = '284972002' in codeSystem 'Referentieset Nationale kernset patientproblemen')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|ondersteunen bij aankleden (code = '313332003' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#tst-1.1-patientprobleem-02|Probleem: tst-1.1-patientprobleem-02]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patientprobleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="22"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|<span id="tst-1.1-patientprobleem-03" title="Intern ID = tst-1.1-patientprobleem-03">Probleem tst-1.1-patientprobleem-03</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem naam
 
|style="background-color: white;"|decubitus (code = '399912005' in codeSystem 'Referentieset Nationale kernset patientproblemen')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|aanleggen van verband op wond (code = '182531007' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#tst-1.1-patientprobleem-03|Probleem: tst-1.1-patientprobleem-03]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="10"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|wisselen van positie van patiënt (code = '225286008' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#tst-1.1-patientprobleem-03|Probleem: tst-1.1-patientprobleem-03]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Actie start datum tijd
 
|style="background-color: white;"|T - 10 dagen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Actie eind datum tijd
 
|style="background-color: white;"|T - 1 dag
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Uitvoerder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Zorgverlener
 
|style="background-color: white;"|Ja
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patientprobleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="11"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|<span id="tst-1.1-patientprobleem-04" title="Intern ID = tst-1.1-patientprobleem-04">Probleem tst-1.1-patientprobleem-04</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem naam
 
|style="background-color: white;"|loopt risico op delier (code = '430794006' in codeSystem 'Referentieset Nationale kernset patientproblemen')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|bevorderen van vochtinname (code = '113148007' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#tst-1.1-patientprobleem-04|Probleem: tst-1.1-patientprobleem-04]]
 
|}
 
=== Verpleegkundige context specificatie gezondheidstoestand===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="8" | Verpleegkundige context specificatie gezondheidstoestand
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="7" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="8"|Voedingvocht
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="32"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Sonde systeem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="9"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Sonde
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Medisch hulpmiddel
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Product
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Product type
 
|style="background-color: white;"|PEJ sonde (code = '8911000146104' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Product omschrijving
 
|style="background-color: white;"|PEJ sonde
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Infuus
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="10"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Infuuskatheter
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Medisch hulpmiddel
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Product
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Product type
 
|style="background-color: white;"|Centraal veneuze katheter (code = '52124006' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Product omschrijving
 
|style="background-color: white;"|centraal veneuze katheter
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="5"|Toelichting
 
|style="background-color: white;"|voor voeding
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Infuus
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="9"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Infuuskatheter
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Medisch hulpmiddel
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Product
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Product type
 
|style="background-color: white;"|Perifeer intraveneus infuus (code = '82449006' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Product omschrijving
 
|style="background-color: white;"|voor medicatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="8"|Uitscheiding
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="8"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Stoma
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="5"|Stoma type
 
|style="background-color: white;"|eindstandige ileostoma (code = '311412005' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="5"|Toelichting
 
|style="background-color: white;"|na subtotale darmresectie
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Stoma
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="5"|Stoma type
 
|style="background-color: white;"|urostoma (code = '281601009' in codeSystem 'SNOMED CT')
 
|}<section end=eovd-saa-tst-1.1-alle_zibs />
 
<section begin=eovd-saa-tst-1.1b-alle_zibs />
 
==Aanmeldbericht - overlap BgZ==
 
 
 
=== Administratieve gegevens===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="7" | Administratieve gegevens
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="6" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="6"|Datum overplaatsing
 
|style="background-color: white;"|T + 1 dag
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Persoonsgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="47"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patient
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="18"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Naamgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="6"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Voornamen
 
|style="background-color: white;"|Erik
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Initialen
 
|style="background-color: white;"|E
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Geslachtsnaam
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Achternaam
 
|style="background-color: white;"|XXX_Altenborg
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Adresgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="6"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Straat
 
|style="background-color: white;"|Knolweg
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Huisnummer
 
|style="background-color: white;"|1000
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Postcode
 
|style="background-color: white;"|9999XA
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Woonplaats
 
|style="background-color: white;"|Stitswerd
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Adres soort
 
|style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Identificatienummer
 
|style="background-color: white;"|999911612 (in identificerend systeem: BSN)
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Geboortedatum
 
|style="background-color: white;"|14 aug 1964
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Geslacht
 
|style="background-color: white;"|Man (code = 'M' in codeSystem 'HL7 AdministrativeGender')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Betaler
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verzekeraar
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Verzekering
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Eind datum tijd
 
|style="background-color: white;"|T + 1 jaar
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Verzekeringssoort
 
|style="background-color: white;"|Basis (code = 'B' in codeSystem '2.16.840.1.113883.2.4.3.11.60.101.5.1')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Contactpersoon
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="18"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Naamgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Voornamen
 
|style="background-color: white;"|Johanna
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Initialen
 
|style="background-color: white;"|J
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Roepnaam
 
|style="background-color: white;"|Hanna
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Geslachtsnaam
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Achternaam
 
|style="background-color: white;"|Bakker
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Contactgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Telefoonnummers
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Telefoonnummer
 
|style="background-color: white;"|+31645678912
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Email adressen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Email adres
 
|style="background-color: white;"|jbakker@123net.nl
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Relatie
 
|style="background-color: white;"|Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): achterneef
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Sturende organisatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="16"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Zorgaanbieder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="14"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Zorgaanbieder identificatienummer
 
|style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z)
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie naam
 
|style="background-color: white;"|AB-zkh
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie locatie
 
|style="background-color: white;"|Noord
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Afdeling specialisme
 
|style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Vektis Zorgverlenersspecificatie (subberoepsgroep)')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Contactgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Telefoonnummers
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Telefoonnummer
 
|style="background-color: white;"|+31182435770
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Email adressen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Email adres
 
|style="background-color: white;"|neurologie@ABZ.nl
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie type
 
|style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '2.16.840.1.113883.2.4.15.1060')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Ontvangende organisatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Zorgaanbieder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Afdeling specialisme
 
|style="background-color: white;"|Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT Vektis Zorgverlenersspecificatie (subberoepsgroep)')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie type
 
|style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '2.16.840.1.113883.2.4.15.1060')
 
|}
 
=== Medische context===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="5" | Medische context
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="4" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Medische diagnose
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="18"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="4"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|ischemisch cerebrovasculair (code = '422504002' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Toelichting
 
|style="background-color: white;"|niet bekend met neurologische klachten
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|neoplasma van colon (code = '126838000')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|oksel (code = '238600001' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|inverse psoriasis (code = '238600001')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Voorgeschiedenis
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|diabetes mellitus (code = '73211009')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Let op
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Alert
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Alert naam
 
|style="background-color: white;"|Drager MRSA (code = '432415000' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Alert
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Alert naam
 
|style="background-color: white;"|Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): ernstige claustrofobie
 
|}<section end=eovd-saa-tst-1.1b-alle_zibs />
 
<section begin=eovd-saa-tst-q.qb-alle_zibs_kind_0-1_jaar />
 
==Aanmeldbericht Kinderen 0-1 jaar - overlap BgZ (concept)==
 
 
 
=== Administratieve gegevens===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="7" | Administratieve gegevens
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="6" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="6"|Datum overplaatsing
 
|style="background-color: white;"|T + 2 dagen
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Persoonsgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="47"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patient
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="18"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Naamgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="6"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Voornamen
 
|style="background-color: white;"|Erik
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Initialen
 
|style="background-color: white;"|E
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Geslachtsnaam
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Achternaam
 
|style="background-color: white;"|XXX_Altenborg
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Adresgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="6"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Straat
 
|style="background-color: white;"|Knolweg
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Huisnummer
 
|style="background-color: white;"|1000
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Postcode
 
|style="background-color: white;"|9999XA
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Woonplaats
 
|style="background-color: white;"|Stitswerd
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Adres soort
 
|style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Identificatienummer
 
|style="background-color: white;"|999911612 (in identificerend systeem: BSN)
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Geboortedatum
 
|style="background-color: white;"|14 aug 1964
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Geslacht
 
|style="background-color: white;"|Man (code = 'M' in codeSystem 'HL7 AdministrativeGender')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Betaler
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verzekeraar
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Verzekering
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Eind datum tijd
 
|style="background-color: white;"|T + 1 jaar
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Verzekeringssoort
 
|style="background-color: white;"|Basis (code = 'B' in codeSystem '2.16.840.1.113883.2.4.3.11.60.101.5.1')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Contactpersoon
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="18"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Naamgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Voornamen
 
|style="background-color: white;"|Johanna
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Initialen
 
|style="background-color: white;"|J
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Roepnaam
 
|style="background-color: white;"|Hanna
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Geslachtsnaam
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Achternaam
 
|style="background-color: white;"|Bakker
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Contactgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Telefoonnummers
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Telefoonnummer
 
|style="background-color: white;"|+31645678912
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Email adressen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Email adres
 
|style="background-color: white;"|jbakker@123net.nl
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Relatie
 
|style="background-color: white;"|Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): achterneef
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Sturende organisatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="16"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Zorgaanbieder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="14"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Zorgaanbieder identificatienummer
 
|style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z)
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie naam
 
|style="background-color: white;"|AB-zkh
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie locatie
 
|style="background-color: white;"|Noord
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Afdeling specialisme
 
|style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Vektis Zorgverlenersspecificatie (subberoepsgroep)')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Contactgegevens
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Telefoonnummers
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Telefoonnummer
 
|style="background-color: white;"|+31182435770
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Email adressen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Email adres
 
|style="background-color: white;"|neurologie@ABZ.nl
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie type
 
|style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '2.16.840.1.113883.2.4.15.1060')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Ontvangende organisatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Zorgaanbieder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Afdeling specialisme
 
|style="background-color: white;"|Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT Vektis Zorgverlenersspecificatie (subberoepsgroep)')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="4"|Organisatie type
 
|style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '2.16.840.1.113883.2.4.15.1060')
 
|}
 
=== Algemene patienten context===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="5" | Algemene patienten context
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="4" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Juridische situatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|<span id="JuridischeSituatie-01" title="Intern ID = JuridischeSituatie-01">Juridische situatie JuridischeSituatie-01</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Vertegenwoordiging
 
|style="background-color: white;"|Onder curatele stelling (code = '9' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Datum aanvang
 
|style="background-color: white;"|T - 1 jaar
 
|}
 
=== Medische context===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="5" | Medische context
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="4" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Medische diagnose
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="18"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="4"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|ischemisch cerebrovasculair (code = '422504002' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Toelichting
 
|style="background-color: white;"|niet bekend met neurologische klachten
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|neoplasma van colon (code = '126838000')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|oksel (code = '238600001' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|inverse psoriasis (code = '238600001')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Voorgeschiedenis
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Probleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem naam
 
|style="background-color: white;"|diabetes mellitus (code = '73211009')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Let op
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Alert
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Alert naam
 
|style="background-color: white;"|Drager MRSA (code = '432415000' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Alert
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Alert naam
 
|style="background-color: white;"|Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): ernstige claustrofobie
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Vrijheidsbeperking
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="9"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Vrijheidsbeperkende interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Wilsbekwaam
 
|style="background-color: white;"|Ja
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Juridische situatie
 
|style="background-color: white;"|Zie [[#JuridischeSituatie-01|Juridische situatie: JuridischeSituatie-01]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Soort interventie
 
|style="background-color: white;"|geforceerd toedienen van voeding bij patiënt (code = '37041007' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Reden van toepassen
 
|style="background-color: white;"|bevorderen van fysieke gezondheid (code = '121581000146106' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Instemming
 
|style="background-color: white;"|Instemming patiënt (code = '2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Begin
 
|style="background-color: white;"|T - 50 dagen
 
|}
 
=== Verpleegkundige context zorgplan===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="7" | Verpleegkundige context zorgplan
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="6" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Actuele patientproblemen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="64"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patientprobleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="15"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|<span id="patientprobleem-01" title="Intern ID = patientprobleem-01">Probleem patientprobleem-01</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="4"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem naam
 
|style="background-color: white;"|probleem met zichzelf wassen (code = '288552005' in codeSystem 'Referentieset Nationale kernset patientproblemen')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Toelichting
 
|style="background-color: white;"|meneer kan niet buigen
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="8"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|ondersteunen bij wassen en/of persoonlijke hygiëne (code = '386420003' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#patientprobleem-01|Probleem: patientprobleem-01]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Uitvoerder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Zorgverlener
 
|style="background-color: white;"|Ja
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patientprobleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="11"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|<span id="patientprobleem-02" title="Intern ID = patientprobleem-02">Probleem patientprobleem-02</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem naam
 
|style="background-color: white;"|probleem met zichzelf kleden (code = '284972002' in codeSystem 'Referentieset Nationale kernset patientproblemen')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|ondersteunen bij aankleden (code = '313332003' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#patientprobleem-02|Probleem: patientprobleem-02]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patientprobleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="22"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|<span id="eovd-saa-tst-patientprobleem-03" title="Intern ID = eovd-saa-tst-patientprobleem-03">Probleem eovd-saa-tst-patientprobleem-03</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem naam
 
|style="background-color: white;"|decubitus (code = '399912005' in codeSystem 'Referentieset Nationale kernset patientproblemen')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|aanleggen van verband op wond (code = '182531007' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#eovd-saa-tst-patientprobleem-03|Probleem: eovd-saa-tst-patientprobleem-03]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="10"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|wisselen van positie van patiënt (code = '225286008' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#eovd-saa-tst-patientprobleem-03|Probleem: eovd-saa-tst-patientprobleem-03]]
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Actie start datum tijd
 
|style="background-color: white;"|T - 10 dagen
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Actie eind datum tijd
 
|style="background-color: white;"|T - 1 dag
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Uitvoerder
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Zorgverlener
 
|style="background-color: white;"|Ja
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Patientprobleem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="11"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|<span id="eovd-saa-tst-patientprobleem-04" title="Intern ID = eovd-saa-tst-patientprobleem-04">Probleem eovd-saa-tst-patientprobleem-04</span>
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem naam
 
|style="background-color: white;"|loopt risico op delier (code = '430794006' in codeSystem 'Referentieset Nationale kernset patientproblemen')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Probleem status
 
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Verpleegkundige interventie
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Interventie
 
|style="background-color: white;"|bevorderen van vochtinname (code = '113148007' in codeSystem 'SNOMED Clinical Terms')
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|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 [[#eovd-saa-tst-patientprobleem-04|Probleem: eovd-saa-tst-patientprobleem-04]]
 
|}
 
=== Verpleegkundige context specificatie gezondheidstoestand===
 
 
 
{| class="wikitable" width="85%"
 
|style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;"  colspan="8" | Verpleegkundige context specificatie gezondheidstoestand
 
|-style="background-color: #1F497D;; color: white; text-align:left;"
 
|colspan="7" width="30%"| Gegevenselement
 
|| Waarde
 
 
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="8"|Voedingvocht
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="32"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Sonde systeem
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="9"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Sonde
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Medisch hulpmiddel
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Product
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Product type
 
|style="background-color: white;"|PEJ sonde (code = '8911000146104' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Product omschrijving
 
|style="background-color: white;"|PEJ sonde
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Infuus
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="10"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Infuuskatheter
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Medisch hulpmiddel
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Product
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Product type
 
|style="background-color: white;"|Centraal veneuze katheter (code = '52124006' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Product omschrijving
 
|style="background-color: white;"|centraal veneuze katheter
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="5"|Toelichting
 
|style="background-color: white;"|voor voeding
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Infuus
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="9"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="6"|Infuuskatheter
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="7"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="5"|Medisch hulpmiddel
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="5"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="4"|Product
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="2"|Product type
 
|style="background-color: white;"|Perifeer intraveneus infuus (code = '82449006' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="3"|Product omschrijving
 
|style="background-color: white;"|voor medicatie
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="8"|Uitscheiding
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="8"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Stoma
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="3"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="5"|Stoma type
 
|style="background-color: white;"|eindstandige ileostoma (code = '311412005' in codeSystem 'SNOMED CT')
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="5"|Toelichting
 
|style="background-color: white;"|na subtotale darmresectie
 
|-style="vertical-align:top; background-color: #E3E3E3;;" 
 
|colspan="7"|Stoma
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|rowspan="2"|
 
|-style="vertical-align:top; background-color: #E3E3E3;;"
 
|colspan="5"|Stoma type
 
|style="background-color: white;"|urostoma (code = '281601009' in codeSystem 'SNOMED CT')
 
|}<section end=eovd-saa-tst-q.qb-alle_zibs_kind_0-1_jaar />
 

Versie van 22 dec 2021 09:36

Deze wiki-pagina is in voorbereiding.