vpk:Vissue-EOVDR-832 Testgegevens eOverdracht addendum: verschil tussen versies
(EOVDR-832: Kwalificatiescript 1.1 toegevoegd) |
(uitvoerder) |
||
| (4 tussenliggende versies door 2 gebruikers niet weergegeven) | |||
| Regel 1: | Regel 1: | ||
{{IssuePaginaWaarschuwing|EOVDR-832|vpk:V4.2_Testgegevens_eOverdracht_addendum}} | {{IssuePaginaWaarschuwing|EOVDR-832|vpk:V4.2_Testgegevens_eOverdracht_addendum}} | ||
__NOINDEX__ | __NOINDEX__ | ||
| + | <!-- BACK TO TOP BUTTON --> | ||
| + | <span id="BackToTop"></span> | ||
| + | <div class="noprint" style="background-color:#FAFAFA; position:fixed; bottom:2%; right:0.5%; padding:0; margin:0;"> | ||
| + | [[#BackToTop|Back to Top]] | ||
| + | </div> | ||
| + | <!-- EINDE BACK TO TOP BUTTON --> | ||
__NUMBEREDHEADINGS__ | __NUMBEREDHEADINGS__ | ||
| Regel 6: | Regel 12: | ||
=Addenda voor inhoudelijke gegevens= | =Addenda voor inhoudelijke gegevens= | ||
| − | |||
<section begin=eOvd-SOV-kwa-1.1-alle_zibs /> | <section begin=eOvd-SOV-kwa-1.1-alle_zibs /> | ||
| − | ==Kwalificatie Overdracht | + | ==Kwalificatie Overdracht 1.1== |
=== Administratieve gegevens=== | === Administratieve gegevens=== | ||
| Regel 24: | Regel 29: | ||
|colspan="7"|Persoonsgegevens | |colspan="7"|Persoonsgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="85"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Patient | |colspan="6"|Patient | ||
| Regel 38: | Regel 43: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Initialen | |colspan="3"|Initialen | ||
| − | |style="background-color: white;"|J | + | |style="background-color: white;"|J. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
| Regel 122: | Regel 127: | ||
|colspan="6"|<span id="eovd-1-1-contactpersoon-01" title="Intern ID = eovd-1-1-contactpersoon-01">Contactpersoon eovd-1-1-contactpersoon-01</span> | |colspan="6"|<span id="eovd-1-1-contactpersoon-01" title="Intern ID = eovd-1-1-contactpersoon-01">Contactpersoon eovd-1-1-contactpersoon-01</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="25"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
| Regel 132: | Regel 137: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Initialen | |colspan="3"|Initialen | ||
| − | |style="background-color: white;"|H | + | |style="background-color: white;"|H. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Roepnaam | |colspan="3"|Roepnaam | ||
| Regel 161: | Regel 166: | ||
|colspan="2"|EmailAdres | |colspan="2"|EmailAdres | ||
|style="background-color: white;"|lenie@123net.nl | |style="background-color: white;"|lenie@123net.nl | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Adresgegevens | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="5"| | ||
| + | |-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;"|1003 | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|AdditioneleInformatie | ||
| + | |style="background-color: white;"|ingang via achtertuin | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|AdresSoort | ||
| + | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Rol | ||
| + | |style="background-color: white;"|Eerste relatie/contactpersoon (code = '1' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.22.472">Vektis Rolcode COD472-VEKT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Relatie | ||
| + | |style="background-color: white;"|Kleindochter (code = 'GRNDDAU' in codeSystem '<span title="2.16.840.1.113883.5.111">HL7 RoleCode</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Contactpersoon | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="19"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Naamgegevens | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="5"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Voornamen | ||
| + | |style="background-color: white;"|Pleun | ||
| + | |-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;"|Bloemist | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Contactgegevens | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="4"| | ||
| + | |-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;"|+316-99990008 | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Adresgegevens | |colspan="5"|Adresgegevens | ||
| Regel 172: | Regel 228: | ||
|style="background-color: white;"|1003 | |style="background-color: white;"|1003 | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|AdresSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Rol | |colspan="4"|Rol | ||
| Regel 199: | Regel 255: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|AfdelingSpecialisme | |colspan="4"|AfdelingSpecialisme | ||
| − | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Contactgegevens | |colspan="5"|Contactgegevens | ||
| Regel 286: | Regel 342: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|AfdelingSpecialisme | |colspan="4"|AfdelingSpecialisme | ||
| − | |style="background-color: white;"|Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT | + | |style="background-color: white;"|Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|OrganisatieType | |colspan="4"|OrganisatieType | ||
| Regel 352: | Regel 408: | ||
|colspan="10"|Levensovertuiging | |colspan="10"|Levensovertuiging | ||
|-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="9"|LevensovertuigingRC | |colspan="9"|LevensovertuigingRC | ||
| Regel 363: | Regel 419: | ||
|colspan="9"|Wilsverklaring | |colspan="9"|Wilsverklaring | ||
|-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="7"|WilsverklaringType | |colspan="7"|WilsverklaringType | ||
| Regel 370: | Regel 426: | ||
|colspan="7"|WilsverklaringDatum | |colspan="7"|WilsverklaringDatum | ||
|style="background-color: white;"|T - 4 jaar | |style="background-color: white;"|T - 4 jaar | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Vertegenwoordiger | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Contactpersoon | ||
| + | |style="background-color: white;"|Zie [[#eovd-1-1-contactpersoon-01|Contactpersoon: eovd-1-1-contactpersoon-01]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Toelichting | |colspan="7"|Toelichting | ||
| Regel 546: | Regel 609: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Specialisme | |colspan="6"|Specialisme | ||
| − | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Zorgaanbieder | |colspan="7"|Zorgaanbieder | ||
| Regel 587: | Regel 650: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Specialisme | |colspan="6"|Specialisme | ||
| − | |style="background-color: white;"|Medisch specialisten, gastro-enterologie (maag-darm-lever-arts) (code = '0318' in codeSystem 'COD016-VEKT | + | |style="background-color: white;"|Medisch specialisten, gastro-enterologie (maag-darm-lever-arts) (code = '0318' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Zorgaanbieder | |colspan="7"|Zorgaanbieder | ||
| Regel 1.027: | Regel 1.090: | ||
|colspan="11"|Actuele patiëntproblemen | |colspan="11"|Actuele patiëntproblemen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="79"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="10"|Patiëntprobleem | |colspan="10"|Patiëntprobleem | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="22"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="9"|<span id="eovd-kwa-1-1-patientprobleem-01" title="Intern ID = eovd-kwa-1-1-patientprobleem-01">Probleem eovd-kwa-1-1-patientprobleem-01</span> | |colspan="9"|<span id="eovd-kwa-1-1-patientprobleem-01" title="Intern ID = eovd-kwa-1-1-patientprobleem-01">Probleem eovd-kwa-1-1-patientprobleem-01</span> | ||
| Regel 1.051: | Regel 1.114: | ||
|colspan="9"|<span id="eovd-kwa-1-1-interventie-01" title="Intern ID = eovd-kwa-1-1-interventie-01">VerpleegkundigeInterventie eovd-kwa-1-1-interventie-01</span> | |colspan="9"|<span id="eovd-kwa-1-1-interventie-01" title="Intern ID = eovd-kwa-1-1-interventie-01">VerpleegkundigeInterventie eovd-kwa-1-1-interventie-01</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Interventie | |colspan="7"|Interventie | ||
| Regel 1.079: | Regel 1.142: | ||
|style="background-color: white;"|let op: valrisico | |style="background-color: white;"|let op: valrisico | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="10"|Patiëntprobleem | + | |colspan="8"|Uitvoerder |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Zorgverlener | ||
| + | |style="background-color: white;"|Ja | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="10"|Patiëntprobleem | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="16"| | |rowspan="16"| | ||
| Regel 1.279: | Regel 1.349: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Specialisme | |colspan="6"|Specialisme | ||
| − | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="9"|ContactMet | |colspan="9"|ContactMet | ||
| Regel 1.307: | Regel 1.377: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Specialisme | |colspan="6"|Specialisme | ||
| − | |style="background-color: white;"|Medisch specialisten, neurochirurgie (code = '0308' in codeSystem 'COD016-VEKT | + | |style="background-color: white;"|Medisch specialisten, neurochirurgie (code = '0308' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="9"|Locatie | |colspan="9"|Locatie | ||
| Regel 1.327: | Regel 1.397: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|AfdelingSpecialisme | |colspan="6"|AfdelingSpecialisme | ||
| − | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Contactgegevens | |colspan="7"|Contactgegevens | ||
| Regel 1.415: | Regel 1.485: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Specialisme | |colspan="6"|Specialisme | ||
| − | |style="background-color: white;"|Ergotherapeuten (code = '8800' in codeSystem 'COD016-VEKT | + | |style="background-color: white;"|Ergotherapeuten (code = '8800' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Contactgegevens | |colspan="7"|Contactgegevens | ||
| Regel 1.452: | Regel 1.522: | ||
|colspan="9"|Zelfzorg | |colspan="9"|Zelfzorg | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="103"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="8"|VermogenTotDrinken | |colspan="8"|VermogenTotDrinken | ||
| Regel 1.635: | Regel 1.705: | ||
|colspan="8"|VermogenTotVerpleegtechnischeHandelingen | |colspan="8"|VermogenTotVerpleegtechnischeHandelingen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="15"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|VerpleegkundigeInterventie | |colspan="7"|VerpleegkundigeInterventie | ||
|-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="6"|VerpleegkundigeInterventie | |colspan="6"|VerpleegkundigeInterventie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Interventie | |colspan="4"|Interventie | ||
| Regel 1.657: | Regel 1.727: | ||
|colspan="4"|ActieStartDatumTijd | |colspan="4"|ActieStartDatumTijd | ||
|style="background-color: white;"|T - 6 dagen | |style="background-color: white;"|T - 6 dagen | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Uitvoerder | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Patient | ||
| + | |style="background-color: white;"|Ja | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Toelichting | |colspan="4"|Toelichting | ||
| Regel 2.576: | Regel 2.653: | ||
|style="background-color: white;"|Niet actueel (code = '73425007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | |style="background-color: white;"|Niet actueel (code = '73425007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|}<section end=eOvd-SOV-kwa-1.1-alle_zibs /> | |}<section end=eOvd-SOV-kwa-1.1-alle_zibs /> | ||
| − | + | <section begin=eOvd-SOV-kwa-1.2-minimaal /> | |
| − | + | ==Kwalificatie Overdracht 1.2 == | |
| − | <section begin=eOvd-SOV-kwa-1. | ||
| − | ==Kwalificatie Overdracht 1. | ||
=== Administratieve gegevens=== | === Administratieve gegevens=== | ||
| Regel 2.591: | Regel 2.666: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Datum overplaatsing | |colspan="6"|Datum overplaatsing | ||
| − | |style="background-color: white;"|T + | + | |style="background-color: white;"|T + 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Persoonsgegevens | |colspan="7"|Persoonsgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="27"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Patient | |colspan="6"|Patient | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
| Regel 2.616: | Regel 2.685: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|XXX_Zuidwijker |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Adresgegevens | |colspan="5"|Adresgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Huisnummer | |colspan="3"|Huisnummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1002 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Postcode | |colspan="3"|Postcode | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999ZZ |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|AdresSoort | |colspan="3"|AdresSoort | ||
|style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Identificatienummer | |colspan="4"|Identificatienummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|999910346 (in identificerend systeem: BSN) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geboortedatum | |colspan="4"|Geboortedatum | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|27 jul 1954 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslacht | |colspan="4"|Geslacht | ||
| Regel 2.677: | Regel 2.722: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|EindDatumTijd | |colspan="2"|EindDatumTijd | ||
| − | |style="background-color: white;"|T + | + | |style="background-color: white;"|T + 250 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Verzekeringssoort | |colspan="2"|Verzekeringssoort | ||
| Regel 2.683: | Regel 2.728: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|IdentificatieNummer | |colspan="3"|IdentificatieNummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9664 (in identificerend systeem: UZOVI) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|OrganisatieNaam | |colspan="3"|OrganisatieNaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Trias |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|VerzekerdeNummer | |colspan="3"|VerzekerdeNummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|12345678 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Sturende organisatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="11"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgaanbieder |
|-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=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|HomeCare |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Zorgverlener | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="6"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
| Regel 2.713: | Regel 2.760: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Moorman |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Ontvangende organisatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgaanbieder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|St. Zonnehof |
| + | |} | ||
| + | === Medische context=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="7" | Medische context | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="6" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Behandelaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Zorgverlener |
|-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="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
|-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"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Köln |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Medische diagnose |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Probleem |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ProbleemNaam |
| + | |style="background-color: white;"|delier (code = '2776000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="4"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |} | ||
| + | === Verpleegkundige context: zorgplan=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="6" | Verpleegkundige context: zorgplan | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="5" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Actuele patiëntproblemen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|<span id="eovd-kwa-1-2-probleem-01" title="Intern ID = eovd-kwa-1-2-probleem-01">Probleem eovd-kwa-1-2-probleem-01</span> |
|-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=" | + | |colspan="2"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|acute verwardheid (code = '130987000' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|<span id="eovd-kwa-1-2-interventie-01" title="Intern ID = eovd-kwa-1-2-interventie-01">VerpleegkundigeInterventie eovd-kwa-1-2-interventie-01</span> | ||
|-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=" | + | |colspan="2"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|omgevingsstimuli minimaliseren (code = '710978006' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgresultaat |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|UitkomstVanZorg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="3"|Zorgresultaat |
| − | |style="background-color: white;"|+ | + | |style="background-color: white;"|DOSS = 2 |
| + | |}<section end=eOvd-SOV-kwa-1.2-minimaal /> | ||
| + | <section begin=eOvd-SOV-tst-1.1-alle_zibs /> | ||
| + | ==Test Overdracht 1.1== | ||
| + | |||
| + | === 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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Persoonsgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="75"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Patient | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="26"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"|Adresgegevens | + | |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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Straat | |colspan="3"|Straat | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Knolweg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Huisnummer | |colspan="3"|Huisnummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1000 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Postcode | |colspan="3"|Postcode | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999XA |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Woonplaats | |colspan="3"|Woonplaats | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stitswerd |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|AdresSoort | |colspan="3"|AdresSoort | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Contactgegevens |
|-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="4"|Telefoonnummers |
|-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=" | + | |colspan="2"|Telefoonnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|+31634567891 |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|EmailAdressen | ||
|-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=" | + | |colspan="2"|EmailAdres |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|evertaltenborg@hotmail.com |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geboortedatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|14 aug 1964 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geslacht |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Man (code = 'M' in codeSystem '<span title="2.16.840.1.113883.5.1">HL7 AdministrativeGender</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Betaler | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Verzekeraar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="8"| | |rowspan="8"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Verzekering |
|-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=" | + | |colspan="2"|EindDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 1 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Verzekeringssoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Basis (code = 'B' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.101.5.1">ZIB Verzekeringssoort</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|IdentificatieNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9664 (in identificerend systeem: UZOVI) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Trias |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|VerzekerdeNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|12345678 |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|<span id="eovd-1-1-contactpersoon-01" title="Intern ID = eovd-1-1-contactpersoon-01">Contactpersoon eovd-1-1-contactpersoon-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="19"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan="3"| | + | |rowspan="7"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Voornamen | ||
| + | |style="background-color: white;"|Johanna | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|J. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Roepnaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hanna |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geslachtsnaam |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="2"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="2"|Achternaam | ||
| + | |style="background-color: white;"|Bakker | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Contactgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Telefoonnummers | ||
|-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=" | + | |colspan="2"|Telefoonnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|+31645678912 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|EmailAdressen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|EmailAdres |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|jbakker@123net.nl |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Rol | ||
| + | |style="background-color: white;"|Eerste relatie/contactpersoon (code = '1' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.22.472">Vektis Rolcode COD472-VEKT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Relatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Dochter (code = 'DAUC' in codeSystem '<span title="2.16.840.1.113883.5.111">HL7 RoleCode</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Contactpersoon |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="15"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Johannes |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|Roepnaam |
| + | |style="background-color: white;"|Hans | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geslachtsnaam |
|-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"|Voorvoegsels |
| + | |style="background-color: white;"|van | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Dijk |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Contactgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Telefoonnummers |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Telefoonnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|+31612121212 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Relatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Anders (code = 'OTH' in codeSystem '<span title="2.16.840.1.113883.5.1008">HL7 NullFlavor</span>'): achterneef |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Sturende organisatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="34"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Zorgaanbieder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="21"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|AB-zkh |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|OrganisatieLocatie |
| − | | | + | |style="background-color: white;"|Noord |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | + | |colspan="4"|AfdelingSpecialisme | |
| − | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |
| − | |colspan="4"| | ||
| − | |style="background-color: white;"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Contactgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Telefoonnummers | ||
|-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=" | + | |colspan="2"|Telefoonnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|+31182435770 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|EmailAdressen |
| + | |-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"|EmailAdres |
| + | |style="background-color: white;"|neurologie@ABZ.nl | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Adresgegevens | ||
|-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="3"|Straat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Knolweg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Huisnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|10 |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|Postcode |
| + | |style="background-color: white;"|9999PO | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Woonplaats |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stitswerd |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|AdresSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Werkadres (code = 'WP' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgverlener |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Charlotte Maria |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|C. M. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Roepnaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Lotte |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
|-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=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bruinsma |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Verpleegkundigen, niet nader gespecificeerd (code = '9100' in codeSystem 'Vektis AGB-medische specialismen') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Ontvangende organisatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Zorgaanbieder | ||
|-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="4"| | + | |colspan="4"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|75131313 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|ThuiszorgOrg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|OrganisatieLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Noord |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|AfdelingSpecialisme |
| + | |style="background-color: white;"|Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|OrganisatieType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') |
| + | |} | ||
| + | === Algemene patiënten context=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="10" | Algemene patiënten context | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="9" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="10"|Gezinssituatie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="22"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="9"|Gezinssituatie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="20"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="8"|BurgerlijkeStaat | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|BurgerlijkeStaatRC |
|-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="5"|BurgerlijkeStaat |
| + | |style="background-color: white;"|Gehuwd (code = 'M' in codeSystem '<span title="2.16.840.1.113883.5.2">HL7 MaritalStatus</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Gezinssamenstelling |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Samenwonend met partner (code = '408821002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|AantalKinderen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|3 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|AantalKinderenInwonend |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|0 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Zorgtaak |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|zorgt voor zijn vrouw die slecht ter been is |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Zorgtaak |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|zorgt voor de hond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Kind |
|-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="6"|Geboortedatum |
| + | |style="background-color: white;"|T - 30 jaar | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Inwonend |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Nee |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Kind | ||
|-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=" | + | |colspan="6"|Geboortedatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 25 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Inwonend |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Nee |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|kinderen wonen ver weg en kunnen niet helpen bij dagelijkse zorg aan echtgenote |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="10"|Juridische situatie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|<span id="eovd-1-1-juridischesituatie-01" title="Intern ID = eovd-1-1-juridischesituatie-01">JuridischeSituatie eovd-1-1-juridischesituatie-01</span> |
|-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=" | + | |colspan="7"|Vertegenwoordiging |
| − | |style="background-color: white;"| | + | |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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|DatumAanvang |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 jaar |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="10"|Woonomgeving | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Woonsituatie |
|-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=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|woning is op derde verdieping, is gelijkvloers en er is een lift aanwezig |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|WoningType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Appartement of flatwoning (code = 'FLATW' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.40.4.13.1">ZIB WoningType</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="10"|Levensovertuiging | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="16"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="9"|LevensovertuigingRC | ||
|-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=" | + | |colspan="7"|Levensovertuiging |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Geen geloof (code = 'GeenGeloof' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.40.4">ZIB NL-CM-CS Algemeen</span>') |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Wilsverklaring |
|-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="7"|WilsverklaringType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Verklaring donorschap (code = 'DO' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.40.4.14.1">ZIB WilsverklaringType</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|WilsverklaringDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 4 jaar |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Vertegenwoordiger | ||
|-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=" | + | |colspan="6"|Contactpersoon |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-contactpersoon-01|Contactpersoon: eovd-1-1-contactpersoon-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wilsverklaring bevindt zich in de portemonnee. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Wilsverklaring |
|-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=" | + | |colspan="7"|WilsverklaringType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Anders (code = 'OTH' in codeSystem '<span title="2.16.840.1.113883.5.1008">HL7 NullFlavor</span>'): Wil niet gevaccineerd worden |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|WilsverklaringDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 jaar |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="10"|Sociale omgeving | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="61"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|ParticipatieInMaatschappij |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|SociaalNetwerk |
| + | |style="background-color: white;"|heeft veel contact met collega's en buren | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Vrijetijdsbesteding |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|gitaar spelen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Arbeidssituatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|werkt als administratief medewerker bij gemeente |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|heeft tijdelijk contract |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|HulpVanAnderen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="19"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Hulpverlener | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="14"| |
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Mantelzorger |
|-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="6"| | + | |colspan="6"|Contactpersoon |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="10"| | |rowspan="10"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Marriet |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|M. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Naamgebruik |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Eigen geslachtsnaam (code = 'NL1' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.101.5.4">ZIB Naamgebruik</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
|-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=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Blauw |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Rol |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Buur (code = '19' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.22.472">Vektis Rolcode COD472-VEKT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Aard |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|helpt met ondersteuning echtgenote als meneer er niet is |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Frequentie | ||
| + | |style="background-color: white;"|zo vaak als nodig | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|SoortHulp |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Mantelzorg (code = '386229000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|HulpVanAnderen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="12"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Hulpverlener | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="6"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="7"|Zorgaanbieder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|WijZorgen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stitswerd |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|OrganisatieType |
| + | |style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Aard |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|ondersteuning bij wassen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Frequentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|dagelijks |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|SoortHulp |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Professionele thuiszorg (code = '60689008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | = | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|Toelichting |
| + | |style="background-color: white;"|niet in het weekend | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|HulpVanAnderen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="20"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Hulpverlener |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Zorgverlener |
|-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="6"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Therese |
| − | + | |-style="vertical-align:top; background-color: #E3E3E3;;" | |
| − | + | |colspan="5"|Geslachtsnaam | |
| − | |||
| − | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Roep |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Contactgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|EmailAdressen |
|-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="3"|EmailAdres |
| + | |style="background-color: white;"|thereseroep@zzp.nl | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Aard |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|ondersteuning bij wassen |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|Frequentie |
| + | |style="background-color: white;"|dagelijks | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|SoortHulp |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Professionele thuiszorg (code = '60689008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|alleen in het weekend |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Communicatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Taalvaardigheid |
|-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="7"|CommunicatieTaal |
| + | |style="background-color: white;"|Nederlands (code = 'nl' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|TaalvaardigheidBegrijpen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|TaalvaardigheidSpreken |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Slecht (code = 'P' in codeSystem '2.16.840.1.113883.5.61') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|TaalvaardigheidLezen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|t.g.v. CVA nu moeite met begrijpen, spreken gaat ook moeilijk i.v.m. afasie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Taalvaardigheid |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan="7"| | + | |rowspan="5"| |
| − | |-style="vertical-align:top; background-color: #E3E3E3;;" | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | |colspan=" | + | |colspan="7"|CommunicatieTaal |
| + | |style="background-color: white;"|Limburgs (code = 'li' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|TaalvaardigheidBegrijpen | ||
| + | |style="background-color: white;"|Goed (code = 'G' in codeSystem '2.16.840.1.113883.5.61') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|TaalvaardigheidSpreken |
| + | |style="background-color: white;"|Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|opgegroeid in Zuid-Limburg |
| + | |} | ||
| + | === Medische context=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="9" | Medische context | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="8" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Behandelaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|<span id="eovdv-1-1-behandelaar-01" title="Intern ID = eovdv-1-1-behandelaar-01">Zorgverlener eovdv-1-1-behandelaar-01</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="14"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Joshua Pieter |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|J. P. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Geslachtsnaam | ||
|-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=" | + | |colspan="4"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Helmond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Zorgaanbieder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|AB-zkh |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | + | |colspan="5"|OrganisatieLocatie | |
| − | + | |style="background-color: white;"|Noord | |
| − | |colspan="5"| | ||
| − | |style="background-color: white;"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Behandelaar |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="16"| | |rowspan="16"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|<span id="eovdv-1-1-behandelaar-02" title="Intern ID = eovdv-1-1-behandelaar-02">Zorgverlener eovdv-1-1-behandelaar-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="14"| | |rowspan="14"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ZorgverlenerIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|03898989 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|G. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Geslachtsnaam |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Spijkerman |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, gastro-enterologie (maag-darm-lever-arts) (code = '0318' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Zorgaanbieder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="4"| | |rowspan="4"| | ||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|ZorgaanbiederIdentificatienummer |
| + | |style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z) | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|AB-zkh |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Noord |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Medische diagnose |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="23"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|<span id="eovd-1-1-probleem-01" title="Intern ID = eovd-1-1-probleem-01">Probleem eovd-1-1-probleem-01</span> |
|-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="6"|ProbleemType |
| + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|ischemisch cerebrovasculair accident (code = '422504002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 100 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"|Toelichting | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|VerificatieStatus | ||
| + | |style="background-color: white;"|Bevestigd (code = '410605003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Toelichting | ||
| + | |style="background-color: white;"|niet bekend met neurologische klachten | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|<span id="eovd-1-1-probleem-02" title="Intern ID = eovd-1-1-probleem-02">Probleem eovd-1-1-probleem-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|neoplasma van colon (code = '126838000') |
| − | | | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | + | |colspan="6"|ProbleemBeginDatum | |
| − | + | |style="background-color: white;"|T - 150 dagen | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | | | ||
| − | | | ||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|<span id="eovd-1-1-probleem-03" title="Intern ID = eovd-1-1-probleem-03">Probleem eovd-1-1-probleem-03</span> |
|-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="6"|ProbleemAnatomischeLocatie |
| − | | | + | |style="background-color: white;"|oksel (code = '91470000' in codeSystem 'SNOMED Clinical Terms') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|ProbleemLateraliteit |
| + | |style="background-color: white;"|Rechts en links (code = '51440002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|inverse psoriasis (code = '238600001') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|ProbleemBeginDatum |
| + | |style="background-color: white;"|T - 10 jaar | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Voorgeschiedenis |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="7"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Probleem | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|diabetes mellitus (code = '73211009') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 12 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Allergie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="37"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|AllergieIntolerantie |
|-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="6"|VeroorzakendeStof |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|nikkelsulfaat (code = '255848005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AllergieCategorie |
| + | |style="background-color: white;"|Stof of product (code = '419199007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AllergieStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actief (code = 'active' in codeSystem '<span title="2.16.840.1.113883.5.14">HL7 ActStatus</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BeginDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 10 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MateVanKritiekZijn |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Matig (code = '6736007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|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=" | + | |colspan="7"|Reactie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|Symptoom |
| − | | | + | |style="background-color: white;"|Contactdermatitis (code = '40275004' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|ReactieBeschrijving |
| + | |style="background-color: white;"|last van jeuk, roodheid en irritatie op de contactplek van nikkel bevattende sieraden. | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|WijzeVanBlootstelling |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|intra-epidermale route (code = '448077001' in codeSystem 'SNOMED Clinical Terms') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|AllergieIntolerantie | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="22"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|VeroorzakendeStof | ||
| + | |style="background-color: white;"|pollen (code = '256259004') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AllergieCategorie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Omgeving (code = '426232007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AllergieStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actief (code = 'active' in codeSystem '<span title="2.16.840.1.113883.5.14">HL7 ActStatus</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BeginDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 500 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MateVanKritiekZijn |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Matig (code = '6736007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|LaatsteReactieDatumTijd |
| + | |style="background-color: white;"|T - 99 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Reactie |
|-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=" | + | |colspan="5"|Symptoom |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Overgevoeligheidsreactie van de bovenste luchtwegen (code = '490008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|SpecifiekeStof |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|graspollen (code = '256277009') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ReactieBeschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|veelvuldig niezen |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|Ernst |
| + | |style="background-color: white;"|Matig (code = '6736007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ReactieTijdstip |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 99 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Reactie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|Symptoom |
| + | |style="background-color: white;"|Kortademigheid (code = '267036007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Symptoom |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Koorts (code = '386661006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|SpecifiekeStof |
| + | |style="background-color: white;"|pollen van paprikaplant (code = '110181000146104') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ReactieBeschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|ernstige benauwdheid en koorts |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Ernst |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ernstig (code = '24484000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ReactieTijdstip |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 200 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Let op |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Alert |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="4"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AlertNaam |
| + | |style="background-color: white;"|Drager MRSA (code = '432415000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BeginDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 20 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AlertType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|waarschuwing (code = '74018-3' in codeSystem '<span title="2.16.840.1.113883.6.1">LOINC</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Alert |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="3"| | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AlertNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Anders (code = 'OTH' in codeSystem '<span title="2.16.840.1.113883.5.1008">HL7 NullFlavor</span>'): ernstige claustrofobie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BeginDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 10 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Vrijheidsbeperking |
|-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="8"|VrijheidsbeperkendeInterventie |
|-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="6"|Wilsbekwaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ja |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|JuridischeSituatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-juridischesituatie-01|JuridischeSituatie: eovd-1-1-juridischesituatie-01]] |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|SoortInterventie |
| − | | | + | |style="background-color: white;"|geforceerd toedienen van voeding bij patiënt (code = '37041007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|RedenVanToepassen |
| + | |style="background-color: white;"|bevorderen van fysieke gezondheid (code = '121581000146106' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Instemming |
| − | |style="background-color: white;"| | + | |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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Begin |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 50 dagen |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Meetwaarden |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="57"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Bloeddruk |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="11"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Meetmethode |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Niet-invasief (code = '22762002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|ManchetType |
| + | |style="background-color: white;"|Standaard (code = 'STD' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.40.4.15.1">ZIB ManchetType</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MeetLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechter bovenarm (code = '368209003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DiastolischEindpunt |
| + | |style="background-color: white;"|Fase V (code = '255272007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|SystolischeBloeddruk |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|170 mm[Hg] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|DiastolischeBloeddruk |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|90 mm[Hg] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|GemiddeldeBloeddruk |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|110 mm[Hg] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BloeddrukDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 20 dagen om 14:45 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|meneer gebruikt medicatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Houding |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Liggende positie (code = '102538003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Polsfrequentie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan | + | |rowspan="5"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|PolsfrequentieWaarde |
| + | |style="background-color: white;"|90 | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|PolsfrequentieDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen om 14:45 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|is altijd sportief geweest |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|PolsRegelmatigheid |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Polsslag regelmatig (code = '271636001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Lichaamstemperatuur |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|TemperatuurWaarde |
| + | |style="background-color: white;"|36.8 Cel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TemperatuurDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 4 dagen om 07 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|voeten voelen heel koud aan |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|TemperatuurType |
| + | |style="background-color: white;"|Tympanische temperatuur (code = '415974002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Ademhaling |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="20"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Ademfrequentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|18 /min |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AdemhalingDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 3 dagen om 14:45 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Ritme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Abnormaal ademhalingsritme (code = '85617008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Diepte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Normale ademhalingsdiepte (code = '301284009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AfwijkendAdemhalingspatroon |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Apneu (code = '1023001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |colspan="6"|ExtraZuurstofToediening |
| + | |style="background-color: white;"|Ja | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Toelichting | ||
| + | |style="background-color: white;"|meneer lijkt angstig | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|ToegediendeZuurstof | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="11"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|FlowRate | ||
| + | |style="background-color: white;"|2 l/min | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|FiO2 | ||
| + | |style="background-color: white;"|0.29 l | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ToedieningHulpmiddel |
|-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="5"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Product |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Neusbril (code = '336623009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|ProductOmschrijving | ||
| + | |style="background-color: white;"|neusbril | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Lichaamsgewicht | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|GewichtWaarde |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|74 kg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|meneer volgt afvaldieet |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|GewichtDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen om 14:30 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Kleding |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Volledig gekleed, inclusief schoenen (code = 'FULL' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.40.4.8.1">ZIB ContextKleding</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|Lichaamslengte |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="4"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|LengteWaarde |
| + | |style="background-color: white;"|170 cm | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|LengteDatumTijd |
| − | |style="background-color: white;"|T - 30 | + | |style="background-color: white;"|T - 5 dagen om 14:30 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|zonder schoenen aan |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Pijnscore |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="9"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|PijnScore | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|PijnscoreWaarde |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|PijnscoreDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen om 14:45 uur |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|PijnMeetmethode |
| − | | | + | |style="background-color: white;"|NRS (code = 'NRS' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.9.1') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| + | |style="background-color: white;"|gehele voet (code = '302545001' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Af en toe pijn, maar niet belemmerend bij het lopen |
| + | |} | ||
| + | === Verpleegkundige context: zorgplan=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="11" | Verpleegkundige context: zorgplan | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="10" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="11"|Actuele patiëntproblemen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="121"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="22"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|<span id="eovd-1-1-patientprobleem-01" title="Intern ID = eovd-1-1-patientprobleem-01">Probleem eovd-1-1-patientprobleem-01</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|probleem met zichzelf wassen en afdrogen (code = '288552005' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|ProbleemBeginDatum |
| − | | | + | |style="background-color: white;"|T - 100 dagen |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|ProbleemStatus |
| + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|meneer kan niet buigen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="9"| | + | |colspan="9"|<span id="eovd-1-1-interventie-01" title="Intern ID = eovd-1-1-interventie-01">VerpleegkundigeInterventie eovd-1-1-interventie-01</span> |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="14"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|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="8"|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=" | + | |colspan="6"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-patientprobleem-01|Probleem: eovd-1-1-patientprobleem-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|Behandeldoel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|GewenstZorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wassen onafhankelijk |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|ActieStartDatumTijd | ||
| + | |style="background-color: white;"|T - 90 dagen | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Frequentie | ||
| + | |style="background-color: white;"|1 /dag | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Instructie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|let op: valrisico |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|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=" | + | |colspan="6"|Zorgverlener |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ja |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="10"| | + | |colspan="10"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="9"| | + | |colspan="9"|<span id="eovd-1-1-patientprobleem-02" title="Intern ID = eovd-1-1-patientprobleem-02">Probleem eovd-1-1-patientprobleem-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|probleem met zichzelf kleden (code = '284972002' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 90 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|<span id="eovd-1-1-interventie-02" title="Intern ID = eovd-1-1-interventie-02">VerpleegkundigeInterventie eovd-1-1-interventie-02</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |rowspan="9"| |
| − | |style="background-color: white;"| | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="7"|Interventie | ||
| + | |style="background-color: white;"|ondersteunen bij aankleden (code = '313332003' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Indicatie |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Probleem |
| + | |style="background-color: white;"|Zie [[#eovd-1-1-patientprobleem-02|Probleem: eovd-1-1-patientprobleem-02]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|Behandeldoel |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|GewenstZorgresultaat |
| − | | | + | |style="background-color: white;"|kleden onafhankelijk |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|Frequentie |
| + | |style="background-color: white;"|3 /dag | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="41"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|<span id="eovd-1-1-patientprobleem-03" title="Intern ID = eovd-1-1-patientprobleem-03">Probleem eovd-1-1-patientprobleem-03</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|ProbleemAnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|hiel (code = '76853006' in codeSystem 'SNOMED Clinical Terms') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|ProbleemLateraliteit | ||
| + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|ProbleemType | ||
| + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|ProbleemNaam | ||
| + | |style="background-color: white;"|decubitus (code = '399912005' in codeSystem 'Referentieset Nationale kernset patientproblemen') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 90 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|VerpleegkundigeInterventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|aanleggen van verband op wond (code = '182531007' in codeSystem 'SNOMED Clinical Terms') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|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=" | + | |colspan="6"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-patientprobleem-03|Probleem: eovd-1-1-patientprobleem-03]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Frequentie | |colspan="7"|Frequentie | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 /dag |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|MedischHulpmiddel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Product |
|-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="5"|ProductType |
| + | |style="background-color: white;"|schuimverband (code = '448416005' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="4"| | |rowspan="4"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Product | ||
|-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="5"| | + | |colspan="5"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|huidvervangende wondbedekkers (code = '465239008' in codeSystem 'SNOMED Clinical Terms') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="9"| | + | |colspan="9"|VerpleegkundigeInterventie |
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="14"| | |rowspan="14"| | ||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|Interventie |
| + | |style="background-color: white;"|wisselen van positie van patiënt (code = '225286008' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Indicatie |
|-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=" | + | |colspan="6"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-patientprobleem-03|Probleem: eovd-1-1-patientprobleem-03]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Behandeldoel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|GewenstZorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wondlengte < 1cm, wondbreedte < 1 cm |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|ActieStartDatumTijd |
| + | |style="background-color: white;"|T - 10 dagen | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|ActieEindDatumTijd | ||
| + | |style="background-color: white;"|T - 1 dag | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Interval | ||
| + | |style="background-color: white;"|4 uur | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Uitvoerder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgverlener |
| − | + | |style="background-color: white;"|Ja | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |style="background-color: white;"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="10"| | + | |colspan="10"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="37"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="9"| | + | |colspan="9"|<span id="eovd-1-1-patientprobleem-04" title="Intern ID = eovd-1-1-patientprobleem-04">Probleem eovd-1-1-patientprobleem-04</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|loopt risico op delier (code = '430794006' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Toelichting | |colspan="7"|Toelichting | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|vastgesteld met DOS score |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="9"| | + | |colspan="9"|VerpleegkundigeInterventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="28"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|bevorderen van vochtinname (code = '113148007' in codeSystem 'SNOMED Clinical Terms') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|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=" | + | |colspan="6"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-patientprobleem-04|Probleem: eovd-1-1-patientprobleem-04]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Behandeldoel | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|GewenstZorgresultaat | ||
| + | |style="background-color: white;"|vochtinname > 1,5 liter/dag | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Instructie | ||
| + | |style="background-color: white;"|Graag er op toezien dat meneer > 1,5 liter per dag drinkt | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Uitvoerder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="18"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Verzorger |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="16"| | |rowspan="16"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Contactpersoon |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="14"| | |rowspan="14"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gerda |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Naamgebruik |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Geslachtsnaam partner (code = 'NL2' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.101.5.4">ZIB Naamgebruik</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|GeslachtsnaamPartner |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|AchternaamPartner |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|XXX_Altenborg |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Contactgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="4"| | |rowspan="4"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Telefoonnummers | ||
|-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=" | + | |colspan="2"|Telefoonnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|+31662626262 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Relatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Echtgenoot (code = 'HUSB' in codeSystem '<span title="2.16.840.1.113883.5.111">HL7 RoleCode</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="11"|Zorgresultaat |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="13"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|UitkomstVanZorg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Zorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|doel deels behaald: kan nog niet rug wassen |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Interventie | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|VerpleegkundigeInterventie | ||
| + | |style="background-color: white;"|Zie [[#eovd-1-1-interventie-01|VerpleegkundigeInterventie: eovd-1-1-interventie-01]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|UitkomstVanZorg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Zorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|doel deels behaald, kan nog niet zelf veters strikken |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Interventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|VerpleegkundigeInterventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-interventie-02|VerpleegkundigeInterventie: eovd-1-1-interventie-02]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="11"|Afspraken patiënt | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="81"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Contact |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="55"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|ContactType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Poliklinisch (code = 'AMB' in codeSystem '<span title="2.16.840.1.113883.5.4">HL7 ActCode</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|ContactMet | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="11"| |
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Zorgverlener |
|-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="7"|Naamgegevens |
|-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=" | + | |colspan="5"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Joshua Pieter |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|J.P. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Geslachtsnaam | ||
|-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=" | + | |colspan="4"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Helmond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|ContactMet | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="11"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Zorgverlener | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="9"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ZorgverlenerIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|03686868 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|F. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Geslachtsnaam | ||
|-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=" | + | |colspan="4"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Snijder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, neurochirurgie (code = '0308' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Locatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="23"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Zorgaanbieder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="21"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|AB-zkh |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|OrganisatieLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Noord |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|AfdelingSpecialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Contactgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Telefoonnummers |
|-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=" | + | |colspan="4"|Telefoonnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|+31182435770 |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|EmailAdressen | ||
|-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=" | + | |colspan="4"|EmailAdres |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|neurologie@ABZ.nl |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Adresgegevens | ||
|-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="5"|Straat |
| − | | | + | |style="background-color: white;"|Knolweg |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|Huisnummer |
| + | |style="background-color: white;"|10 | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Postcode |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999PO |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Woonplaats |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stitswerd |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|AdresSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Werkadres (code = 'WP' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|OrganisatieType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|BeginDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 5 dagen om 10:00 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|EindDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 5 dagen om 10:30 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|RedenContact |
|-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=" | + | |colspan="7"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-probleem-01|Probleem: eovd-1-1-probleem-01]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="10"|Contact | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="23"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|ContactType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Thuis (code = 'HH' in codeSystem '<span title="2.16.840.1.113883.5.4">HL7 ActCode</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|ContactMet |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Zorgverlener | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="14"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ZorgverlenerIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|88131313 (in identificerend systeem: AGB-Z) |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|W. |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Geslachtsnaam |
|-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=" | + | |colspan="4"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bloem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ergotherapeuten (code = '8800' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Contactgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|EmailAdressen |
|-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=" | + | |colspan="4"|EmailAdres |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|bloem@ergotherapie.nl |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|BeginDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 12 dagen om 15:15 uur |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|RedenContact | ||
|-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=" | + | |colspan="7"|RedenContactTekst |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Controle voortgang revalidatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Wensen en behoeften patiënt en/of naasten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|meneer wil zo snel mogelijk weer zelfstandig kunnen functioneren en zijn vrouw kunnen verzorgen |
| + | |} | ||
| + | === Verpleegkundige context: specificatie gezondheidstoestand=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="9" | Verpleegkundige context: specificatie gezondheidstoestand | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="8" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Zelfzorg | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="103"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotDrinken |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Drinken | ||
| + | |style="background-color: white;"|Hulp nodig (code = '16681000146102' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DrinkBeperkingen |
| + | |style="background-color: white;"|Bereiden (openen/uitschenken) (code = '286506008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|VermogenTotDrinken |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Drinken | ||
| + | |style="background-color: white;"|Onafhankelijk (code = '19841000146104' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DrinkBeperkingen |
| + | |style="background-color: white;"|Vastpakken (code = '307071002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotEten | ||
|-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="6"| | + | |colspan="6"|Eten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '129033007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|EetBeperkingen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Snijden/openen (code = '289078003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|VermogenTotEten |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="3"| | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Eten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '165224005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|EetBeperkingen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Eetgerei hanteren (code = '289046006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotMondverzorging |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="18"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|VerzorgenTanden |
| + | |style="background-color: white;"|Hulp nodig (code = '16671000146104' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Prothese |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|MedischHulpmiddel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="5"|Product | ||
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gebitsprothese (code = '27606000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gebitsprothese bovenkaak |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Prothese | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gebitsprothese (code = '27606000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gebitsprothese onderkaak |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotZichWassen | ||
|-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="6"| | + | |colspan="6"|ZichWassen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '16621000146103' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|TeWassenLichaamsdeel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onderlichaam (code = '362875007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotZichWassen | ||
|-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="6"| | + | |colspan="6"|ZichWassen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '16621000146103' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|TeWassenLichaamsdeel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bovenlichaam (code = '362874006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotZichKleden | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |rowspan="3"| |
| − | |style="background-color: white;"| | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="6"|ZichKleden | ||
| + | |style="background-color: white;"|Hulp nodig (code = '129039006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|TeKledenLichaamsdeel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onderlichaam (code = '362875007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|VermogenTotZichKleden |
|-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="6"| | + | |colspan="6"|ZichKleden |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '129035000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|TeKledenLichaamsdeel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bovenlichaam (code = '362874006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotUiterlijkeVerzorging | ||
|-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="6"| | + | |colspan="6"|UiterlijkeVerzorging |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '27941000146109' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|VermogenTotToiletgang |
|-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="6"| | + | |colspan="6"|Toiletgebruik |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '129062008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '0') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotZelfstandigMedicatiegebruik | ||
|-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="6"| | + | |colspan="6"|ZelfstandigMedicatiegebruik |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '27921000146103' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|HulpBijToediening | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="14"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VerpleegkundigeInterventie |
|-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="4"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|bevorderen van therapietrouw met behulp van medicijndispenser (code = '710153008' in codeSystem 'SNOMED Clinical Terms') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Behandeldoel | ||
|-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=" | + | |colspan="3"|GewenstZorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|therapietrouw |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Frequentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 /d |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|MedischHulpmiddel | |colspan="5"|MedischHulpmiddel | ||
| Regel 4.655: | Regel 4.722: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|ProductType | |colspan="2"|ProductType | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|medicatierol (code = '713308004' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|ProductOmschrijving | |colspan="3"|ProductOmschrijving | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|baxterrol |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|VermogenTotVerpleegtechnischeHandelingen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="15"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|VerpleegkundigeInterventie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="12"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="6"|VerpleegkundigeInterventie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stoma care procedure (code = '225194008' in codeSystem 'SNOMED Clinical Terms') |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Behandeldoel |
|-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=" | + | |colspan="3"|GewenstZorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|goede hygiene met betrekking tot stoma |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ActieStartDatumTijd |
| − | |style="background-color: white;"|T - | + | |style="background-color: white;"|T - 6 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="5"|Uitvoerder |
| − | |style="background-color: white;"| | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | |-style="vertical-align:top; background-color: #E3E3E3;;" | + | |rowspan="2"| |
| − | |colspan=" | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="3"|Patient | ||
| + | |style="background-color: white;"|Ja | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Toelichting | ||
| + | |style="background-color: white;"|toezicht bij uitvoer, en instructie hygiënisch werken | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|VerrichtenVPKHandeling | ||
| + | |style="background-color: white;"|Hulp nodig (code = '27931000146101' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotVerpleegtechnischeHandelingen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="9"| | |rowspan="9"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|VerpleegkundigeInterventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="6"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|VerpleegkundigeInterventie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|vervangen van verband (code = '18949003' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ActieStartDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 dag |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Interval |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|VerrichtenVPKHandeling |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '27931000146101' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting zelfzorg |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|kan zich steeds beter redden met wassen en kleden, knoopjes dichtdoen en schoenen met hulp. Ileostoma instructies gestart. |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Mobiliteit |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="28"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Mobiliteit |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="26"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Lopen |
| + | |style="background-color: white;"|Hulp nodig (code = '16581000146103' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Traplopen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Volledig afhankelijk (code = '301589003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|HoudingVeranderen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '19821000146105' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|HoudingHandhaven |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '19811000146100' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|UitvoerenTransfer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '714917003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-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=" | + | |colspan="5"|Product |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|rollator (code = '404946006' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|rollator |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"|1 | + | |style="background-color: white;"|T - 1 jaar |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|MedischHulpmiddel |
|-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="6"|MedischHulpmiddel |
| − | |||
| − | |||
|-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="5"|Product |
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|rolstoel (code = '58938008' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|rolstoel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 maand |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Toelichting |
| + | |style="background-color: white;"|voor langere afstanden | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|lopen is stuk verbeterd, rechter been minder krachtig |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Voeding/vocht |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="127"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Voedingsadvies | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DieetType |
| + | |style="background-color: white;"|suikervrij, diabetes dieet | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Consistentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|dik vloeibaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|eet naar eigen keuze minder vlees |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Voedingsadvies |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DieetType |
| + | |style="background-color: white;"|geen varkensvlees | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|SNAQScore |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|GewichtsverliesScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|LossAverage (code = 'G1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.1 (ordinal = '2') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|EetlustScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.2 (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VoedingsScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|GeenVoeding (code = 'Z0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.3 (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TotaalScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|SNAQScoreDatumTijd |
| − | |style="background-color: white;"|T - | + | |style="background-color: white;"|T - 6 dagen om 17 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|geen verminderde eetlust ondanks chemotherapie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|SNAQrcScore |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|GewichtsverliesScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|LossHigh (code = 'G2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.1 (ordinal = '2') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|EetlustScore |
| + | |style="background-color: white;"|Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.2 (ordinal = '0') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|BMIScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gezond (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.3 (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|HulpBijEten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '165224005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '0') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|TotaalScore |
| − | | | + | |style="background-color: white;"|2 |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|SNAQrcScoreDatumTijd |
| + | |style="background-color: white;"|T - 6 dagen om 17 uur | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|geen verminderde eetlust ondanks chemotherapie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|SNAQ65+Score |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="8"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|GewichtsverliesScore |
| − | | | + | |style="background-color: white;"|LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.1 (ordinal = '0') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|BovenarmOmtrekScore |
| + | |style="background-color: white;"|Normaal (code = 'A0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.4 (ordinal = '0') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|EetlustScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.2 (ordinal = '0') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|InspanningsScore |
| + | |style="background-color: white;"|Mogelijk (code = 'In0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.3 (ordinal = '0') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TotaalScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|0 |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|SNAQ65+ScoreDatumTijd |
| + | |style="background-color: white;"|T - 6 dagen om 17 uur | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|geen verminderde eetlust ondanks chemotherapie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|MUSTScore |
|-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="6"| | + | |colspan="6"|BMIScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|BMIHigh (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.1 (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|GewichtsverliesScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.2 (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ZiekteScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ziek (code = 'Z1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.3 (ordinal = '2') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TotaalScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|MUSTScoreDatumTijd |
| + | |style="background-color: white;"|T - 12 dagen om 17 uur | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Vochtbalans |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|VochtTotaalIn |
| + | |style="background-color: white;"|1400 ml | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VochtTotaalUit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1000 ml |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VochtbalansStarttijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 6 dagen om 07 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VochtbalansStoptijd |
| − | |style="background-color: white;"|T - 5 dagen | + | |style="background-color: white;"|T - 5 dagen om 07 uur |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|SondeSysteem | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="15"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="7"|Sonde | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="11"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-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="5"|Product |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Neus-maagsonde (code = '17102003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ProductOmschrijving |
| + | |style="background-color: white;"|neus- maagsonde | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|AnatomischeLocatie | ||
| + | |style="background-color: white;"|neusgat (code = '363538002' in codeSystem 'SNOMED Clinical Terms') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Lateraliteit | ||
| + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Zorgverlener | ||
| + | |style="background-color: white;"|Zie [[#eovdv-1-1-behandelaar-02|Zorgverlener: eovdv-1-1-behandelaar-02]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|SondeLengte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|575 mm |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Toelichting |
| + | |style="background-color: white;"|wegens misselijkheid door chemotherapie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|SondeSysteem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="17"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Sonde |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Product | ||
|-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="3"| | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|PEJ sonde (code = '8911000146104' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ProductOmschrijving |
| + | |style="background-color: white;"|PEJ sonde | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|MedischHulpmiddel |
|-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=" | + | |colspan="6"|Product |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|enterale voedingspomp (code = '468664004' in codeSystem 'SNOMED Clinical Terms') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|ProductOmschrijving | ||
| + | |style="background-color: white;"|enterale voedingspomp | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Infuus |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="27"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Infuuskatheter |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="12"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|MedischHulpmiddel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Centraal veneuze katheter (code = '52124006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ProductOmschrijving |
| + | |style="background-color: white;"|centraal veneuze katheter | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 20 dagen |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Toelichting |
| + | |style="background-color: white;"|onder sleutelbeen links | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|structuur van vena subclavia (code = '9454009' in codeSystem 'SNOMED Clinical Terms') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Lateraliteit |
| − | | | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Zorgverlener |
| + | |style="background-color: white;"|Zie [[#eovdv-1-1-behandelaar-02|Zorgverlener: eovdv-1-1-behandelaar-02]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|voor voeding |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|LumenOfLijn |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|LijnStatus |
| − | | | + | |style="background-color: white;"|Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|LumenLocatie |
| + | |style="background-color: white;"|Distaal (code = '46053002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|LumenOfLijn |
|-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="5"| | + | |colspan="5"|LijnStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Afgedopt (code = 'DOP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|LumenLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Mediaal (code = '255561001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|LumenOfLijn |
|-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=" | + | |colspan="5"|LijnStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|LumenLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Distaal (code = '46053002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Infuus |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Infuuskatheter |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Perifeer intraveneus infuus (code = '82449006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Perifeer intraveneus infuus |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|BeginDatum |
| − | | | + | |style="background-color: white;"|T - 15 dagen |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|AnatomischeLocatie |
| + | |style="background-color: white;"|onderarm (code = '14975008' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|voor medicatie |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|LumenOfLijn | ||
|-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=" | + | |colspan="5"|LijnStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Uitscheiding |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="41"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Blaasfunctie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="13"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|UrineContinentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Af en toe een ongelukje (max. 1 keer per 24 uur) (code = '165233007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Urostoma |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Stoma |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-stoma-02|Stoma: eovd-1-1-stoma-02]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Incontinentiemateriaal |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan="6"| | + | |rowspan="7"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|MedischHulpmiddel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="5"|Product | ||
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|inlegger voor incontinentiebroek (code = '470713005' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|inlegger |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Darmfunctie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Stoma |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-stoma-01|Stoma: eovd-1-1-stoma-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|DefecatieConsistentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Helemaal vloeibaar (code = 'Type 7' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.3.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|stoma na subtotale darmresectie wegens coloncarcinoom |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|<span id="eovd-1-1-stoma-01" title="Intern ID = eovd-1-1-stoma-01">Stoma eovd-1-1-stoma-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|StomaType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|eindstandige ileostoma (code = '311412005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|StomaMateriaal |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="7"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|MedischHulpmiddel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|ProductType | ||
| + | |style="background-color: white;"|Ileostomy bag (code = '417136005' in codeSystem 'SNOMED Clinical Terms') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|ProductOmschrijving | ||
| + | |style="background-color: white;"|stomazak voor ileostoma | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|AnatomischeLocatie | ||
| + | |style="background-color: white;"|onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Lateraliteit |
| − | | | + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AanlegDatum |
| + | |style="background-color: white;"|T - 12 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|na subtotale darmresectie wegens coloncarcinoom |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|<span id="eovd-1-1-stoma-02" title="Intern ID = eovd-1-1-stoma-02">Stoma eovd-1-1-stoma-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|StomaType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|urostoma (code = '281601009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| + | |style="background-color: white;"|buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|AanlegDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 4 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Huid |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="100"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Brandwond |
|-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="6"|OntstaansDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 2 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Uitgebreidheid |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 % |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|BrandwondSoort |
| + | |style="background-color: white;"|Thermische brandwond (code = '105594005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|onderarm (code = '362741001' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | = | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Dieptegraad |
| − | | | + | |style="background-color: white;"|1e graad (code = '77140003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Toelichting |
| + | |style="background-color: white;"|Meneer kreeg hete thee over zich heen, wond is ongeveer 2 bij 2 cm; geen verband nodig. | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|DatumLaatsteVerbandwissel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 dag |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Brandwond | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|OntstaansDatum |
| + | |style="background-color: white;"|T - 2 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Uitgebreidheid |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 % |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|BrandwondSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Thermische brandwond (code = '105594005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| + | |style="background-color: white;"|handrug (code = '63125000' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Dieptegraad |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2e graad, oppervlakkig (code = '262587005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|DecubitusWond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|DecubitusCategorie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Decubitus categorie 2 (code = '420324007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '2') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|OntstaansDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 2 dagen |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| + | |style="background-color: white;"|hiel (code = '76853006' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DatumLaatsteVerbandwissel |
| − | | | + | |style="background-color: white;"|T - 1 dag |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondlengte |
| − | | | + | |style="background-color: white;"|2 cm |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondbreedte |
| + | |style="background-color: white;"|2 cm | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wonddiepte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|0.5 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Wond is niet geïnfecteerd. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|DecubitusWond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DecubitusCategorie |
| − | | | + | |style="background-color: white;"|Decubitus categorie 1 (code = '421076008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '1') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|OntstaansDatum |
| + | |style="background-color: white;"|T - 20 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|stuitje (code = '182028002' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|DatumLaatsteVerbandwissel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 dag |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondlengte |
| + | |style="background-color: white;"|3 cm | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Wondbreedte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Wonddiepte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|0.2 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|Huidaandoening |
|-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="6"| | + | |colspan="6"|SoortAandoening |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Intertrigo/smetten (code = '58759008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|OntstaansDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 6 dagen |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| + | |style="background-color: white;"|lies (code = '26893007' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Smetten zonder natten of infectie, inmiddels genezen. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|Huidaandoening |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|SoortAandoening |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Anders (code = 'OTH' in codeSystem '<span title="2.16.840.1.113883.5.1008">HL7 NullFlavor</span>'): Inverse psoriasis |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|OntstaansDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 10 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Oorzaak |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-probleem-03|Probleem: eovd-1-1-probleem-03]] |
| − | |- | ||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| + | |style="background-color: white;"|oksel (code = '91470000' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechts en links (code = '51440002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|Wond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="13"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|WondSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Traumatische wond (code = '416462003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|WondWeefsel |
| − | | | + | |style="background-color: white;"|Rode wond (code = 'ROOD' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.2') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|WondInfectie |
| + | |style="background-color: white;"|Nee | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondVochtigheid |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Droge wond (code = 'DROOG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondlengte |
| + | |style="background-color: white;"|2 cm | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wondbreedte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|4 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wonddiepte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|0.1 cm |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| − | | | + | |style="background-color: white;"|knie (code = '72696002' in codeSystem 'SNOMED Clinical Terms') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Lateraliteit |
| + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondOntstaansdatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 12 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|DatumLaatsteVerbandwissel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 dag |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Toelichting |
| + | |style="background-color: white;"|oppervlakkige schaafwond na CVA, geen verband nodig | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Wond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="18"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|WondSoort |
| + | |style="background-color: white;"|Chirurgische wond (code = '112633009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondInfectie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Nee |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|WondVochtigheid |
| + | |style="background-color: white;"|Vochtige wond (code = 'VOCHTIG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondRand |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ondermijning (code = '449752001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wondlengte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|5 cm |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondbreedte |
| − | | | + | |style="background-color: white;"|1 cm |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wonddiepte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|4 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Drain |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wonddrain (code = '258646005' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wonddrain |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 12 dagen |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Wond | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="11"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Oncologische ulcer (code = '94579000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|WondWeefsel |
| − | | | + | |style="background-color: white;"|Graad II (code = 'GRAAD2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.1') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|WondInfectie |
| + | |style="background-color: white;"|Nee | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Wondlengte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Wondbreedte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Wonddiepte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|WondOntstaansdatum | ||
| + | |style="background-color: white;"|T - 1 maand | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|DatumLaatsteVerbandwissel | ||
| + | |style="background-color: white;"|T - 1 dag | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Zintuigen | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="32"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|FunctieHoren | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="18"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|HoorFunctie | ||
| + | |style="background-color: white;"|Verminderde gehoorfunctie (code = '15188001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|HorenHulpmiddel |
|-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="6"|MedischHulpmiddel | |colspan="6"|MedischHulpmiddel | ||
|-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="5"|Product | |colspan="5"|Product | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="3"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|ProductID | ||
| + | |style="background-color: white;"|012345678905 (code = '012345678905Global Trade Item Number (GTIN)') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|ProductType | |colspan="3"|ProductType | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gehoorapparaat (code = '6012004' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|ProductOmschrijving | |colspan="4"|ProductOmschrijving | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gehoorapparaat |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Linkeroor (code = '89644007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|HorenHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|MedischHulpmiddel | |colspan="6"|MedischHulpmiddel | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|ProductOmschrijving | ||
| + | |style="background-color: white;"|Gehoorapparaat | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|AnatomischeLocatie | ||
| + | |style="background-color: white;"|Rechteroor (code = '25577004' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|FunctieZien | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="11"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|VisueleFunctie | ||
| + | |style="background-color: white;"|Verminderd gezichtsvermogen (code = '397540003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|ZienHulpmiddel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|MedischHulpmiddel | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Product | |colspan="5"|Product | ||
| Regel 5.560: | Regel 5.633: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|ProductType | |colspan="3"|ProductType | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|bril (code = '50121007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|ProductOmschrijving | |colspan="4"|ProductOmschrijving | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|bril |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Toelichting | |colspan="6"|Toelichting | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|zonder bril bestaat verhoogd valrisico |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="9"| | + | |colspan="9"|Ziektebeleving |
|-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="8"| | + | |colspan="8"|Ziektebeleving |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="4"| | |rowspan="4"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ZiekteInzichtVanPatiënt |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|meneer kan niet overzien wat de ziekte betekent in het dagelijkse leven |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|OmgaanMetZiekteprocesDoorPatiënt |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|meneer wil niet praten over de toekomst. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|OmgaanMetZiekteprocesDoorNaasten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|echtgenote maakt zich zorgen of zij de zorg voor meneer wel aan kan, omdat zij zelf ook slecht ter been is |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Mentale status |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="15"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|Probleem |
|-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="6"| | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Symptoom (code = '418799008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|gedaald bewustzijn (code = '443371007' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 22 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Toelichting | |colspan="6"|Toelichting | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|sinds cva, verminderde alertheid |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|Probleem |
|-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="6"| | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Klacht (code = '409586006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|toestand van verwardheid (code = '286933003' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 22 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ProbleemEindDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"|2 | + | |style="background-color: white;"|Niet actueel (code = '73425007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |}<section end=eOvd-SOV-tst-1.1-alle_zibs /> | ||
| + | <section begin=eOvd-SOV-tst-1.5-zwangerschap /> | ||
| + | ==Test Overdracht 1.5== | ||
| + | |||
| + | === 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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Datum overplaatsing |
| − | |style="background-color: white;"|T - | + | |style="background-color: white;"|T + 2 dagen |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Persoonsgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="31"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Patient |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="18"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Naamgegevens | ||
|-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="3"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|M. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
|-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=" | + | |colspan="2"|Voorvoegsels |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|van de |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|XXX_Quigleys |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Adresgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Straat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Knolweg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Huisnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1000 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Postcode |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999ZA |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Woonplaats |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stitswerd |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|AdresSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Identificatienummer |
| + | |style="background-color: white;"|999900912 (in identificerend systeem: BSN) | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geboortedatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|5 nov 1963 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geslacht |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Vrouw (code = 'F' in codeSystem '<span title="2.16.840.1.113883.5.1">HL7 AdministrativeGender</span>') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Betaler |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Verzekeraar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Verzekering |
|-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"|EindDatumTijd |
| + | |style="background-color: white;"|T + 250 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Verzekeringssoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Basis (code = 'B' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.101.5.1">ZIB Verzekeringssoort</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|IdentificatieNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9664 (in identificerend systeem: UZOVI) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Trias |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|VerzekerdeNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|12345678 |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Sturende organisatie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="15"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="6"|Zorgaanbieder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|75616161 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|HomeCare |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|OrganisatieType |
| + | |style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgverlener |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="8"| | |rowspan="8"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Naamgegevens |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|Voornamen |
| + | |style="background-color: white;"|Bart | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geslachtsnaam |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Moorman |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Verpleegkundigen, niet nader gespecificeerd (code = '9100' in codeSystem 'Vektis AGB-medische specialismen') |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Ontvangende organisatie |
|-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="6"| | + | |colspan="6"|Zorgaanbieder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|06121212 (in identificerend systeem: URA) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|AB-zkh |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|AfdelingSpecialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, obstetrie en gynaecologie (code = '0307' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |colspan="4"|OrganisatieType |
| + | |style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') | ||
| + | |} | ||
| + | === Medische context=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="7" | Medische context | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="6" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Behandelaar | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="11"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgverlener |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="9"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ZorgverlenerIdentificatienummer |
| + | |style="background-color: white;"|03171717 (in identificerend systeem: AGB-Z) | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Naamgegevens |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|Initialen |
| + | |style="background-color: white;"|K. | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geslachtsnaam |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Oosterhout |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Specialisme | ||
| + | |style="background-color: white;"|Medisch specialisten, obstetrie en gynaecologie (code = '0307' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Medische diagnose | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="8"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="6"|Probleem | ||
|-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="4"| | + | |colspan="4"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|zwangerschapsgeïnduceerde hypertensie (code = '48194001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 10 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|VerificatieStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bevestigd (code = '410605003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Pijnscore |
|-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="6"|PijnScore |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|PijnscoreWaarde |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|PijnscoreDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 dag om 12:30 uur |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|PijnMeetmethode |
| + | |style="background-color: white;"|VAS10 (code = 'VAS10' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.9.1') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|structuur van rug exclusief nek (code = '77568009' in codeSystem 'SNOMED Clinical Terms') |
| − | | | + | |} |
| − | + | === Verpleegkundige context: zorgplan=== | |
| − | |style="background-color: white;"| | + | |
| + | {| 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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Actuele patiëntproblemen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="16"| | |rowspan="16"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|<span id="eovd-1-5-probleem-01" title="Intern ID = eovd-1-5-probleem-01">Probleem eovd-1-5-probleem-01</span> |
|-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="3"|ProbleemAnatomischeLocatie |
| + | |style="background-color: white;"|structuur van rug exclusief nek (code = '77568009' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|pijn (bevinding) (code = '22253000' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 10 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-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;"|bij lopen |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|<span id="eovd-1-5-interventie-01" title="Intern ID = eovd-1-5-interventie-01">VerpleegkundigeInterventie eovd-1-5-interventie-01</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|afleiden (code = '414039005' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Indicatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-5-probleem-01|Probleem: eovd-1-5-probleem-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Zorgresultaat |
|-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="6"|UitkomstVanZorg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Zorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|zie pijnscore |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Interventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|VerpleegkundigeInterventie |
| − | |style="background-color: white;"|Zie [[#eovd-1- | + | |style="background-color: white;"|Zie [[#eovd-1-5-interventie-01|VerpleegkundigeInterventie: eovd-1-5-interventie-01]] |
| + | |} | ||
| + | === Verpleegkundige context: specificatie gezondheidstoestand=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="5" | Verpleegkundige context: specificatie gezondheidstoestand | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="4" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Voortplanting |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Zwangerschap |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="2"|Zwanger |
| + | |style="background-color: white;"|Ja | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|ATermeDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 120 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|DatumLaatsteMenstruatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 170 dagen |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="2"|Zwangerschapsduur |
| + | |style="background-color: white;"|160 dagen | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="2"|Graviditeit | ||
| + | |style="background-color: white;"|1 | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Pariteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|0 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Mevrouw is vaak misselijk in de ochtend. |
| + | |}<section end=eOvd-SOV-tst-1.5-zwangerschap /> | ||
| + | <section begin=eOvd-SOV-tst-1.6-interventie-ggz /> | ||
| + | ==Test Overdracht 1.6== | ||
| + | |||
| + | === 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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Datum overplaatsing |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 1 dag |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Persoonsgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="30"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Patient |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="17"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Initialen | ||
| + | |style="background-color: white;"|M. | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geslachtsnaam |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|XXX_Arcken |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Adresgegevens | ||
|-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="3"|Straat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Knolweg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Huisnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1000 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Postcode |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999XA |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Woonplaats |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stitswerd |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|AdresSoort |
| + | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Identificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|999900043 (in identificerend systeem: BSN) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geboortedatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|18 sep 1963 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geslacht |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Vrouw (code = 'F' in codeSystem '<span title="2.16.840.1.113883.5.1">HL7 AdministrativeGender</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Betaler | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Verzekeraar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Verzekering |
|-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=" | + | |colspan="2"|EindDatumTijd |
| − | |style="background-color: white;"|T | + | |style="background-color: white;"|T + 250 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Verzekeringssoort |
| − | |style="background-color: white;"|1 | + | |style="background-color: white;"|Basis (code = 'B' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.101.5.1">ZIB Verzekeringssoort</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|IdentificatieNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9664 (in identificerend systeem: UZOVI) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Trias |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|VerzekerdeNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|12345678 |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Sturende organisatie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="14"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgaanbieder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|75616161 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|HomeCare |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Zorgverlener | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bart |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Geslachtsnaam |
|-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=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Moorman |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Ontvangende organisatie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="6"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="6"|Zorgaanbieder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|75727272 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|St. Geestelijk Welzijn |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieType |
| − | |style="background-color: white;"|2 | + | |style="background-color: white;"|Geestelijke Gezondheidszorg (code = 'G5' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') |
| + | |} | ||
| + | === Algemene patiënten context=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="5" | Algemene patiënten 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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="4"|<span id="eovd-1-6-juridischesituatie-01" title="Intern ID = eovd-1-6-juridischesituatie-01">JuridischeSituatie eovd-1-6-juridischesituatie-01</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|JuridischeStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechterlijke machtiging (code = 'RM' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.2') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="2"|DatumAanvang |
| + | |style="background-color: white;"|T - 3 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|DatumEinde |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 3 maanden |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|JuridischeSituatie | ||
|-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=" | + | |colspan="2"|Vertegenwoordiging |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Mentorschap (code = '8' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="2"|DatumAanvang |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 6 maanden |
| + | |} | ||
| + | === Medische context=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="7" | Medische context | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="6" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Behandelaar | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="12"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="6"|Zorgverlener | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ZorgverlenerIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|01171717 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|K. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
|-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=" | + | |colspan="2"|Voorvoegsels |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|van |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Eindhoven |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Huisartspraktijk (code = '0100' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Medische diagnose |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="8"| | |rowspan="8"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Probleem | ||
|-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="4"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ProbleemNaam |
| + | |style="background-color: white;"|niet-organische psychose (code = '191525009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|VerificatieStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bevestigd (code = '410605003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Vrijheidsbeperking |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="20"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|VrijheidsbeperkendeInterventie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="8"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Wilsbekwaam |
| − | |||
| − | |||
| − | |||
|style="background-color: white;"|Nee | |style="background-color: white;"|Nee | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|WilsbekwaamToelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wegens psychose |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|JuridischeSituatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-6-juridischesituatie-01|JuridischeSituatie: eovd-1-6-juridischesituatie-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|SoortInterventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|geslotendeurprocedure (code = '225210009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|RedenVanToepassen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|afwenden van situatie die kan resulteren in toebrengen van schade aan zichzelf of aan anderen (code = '121481000146105' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Instemming |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Geen instemming patiënt (code = '1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Begin |
| − | + | |style="background-color: white;"|T + 1 dag | |
| − | |||
| − | |||
| − | |style="background-color: white;"|T | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VrijheidsbeperkendeInterventie |
|-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="4"|Wilsbekwaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Nee |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|WilsbekwaamToelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wegens psychose |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|JuridischeSituatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-6-juridischesituatie-01|JuridischeSituatie: eovd-1-6-juridischesituatie-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|SoortInterventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|separeren in extra beveiligde kamer (code = '124041000146108' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|RedenVanToepassen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|afwenden van situatie die kan resulteren in toebrengen van schade aan zichzelf of aan anderen (code = '121481000146105' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Instemming |
| − | |style="background-color: white;"|1 | + | |style="background-color: white;"|Geen instemming patiënt (code = '1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Begin |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 1 dag |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Einde |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 3 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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Actuele patiëntproblemen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="17"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="15"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|<span id="eovd-1-6-probleem-01" title="Intern ID = eovd-1-6-probleem-01">Probleem eovd-1-6-probleem-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|fysieke agressie (code = '248004009' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|<span id="eovd-1-6-interventie-01" title="Intern ID = eovd-1-6-interventie-01">VerpleegkundigeInterventie eovd-1-6-interventie-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|rustige en geruststellende houding aannemen (code = '225980008' in codeSystem 'SNOMED Clinical Terms') |
| + | |-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=" | + | |colspan="2"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-6-probleem-01|Probleem: eovd-1-6-probleem-01]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Behandeldoel | ||
|-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=" | + | |colspan="2"|GewenstZorgresultaat |
| − | + | |style="background-color: white;"|Veilige omgeving is gerealiseerd voor patient/ naasten; duur VBI beperken | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | | | ||
| − | |style="background-color: white;"| | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Zorgresultaat |
|-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="6"|UitkomstVanZorg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Zorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|doel is behaald |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Interventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="2"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|VerpleegkundigeInterventie | ||
| + | |style="background-color: white;"|Zie [[#eovd-1-6-interventie-01|VerpleegkundigeInterventie: eovd-1-6-interventie-01]] | ||
| + | |}<section end=eOvd-SOV-tst-1.6-interventie-ggz /> | ||
| + | <section begin=eOvd-SOV-tst-1.7-interventie-wzd /> | ||
| + | ==Test Overdracht 1.7== | ||
| + | |||
| + | === 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 + 5 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Persoonsgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="30"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Patient |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="17"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|M. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
|-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=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|XXX_Schouten-Baak |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Adresgegevens |
|-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="3"|Straat |
| + | |style="background-color: white;"|Knolweg | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Huisnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1001 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Postcode |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999XX |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|Woonplaats |
| + | |style="background-color: white;"|Stitswerd | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|AdresSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Identificatienummer | ||
| + | |style="background-color: white;"|999900055 (in identificerend systeem: BSN) | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geboortedatum | ||
| + | |style="background-color: white;"|18 sep 1963 | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslacht | ||
| + | |style="background-color: white;"|Man (code = 'M' in codeSystem '<span title="2.16.840.1.113883.5.1">HL7 AdministrativeGender</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Betaler |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Verzekeraar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Verzekering |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="2"|EindDatumTijd | ||
| + | |style="background-color: white;"|T + 250 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="2"|Verzekeringssoort |
| + | |style="background-color: white;"|Basis (code = 'B' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.101.5.1">ZIB Verzekeringssoort</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|IdentificatieNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9664 (in identificerend systeem: UZOVI) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Trias |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|VerzekerdeNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|12345678 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Sturende organisatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgaanbieder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="4"| | |rowspan="4"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|75616161 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|HomeCare |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgverlener |
|-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="5"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bart |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
|-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 | + | |colspan="2"|Achternaam |
| − | + | |style="background-color: white;"|Moorman | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |style="background-color: white;"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Ontvangende organisatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Zorgaanbieder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|47707070 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|St. Zonnehof |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Verpleeghuis (code = 'R5' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') |
| − | + | |} | |
| − | + | === Algemene patiënten context=== | |
| − | |||
| − | |} | ||
| − | |||
| − | |||
| − | |||
| − | === | ||
{| class="wikitable" width="85%" | {| class="wikitable" width="85%" | ||
| − | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan=" | + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="5" | Algemene patiënten context |
|-style="background-color: #1F497D;; color: white; text-align:left;" | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| − | |colspan=" | + | |colspan="4" width="30%"| Gegevenselement |
|| Waarde | || Waarde | ||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Juridische situatie |
|-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="4"|<span id="eovd-1-7-juridischesituatie-01" title="Intern ID = eovd-1-7-juridischesituatie-01">JuridischeSituatie eovd-1-7-juridischesituatie-01</span> |
|-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"|JuridischeStatus |
| + | |style="background-color: white;"|Besluit tot opname en verblijf (code = 'OPM' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.2') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|DatumAanvang |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|JuridischeSituatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="3"| | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Vertegenwoordiging |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zaakwaarneming (code = '10' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|DatumAanvang |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 6 maanden |
| + | |} | ||
| + | === Medische context=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="7" | Medische context | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="6" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Behandelaar | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="12"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="6"|Zorgverlener | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ZorgverlenerIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|01171717 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Naamgegevens |
|-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="3"|Initialen |
| + | |style="background-color: white;"|K. | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Geslachtsnaam |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="3"| | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Voorvoegsels |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|van |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Eindhoven |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Huisartspraktijk (code = '0100' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Medische diagnose |
|-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="6"| | + | |colspan="6"|Probleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|delier (code = '2776000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|ProbleemBeginDatum | ||
| + | |style="background-color: white;"|T - 10 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Vrijheidsbeperking |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="19"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VrijheidsbeperkendeInterventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Wilsbekwaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Nee |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|WilsbekwaamToelichting |
| + | |style="background-color: white;"|Kan eigen situatie niet beoordelen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|JuridischeSituatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-7-juridischesituatie-01|JuridischeSituatie: eovd-1-7-juridischesituatie-01]] |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|SoortInterventie |
| − | | | + | |style="background-color: white;"|constante supervisie met camera (code = '121411000146104' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|RedenVanToepassen |
| + | |style="background-color: white;"|afwenden van crisissituatie (code = '121491000146107' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Instemming |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Instemming wettelijke vertegenwoordiger (code = '4' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Begin |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 4 dagen |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VrijheidsbeperkendeInterventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Wilsbekwaam |
| + | |style="background-color: white;"|Nee | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|WilsbekwaamToelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Kan zich niet orienteren |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|JuridischeSituatie |
| + | |style="background-color: white;"|Zie [[#eovd-1-7-juridischesituatie-01|JuridischeSituatie: eovd-1-7-juridischesituatie-01]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|SoortInterventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|constante supervisie met elektronisch traceringsmiddel (code = '121451000146100' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|RedenVanToepassen |
| + | |style="background-color: white;"|afwenden van situatie die kan resulteren in toebrengen van schade aan zichzelf of aan anderen (code = '121481000146105' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Instemming |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Instemming wettelijke vertegenwoordiger (code = '4' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Begin |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 4 dagen |
| − | + | |} | |
| − | + | === Verpleegkundige context: zorgplan=== | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | | | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
{| class="wikitable" width="85%" | {| class="wikitable" width="85%" | ||
| − | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="7" | | + | |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;" | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
|colspan="6" width="30%"| Gegevenselement | |colspan="6" width="30%"| Gegevenselement | ||
|| Waarde | || Waarde | ||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Actuele patiëntproblemen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="17"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="15"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|<span id="eovd-1-7-probleem-01" title="Intern ID = eovd-1-7-probleem-01">Probleem eovd-1-7-probleem-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|acute verwardheid (code = '130987000' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|ProbleemBeginDatum |
| + | |style="background-color: white;"|T - 5 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|<span id="eovd-1-7-interventie-01" title="Intern ID = eovd-1-7-interventie-01">VerpleegkundigeInterventie eovd-1-7-interventie-01</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="8"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|omgevingsstimuli minimaliseren (code = '710978006' in codeSystem 'SNOMED Clinical Terms') |
| + | |-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=" | + | |colspan="2"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-7-probleem-01|Probleem: eovd-1-7-probleem-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Behandeldoel |
| + | |-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"|GewenstZorgresultaat |
| + | |style="background-color: white;"|DOSS < 3 | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Zorgresultaat |
|-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="6"|UitkomstVanZorg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Zorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|DOSS = 2 |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Interventie | ||
|-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="3"| | + | |colspan="3"|VerpleegkundigeInterventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-7-interventie-01|VerpleegkundigeInterventie: eovd-1-7-interventie-01]] |
| + | |}<section end=eOvd-SOV-tst-1.7-interventie-wzd /> | ||
| + | <section begin=eOvd-SOV-tst-1.8-uitscheiding /> | ||
| + | ==Test Overdracht 1.8== | ||
| + | |||
| + | === 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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Datum overplaatsing |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 2 dagen |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Persoonsgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="29"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Patient |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|M. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
|-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=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|XXX_Koutrik |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |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;"|1002 | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Postcode | ||
| + | |style="background-color: white;"|9999ZZ | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Woonplaats | ||
| + | |style="background-color: white;"|STITSWERD | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|AdresSoort | ||
| + | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Identificatienummer | ||
| + | |style="background-color: white;"|999900067 (in identificerend systeem: BSN) | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Geboortedatum |
| + | |style="background-color: white;"|18 sep 1963 | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Betaler |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan="5"| | + | |rowspan="10"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Verzekeraar | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="8"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Verzekering |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="2"|EindDatumTijd | ||
| + | |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 '<span title="2.16.840.1.113883.2.4.3.11.60.101.5.1">ZIB Verzekeringssoort</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|IdentificatieNummer | ||
| + | |style="background-color: white;"|9664 (in identificerend systeem: UZOVI) | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|OrganisatieNaam |
| + | |style="background-color: white;"|Trias | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|VerzekerdeNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|12345678 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Sturende organisatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="15"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Zorgaanbieder | |colspan="6"|Zorgaanbieder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|ZorgaanbiederIdentificatienummer | |colspan="4"|ZorgaanbiederIdentificatienummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|06121212 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|OrganisatieNaam | |colspan="4"|OrganisatieNaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|EF-zkh |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|AfdelingSpecialisme | ||
| + | |style="background-color: white;"|Medisch specialisten, urologie (code = '0306' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|OrganisatieType | ||
| + | |style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Zorgverlener | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="7"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Naamgegevens | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="5"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Voornamen | ||
| + | |style="background-color: white;"|Bart | ||
| + | |-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;"|Moorman | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Ontvangende organisatie | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="6"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Zorgaanbieder | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="4"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|ZorgaanbiederIdentificatienummer | ||
| + | |style="background-color: white;"|47707070 (in identificerend systeem: AGB-Z) | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|OrganisatieNaam | ||
| + | |style="background-color: white;"|St. Zonnehof | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|OrganisatieType | ||
| + | |style="background-color: white;"|Verpleeghuis (code = 'R5' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') | ||
|} | |} | ||
=== Medische context=== | === Medische context=== | ||
| Regel 6.733: | Regel 6.930: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|ZorgverlenerIdentificatienummer | |colspan="4"|ZorgverlenerIdentificatienummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|03848484 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
| Regel 6.740: | Regel 6.937: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Initialen | |colspan="3"|Initialen | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|P. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
| Regel 6.747: | Regel 6.944: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Boomsma |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Specialisme | |colspan="4"|Specialisme | ||
| − | |style="background-color: white;"|Medisch specialisten, | + | |style="background-color: white;"|Medisch specialisten, urologie (code = '0306' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Medische diagnose | |colspan="7"|Medische diagnose | ||
| Regel 6.761: | Regel 6.958: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|ProbleemNaam | |colspan="4"|ProbleemNaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|fistel tussen blaas en sigmoïd (code = '197861003') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|ProbleemStatus | |colspan="4"|ProbleemStatus | ||
|style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| − | |} | + | |} |
| − | + | === Verpleegkundige context: zorgplan=== | |
| − | |||
| − | |||
| − | === | ||
{| class="wikitable" width="85%" | {| class="wikitable" width="85%" | ||
| − | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="7" | | + | |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;" | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
|colspan="6" width="30%"| Gegevenselement | |colspan="6" width="30%"| Gegevenselement | ||
|| Waarde | || Waarde | ||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Actuele patiëntproblemen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="13"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="11"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|<span id="eovd-1.8-patientprobleem-01" title="Intern ID = eovd-1.8-patientprobleem-01">Probleem eovd-1.8-patientprobleem-01</span> |
|-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="3"| | + | |colspan="3"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|incontinentie voor feces (code = '72042002' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|VerpleegkundigeInterventie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|zorg bij fecale incontinentie (code = '386223004' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Indicatie |
|-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"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1.8-patientprobleem-01|Probleem: eovd-1.8-patientprobleem-01]] |
| + | |} | ||
| + | === 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"|Uitscheiding | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="26"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Blaasfunctie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|UrineKatheter | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="8"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="5"|MedischHulpmiddel | ||
|-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="4"|Product |
|-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=" | + | |colspan="2"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Verblijfskatheter (code = '23973005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Verblijfskatheter |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Darmfunctie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="13"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|FecesContinentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Incontinent (code = '72042002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Frequentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 per dag |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|DefecatieConsistentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zachte stukjes met gehavende randen (code = 'Type 6' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.3.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|DefecatieKleur |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Grijswit (code = '267056008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Incontinentiemateriaal | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |rowspan="7"| |
| − | |style="background-color: white;"| | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="5"|MedischHulpmiddel | ||
| + | |-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"|ProductType | ||
| + | |style="background-color: white;"|opvangzak voor fecesincontinentie (code = '469627000' in codeSystem 'SNOMED Clinical Terms') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|ProductOmschrijving | ||
| + | |style="background-color: white;"|opvangzak voor fecesincontinentie | ||
| + | |}<section end=eOvd-SOV-tst-1.8-uitscheiding /> | ||
| + | <section begin=eOvd-SOV-val-1.1-alle_zibs /> | ||
| + | ==Validatie Overdracht 1.1== | ||
| + | |||
| + | === 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="89"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Patient | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="30"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Naamgegevens | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="10"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Voornamen | ||
| + | |style="background-color: white;"|Rihanna | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Initialen | ||
| + | |style="background-color: white;"|R. | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="2"|Voorvoegsels | ||
| + | |style="background-color: white;"|van | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="2"|Achternaam | ||
| + | |style="background-color: white;"|XXX_Zelst | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|GeslachtsnaamPartner | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|AchternaamPartner |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Asaroğlu |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Adresgegevens | |colspan="5"|Adresgegevens | ||
| Regel 6.864: | Regel 7.131: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Straat | |colspan="3"|Straat | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Knolweg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Huisnummer | |colspan="3"|Huisnummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1003 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Postcode | |colspan="3"|Postcode | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999ZA |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Woonplaats | |colspan="3"|Woonplaats | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stitswerd |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|AdresSoort | |colspan="3"|AdresSoort | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Officieel adres (code = 'HP' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Contactgegevens | |colspan="5"|Contactgegevens | ||
|-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="4"|Telefoonnummers | |colspan="4"|Telefoonnummers | ||
| Regel 6.887: | Regel 7.154: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Telefoonnummer | |colspan="2"|Telefoonnummer | ||
| − | |style="background-color: white;"|+ | + | |style="background-color: white;"|+316-99990108 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | + | |colspan="4"|EmailAdressen | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |colspan="4"|EmailAdressen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|EmailAdres | |colspan="2"|EmailAdres | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|rzelst195407@gmail.com |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Identificatienummer | |colspan="4"|Identificatienummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|999910371 (in identificerend systeem: BSN) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geboortedatum | |colspan="4"|Geboortedatum | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|29 jul 1954 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslacht | |colspan="4"|Geslacht | ||
| Regel 6.932: | Regel 7.185: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|EindDatumTijd | |colspan="2"|EindDatumTijd | ||
| − | |style="background-color: white;"|T + | + | |style="background-color: white;"|T + 1 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Verzekeringssoort | |colspan="2"|Verzekeringssoort | ||
| Regel 6.938: | Regel 7.191: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|IdentificatieNummer | |colspan="3"|IdentificatieNummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9665 (in identificerend systeem: UZOVI) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|OrganisatieNaam | |colspan="3"|OrganisatieNaam | ||
| Regel 6.944: | Regel 7.197: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|VerzekerdeNummer | |colspan="3"|VerzekerdeNummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|12345679 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"|Contactpersoon | + | |colspan="6"|<span id="eovd-1-1-contactpersoon-01" title="Intern ID = eovd-1-1-contactpersoon-01">Contactpersoon eovd-1-1-contactpersoon-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="25"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
|-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="3"|Voornamen | |colspan="3"|Voornamen | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Helena |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Initialen | |colspan="3"|Initialen | ||
| Regel 6.961: | Regel 7.214: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Roepnaam | |colspan="3"|Roepnaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Lenie |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
| Regel 6.971: | Regel 7.221: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Slager |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Contactgegevens | |colspan="5"|Contactgegevens | ||
| Regel 6.989: | Regel 7.232: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Telefoonnummer | |colspan="2"|Telefoonnummer | ||
| − | |style="background-color: white;"|+ | + | |style="background-color: white;"|+316-99990009 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|EmailAdressen | |colspan="4"|EmailAdressen | ||
| Regel 6.996: | Regel 7.239: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|EmailAdres | |colspan="2"|EmailAdres | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|lenie@123net.nl |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Adresgegevens | |colspan="5"|Adresgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Straat | |colspan="3"|Straat | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Knolweg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Huisnummer | |colspan="3"|Huisnummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1003 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|AdditioneleInformatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|ingang via achtertuin |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|AdresSoort | |colspan="3"|AdresSoort | ||
| Regel 7.031: | Regel 7.259: | ||
|colspan="4"|Rol | |colspan="4"|Rol | ||
|style="background-color: white;"|Eerste relatie/contactpersoon (code = '1' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.22.472">Vektis Rolcode COD472-VEKT</span>') | |style="background-color: white;"|Eerste relatie/contactpersoon (code = '1' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.22.472">Vektis Rolcode COD472-VEKT</span>') | ||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Relatie | |colspan="4"|Relatie | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Schoondochter (code = 'DAUINLAW' in codeSystem '<span title="2.16.840.1.113883.5.111">HL7 RoleCode</span>') |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Contactpersoon |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="19"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Voornamen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Pleun |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
|-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=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bloemist |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Contactgegevens | |colspan="5"|Contactgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Telefoonnummers | |colspan="4"|Telefoonnummers | ||
| Regel 7.070: | Regel 7.290: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Telefoonnummer | |colspan="2"|Telefoonnummer | ||
| − | |style="background-color: white;"|+ | + | |style="background-color: white;"|+316-99990008 |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Adresgegevens | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="4"| | ||
| + | |-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;"|1003 | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|AdresSoort | ||
| + | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Rol | ||
| + | |style="background-color: white;"|Buur (code = '19' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.22.472">Vektis Rolcode COD472-VEKT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Relatie | ||
| + | |style="background-color: white;"|Anders (code = 'OTH' in codeSystem '<span title="2.16.840.1.113883.5.1008">HL7 NullFlavor</span>'): Rechter buurman | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Sturende organisatie | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="34"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="6"|Zorgaanbieder |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="21"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|ZorgaanbiederIdentificatienummer | ||
| + | |style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z) | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|OrganisatieNaam | ||
| + | |style="background-color: white;"|AB-zkh | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|OrganisatieLocatie | ||
| + | |style="background-color: white;"|Noord | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|AfdelingSpecialisme |
| + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Contactgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Telefoonnummers |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Telefoonnummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|+31182435770 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|EmailAdressen | |colspan="4"|EmailAdressen | ||
| Regel 7.091: | Regel 7.347: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|EmailAdres | |colspan="2"|EmailAdres | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|neurologie@ABZ.nl |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Adresgegevens | |colspan="5"|Adresgegevens | ||
|-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="3"|Straat | |colspan="3"|Straat | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Knolweg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Huisnummer | |colspan="3"|Huisnummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|10 |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Postcode | |colspan="3"|Postcode | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999PO |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Woonplaats | |colspan="3"|Woonplaats | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stitswerd |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|AdresSoort | |colspan="3"|AdresSoort | ||
| Regel 7.132: | Regel 7.373: | ||
|colspan="6"|Zorgverlener | |colspan="6"|Zorgverlener | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
|-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="3"|Voornamen | |colspan="3"|Voornamen | ||
| Regel 7.142: | Regel 7.383: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Initialen | |colspan="3"|Initialen | ||
| − | |style="background-color: white;"|C.M. | + | |style="background-color: white;"|C. M. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Roepnaam | |colspan="3"|Roepnaam | ||
|style="background-color: white;"|Lotte | |style="background-color: white;"|Lotte | ||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
|-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"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bruinsma |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Specialisme | |colspan="4"|Specialisme | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Verpleegkundigen, niet nader gespecificeerd (code = '9100' in codeSystem 'Vektis AGB-medische specialismen') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Ontvangende organisatie | |colspan="7"|Ontvangende organisatie | ||
| Regel 7.214: | Regel 7.407: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|ZorgaanbiederIdentificatienummer | |colspan="4"|ZorgaanbiederIdentificatienummer | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|75131313 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|OrganisatieNaam | |colspan="4"|OrganisatieNaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|ThuiszorgOrg |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|OrganisatieLocatie | |colspan="4"|OrganisatieLocatie | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Noord |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|AfdelingSpecialisme | |colspan="4"|AfdelingSpecialisme | ||
| − | |style="background-color: white;"|Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT | + | |style="background-color: white;"|Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|OrganisatieType | |colspan="4"|OrganisatieType | ||
|style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') | |style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') | ||
|} | |} | ||
| − | === | + | === Algemene patiënten context=== |
{| class="wikitable" width="85%" | {| class="wikitable" width="85%" | ||
| − | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan=" | + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="10" | Algemene patiënten context |
|-style="background-color: #1F497D;; color: white; text-align:left;" | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| − | |colspan=" | + | |colspan="9" width="30%"| Gegevenselement |
|| Waarde | || Waarde | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Gezinssituatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Gezinssituatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|BurgerlijkeStaat | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|BurgerlijkeStaatRC |
|-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=" | + | |colspan="5"|BurgerlijkeStaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gehuwd (code = 'M' in codeSystem '<span title="2.16.840.1.113883.5.2">HL7 MaritalStatus</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Gezinssamenstelling |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Alleenwonend (code = '105529008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Zorgtaak |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|zorgt voor zijn kat |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Juridische situatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|<span id="eovd-val-1-1-juridischesituatie-01" title="Intern ID = eovd-val-1-1-juridischesituatie-01">JuridischeSituatie eovd-val-1-1-juridischesituatie-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="3"| | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Vertegenwoordiging |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bewindvoering (code = '7' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|DatumAanvang |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 jaar |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Woonomgeving |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Woonsituatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|WoningType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Aanleunwoning (code = 'AANLW' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.40.4.13.1">ZIB WoningType</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Levensovertuiging |
|-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="9"|LevensovertuigingRC |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Levensovertuiging |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Protestant (code = '309885004' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Wilsverklaring |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="7"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|WilsverklaringType |
| + | |style="background-color: white;"|Niet reanimeren verklaring (code = 'NR' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.40.4.14.1">ZIB WilsverklaringType</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|WilsverklaringDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 4 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Vertegenwoordiger |
|-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=" | + | |colspan="6"|Contactpersoon |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-1-1-contactpersoon-01|Contactpersoon: eovd-1-1-contactpersoon-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wilsverklaring bevindt zich in de portemonnee. |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Sociale omgeving |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="39"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|ParticipatieInMaatschappij |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|SociaalNetwerk |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|heeft veel contact met buren |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Vrijetijdsbesteding |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|viool spelen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Arbeidssituatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gepensioneerd |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="9"| | + | |colspan="9"|HulpVanAnderen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="19"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="8"| | + | |colspan="8"|Hulpverlener |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Mantelzorger |
|-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="6"| | + | |colspan="6"|Contactpersoon |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
|-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="3"|Voornamen | |colspan="3"|Voornamen | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Marriet |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Initialen | |colspan="3"|Initialen | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|M. |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Naamgebruik | |colspan="3"|Naamgebruik | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Eigen geslachtsnaam (code = 'NL1' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.101.5.4">ZIB Naamgebruik</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
|-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"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Blauw |
| − | |-style="vertical-align:top; background-color: #E3E3E3;;" | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | |colspan="4"| | + | |colspan="4"|Rol |
| + | |style="background-color: white;"|Buur (code = '19' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.22.472">Vektis Rolcode COD472-VEKT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|Aard |
| + | |style="background-color: white;"|helpt met ondersteuning echtgenoot als mevrouw er niet is | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Frequentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|zo vaak als nodig |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|SoortHulp |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Mantelzorg (code = '386229000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|HulpVanAnderen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="12"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Hulpverlener |
|-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=" | + | |colspan="7"|Zorgaanbieder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|WijZorgen |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|OrganisatieLocatie |
| + | |style="background-color: white;"|Stitswerd | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Thuiszorg (code = 'T2' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|Aard |
| + | |style="background-color: white;"|ondersteuning bij wassen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Frequentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|dagelijks |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|SoortHulp |
| + | |style="background-color: white;"|Professionele thuiszorg (code = '60689008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|niet in het weekend |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="10"|Communicatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Taalvaardigheid |
|-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=" | + | |colspan="7"|CommunicatieTaal |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Nederlands (code = 'nl' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|TaalvaardigheidBegrijpen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|TaalvaardigheidSpreken |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Slecht (code = 'P' in codeSystem '2.16.840.1.113883.5.61') |
| − | |-style="vertical-align:top; background-color: #E3E3E3;;" | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | |colspan=" | + | |colspan="7"|TaalvaardigheidLezen |
| + | |style="background-color: white;"|Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|Toelichting |
| + | |style="background-color: white;"|t.g.v. CVA nu moeite met begrijpen, spreken gaat ook moeilijk i.v.m. afasie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Taalvaardigheid |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|CommunicatieTaal |
| + | |style="background-color: white;"|Limburgs (code = 'li' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|TaalvaardigheidBegrijpen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Goed (code = 'G' in codeSystem '2.16.840.1.113883.5.61') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="7"|TaalvaardigheidSpreken |
| + | |style="background-color: white;"|Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|opgegroeid in Zuid-Limburg |
| + | |} | ||
| + | === Medische context=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="9" | Medische context | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="8" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Behandelaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|<span id="eovd-val-1-1-behandelaar-01" title="Intern ID = eovd-val-1-1-behandelaar-01">Zorgverlener eovd-val-1-1-behandelaar-01</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="14"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Naamgegevens |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|Voornamen |
| + | |style="background-color: white;"|Joshua Pieter | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|J. P. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Geslachtsnaam |
|-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=" | + | |colspan="4"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Helmond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Zorgaanbieder | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|AB-zkh |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Noord |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Behandelaar | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="16"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|<span id="eovd-val-1-1-behandelaar-02" title="Intern ID = eovd-val-1-1-behandelaar-02">Zorgverlener eovd-val-1-1-behandelaar-02</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="14"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ZorgverlenerIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|03898989 (in identificerend systeem: AGB-Z) |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|G. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Geslachtsnaam | ||
|-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=" | + | |colspan="4"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Spijkerman |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, gastro-enterologie (maag-darm-lever-arts) (code = '0318' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Zorgaanbieder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|ZorgaanbiederIdentificatienummer |
| − | | | + | |style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z) |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|OrganisatieNaam |
| + | |style="background-color: white;"|AB-zkh | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|OrganisatieLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Noord |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Medische diagnose |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="21"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|<span id="eovd-val-1-1-probleem-01" title="Intern ID = eovd-val-1-1-probleem-01">Probleem eovd-val-1-1-probleem-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|cardiovasculair letsel (code = '282728007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|ProbleemBeginDatum | ||
| + | |style="background-color: white;"|T - 100 dagen | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|ProbleemStatus | ||
| + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VerificatieStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Bevestigd (code = '410605003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|<span id="eovd-val-1-1-probleem-02" title="Intern ID = eovd-val-1-1-probleem-02">Probleem eovd-val-1-1-probleem-02</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|benigne neoplasma van colon (code = '92065004') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 150 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|<span id="eovd-val-1-1-probleem-03" title="Intern ID = eovd-val-1-1-probleem-03">Probleem eovd-val-1-1-probleem-03</span> |
|-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="6"|ProbleemLateraliteit |
| + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|ProbleemNaam |
| + | |style="background-color: white;"|gecompliceerde fractuur van enkel (code = '48187004' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Voorgeschiedenis | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Probleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Diagnose (code = '282291009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|diabetes mellitus (code = '73211009') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 12 jaar |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|ProbleemStatus |
| + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Allergie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="37"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|AllergieIntolerantie |
|-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="6"|VeroorzakendeStof |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|nikkelsulfaat (code = '255848005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AllergieCategorie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stof of product (code = '419199007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AllergieStatus |
| + | |style="background-color: white;"|Actief (code = 'active' in codeSystem '<span title="2.16.840.1.113883.5.14">HL7 ActStatus</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BeginDatumTijd |
| − | |style="background-color: white;"|T | + | |style="background-color: white;"|T - 10 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MateVanKritiekZijn |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Matig (code = '6736007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|opgemerkt bij het dragen van nikkel bevattende sieraden. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Reactie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Symptoom |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Contactdermatitis (code = '40275004' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ReactieBeschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|last van jeuk, roodheid en irritatie op de contactplek van nikkel bevattende sieraden. |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|WijzeVanBlootstelling |
| + | |style="background-color: white;"|intra-epidermale route (code = '448077001' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|AllergieIntolerantie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="22"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VeroorzakendeStof |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|pollen (code = '256259004') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AllergieCategorie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Omgeving (code = '426232007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AllergieStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actief (code = 'active' in codeSystem '<span title="2.16.840.1.113883.5.14">HL7 ActStatus</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|BeginDatumTijd |
| − | | | + | |style="background-color: white;"|T - 500 dagen |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|MateVanKritiekZijn |
| + | |style="background-color: white;"|Matig (code = '6736007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|LaatsteReactieDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 99 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | + | |colspan="7"|Reactie | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |colspan="7"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|Symptoom |
| + | |style="background-color: white;"|Overgevoeligheidsreactie van de bovenste luchtwegen (code = '490008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|SpecifiekeStof |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|graspollen (code = '256277009') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ReactieBeschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|veelvuldig niezen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Ernst |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Matig (code = '6736007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|ReactieTijdstip |
| + | |style="background-color: white;"|T - 99 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Reactie |
|-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="5"|Symptoom |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Kortademigheid (code = '267036007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|Symptoom |
| + | |style="background-color: white;"|Koorts (code = '386661006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|SpecifiekeStof |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|pollen van paprikaplant (code = '110181000146104') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|ReactieBeschrijving |
| + | |style="background-color: white;"|ernstige benauwdheid en koorts | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Ernst |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ernstig (code = '24484000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ReactieTijdstip |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 200 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Let op |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Alert |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AlertNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Drager MRSA (code = '432415000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BeginDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 20 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AlertType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|waarschuwing (code = '74018-3' in codeSystem '<span title="2.16.840.1.113883.6.1">LOINC</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Alert | ||
|-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=" | + | |colspan="6"|AlertNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Anders (code = 'OTH' in codeSystem '<span title="2.16.840.1.113883.5.1008">HL7 NullFlavor</span>'): ernstige claustrofobie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | + | |colspan="6"|BeginDatumTijd | |
| − | + | |style="background-color: white;"|T - 10 jaar | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |colspan="6"| | ||
| − | |style="background-color: white;"|T | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Vrijheidsbeperking |
|-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="8"|VrijheidsbeperkendeInterventie |
|-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="6"|Wilsbekwaam |
| + | |style="background-color: white;"|Ja | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|JuridischeSituatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-val-1-1-juridischesituatie-01|JuridischeSituatie: eovd-val-1-1-juridischesituatie-01]] |
| − | |- | ||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|SoortInterventie |
| + | |style="background-color: white;"|geforceerd toedienen van voeding bij patiënt (code = '37041007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|RedenVanToepassen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|bevorderen van fysieke gezondheid (code = '121581000146106' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Begin |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 50 dagen |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Meetwaarden | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="57"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="8"|Bloeddruk | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="11"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Meetmethode |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Niet-invasief (code = '22762002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ManchetType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Standaard (code = 'STD' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.40.4.15.1">ZIB ManchetType</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MeetLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechter bovenarm (code = '368209003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|DiastolischEindpunt |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Fase V (code = '255272007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|SystolischeBloeddruk |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|170 mm[Hg] |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DiastolischeBloeddruk |
| − | | | + | |style="background-color: white;"|90 mm[Hg] |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|GemiddeldeBloeddruk |
| − | | | + | |style="background-color: white;"|110 mm[Hg] |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|BloeddrukDatumTijd |
| + | |style="background-color: white;"|T - 20 dagen om 14:45 uur | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|mevrouw gebruikt medicatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Houding |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Liggende positie (code = '102538003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Polsfrequentie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|PolsfrequentieWaarde |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|90 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|PolsfrequentieDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen om 14:45 uur |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Toelichting | ||
| + | |style="background-color: white;"|is altijd sportief geweest | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|PolsRegelmatigheid | ||
| + | |style="background-color: white;"|Polsslag regelmatig (code = '271636001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Lichaamstemperatuur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|TemperatuurWaarde |
| + | |style="background-color: white;"|36.8 Cel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TemperatuurDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 4 dagen om 07 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|voeten voelen heel koud aan |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TemperatuurType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Tympanische temperatuur (code = '415974002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Ademhaling |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="20"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Ademfrequentie |
| − | | | + | |style="background-color: white;"|18 /min |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AdemhalingDatumTijd |
| + | |style="background-color: white;"|T - 3 dagen om 14:45 uur | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Ritme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Abnormaal ademhalingsritme (code = '85617008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Diepte |
| + | |style="background-color: white;"|Normale ademhalingsdiepte (code = '301284009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AfwijkendAdemhalingspatroon |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Apneu (code = '1023001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ExtraZuurstofToediening |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ja |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Toelichting |
| + | |style="background-color: white;"|mevrouw lijkt angstig | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|ToegediendeZuurstof |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="11"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|FlowRate |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 l/min |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|FiO2 |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|0.29 l |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|ToedieningHulpmiddel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Product |
|-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"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Neusbril (code = '336623009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|neusbril |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Lichaamsgewicht |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|GewichtWaarde |
| + | |style="background-color: white;"|74 kg | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|mevrouw volgt afvaldieet |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|GewichtDatumTijd |
| + | |style="background-color: white;"|T - 5 dagen om 14:30 uur | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Kleding |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Volledig gekleed, inclusief schoenen (code = 'FULL' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.40.4.8.1">ZIB ContextKleding</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Lichaamslengte |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|LengteWaarde |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|170 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|LengteDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen om 14:30 uur |
| − | |-style="vertical-align:top; background-color: #E3E3E3;;" | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | |colspan=" | + | |colspan="6"|Toelichting |
| + | |style="background-color: white;"|zonder schoenen aan | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Pijnscore | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="9"| | |rowspan="9"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|PijnScore |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="7"| | |rowspan="7"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|PijnscoreWaarde |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|PijnscoreDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen om 14:45 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|PijnMeetmethode |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|NRS (code = 'NRS' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.9.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|gehele voet (code = '302545001' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"|niet | + | |style="background-color: white;"|Af en toe pijn, maar niet belemmerend bij het lopen |
| − | |} | + | |} |
| − | + | === Verpleegkundige context: zorgplan=== | |
| − | == | ||
| − | |||
| − | |||
{| class="wikitable" width="85%" | {| class="wikitable" width="85%" | ||
| − | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan=" | + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="9" | Verpleegkundige context: zorgplan |
|-style="background-color: #1F497D;; color: white; text-align:left;" | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| − | |colspan=" | + | |colspan="8" width="30%"| Gegevenselement |
|| Waarde | || Waarde | ||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Actuele patiëntproblemen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="41"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="22"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|<span id="eovd-val-1-1-patientprobleem-01" title="Intern ID = eovd-val-1-1-patientprobleem-01">Probleem eovd-val-1-1-patientprobleem-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|probleem met zichzelf wassen en afdrogen (code = '288552005' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="5"|ProbleemBeginDatum |
| + | |style="background-color: white;"|T - 100 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|mevrouw kan niet buigen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|<span id="eovd-val-1-1-interventie-01" title="Intern ID = eovd-val-1-1-interventie-01">VerpleegkundigeInterventie eovd-val-1-1-interventie-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Interventie |
| − | |style="background-color: white;"| | + | |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="6"|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=" | + | |colspan="4"|Probleem |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-val-1-1-patientprobleem-01|Probleem: eovd-val-1-1-patientprobleem-01]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Behandeldoel | ||
|-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=" | + | |colspan="4"|GewenstZorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wassen onafhankelijk |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ActieStartDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 90 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Frequentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 /dag |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Instructie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|let op: valrisico |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Uitvoerder |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Zorgverlener |
| + | |style="background-color: white;"|Ja | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|<span id="eovd-val-1-1-patientprobleem-02" title="Intern ID = eovd-val-1-1-patientprobleem-02">Probleem eovd-val-1-1-patientprobleem-02</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|probleem met zichzelf kleden (code = '284972002' in codeSystem 'Referentieset Nationale kernset patientproblemen') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 90 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|<span id="eovd-val-1-1-interventie-02" title="Intern ID = eovd-val-1-1-interventie-02">VerpleegkundigeInterventie eovd-val-1-1-interventie-02</span> | ||
|-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="5"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|ondersteunen bij aankleden (code = '313332003' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Indicatie |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Probleem |
| + | |style="background-color: white;"|Zie [[#eovd-val-1-1-patientprobleem-02|Probleem: eovd-val-1-1-patientprobleem-02]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Behandeldoel |
|-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="4"| | + | |colspan="4"|GewenstZorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|kleden onafhankelijk |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Frequentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|3 /dag |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Zorgresultaat | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="13"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan | + | |colspan="8"|UitkomstVanZorg |
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgresultaat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|doel deels behaald: kan nog niet rug wassen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Interventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|VerpleegkundigeInterventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-val-1-1-interventie-01|VerpleegkundigeInterventie: eovd-val-1-1-interventie-01]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|UitkomstVanZorg | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Zorgresultaat |
| + | |style="background-color: white;"|doel deels behaald, kan nog niet zelf veters strikken | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Interventie |
|-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=" | + | |colspan="5"|VerpleegkundigeInterventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-val-1-1-interventie-02|VerpleegkundigeInterventie: eovd-val-1-1-interventie-02]] |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Afspraken patiënt | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="81"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="8"|Contact | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="55"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ContactType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Poliklinisch (code = 'AMB' in codeSystem '<span title="2.16.840.1.113883.5.4">HL7 ActCode</span>') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ContactMet |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="11"| | |rowspan="11"| | ||
| Regel 8.208: | Regel 8.311: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="9"| | |rowspan="9"| | ||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="6"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Voornamen | ||
| + | |style="background-color: white;"|Joshua Pieter | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="3"|Initialen | |colspan="3"|Initialen | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|J.P. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
| Regel 8.224: | Regel 8.327: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Helmond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Specialisme | |colspan="4"|Specialisme | ||
| − | |style="background-color: white;"|Medisch specialisten, | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ContactMet |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="11"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Zorgverlener |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="9"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ZorgverlenerIdentificatienummer |
| + | |style="background-color: white;"|03686868 (in identificerend systeem: AGB-Z) | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Initialen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|F. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Geslachtsnaam | ||
|-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=" | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Snijder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Specialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, neurochirurgie (code = '0308' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Locatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="23"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Zorgaanbieder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="21"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ZorgaanbiederIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|06590457 (in identificerend systeem: AGB-Z) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|AB-zkh |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|OrganisatieLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Noord |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|AfdelingSpecialisme |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Contactgegevens |
|-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="4"|Telefoonnummers |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |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"|EmailAdressen | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="2"|EmailAdres | ||
| + | |style="background-color: white;"|neurologie@ABZ.nl | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Adresgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Straat |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Knolweg |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Huisnummer | ||
| + | |style="background-color: white;"|10 | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Postcode |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999PO |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|Woonplaats |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stitswerd |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="3"| | + | |colspan="3"|AdresSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Werkadres (code = 'WP' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Algemeen ziekenhuis (code = 'V6' in codeSystem '<span title="2.16.840.1.113883.2.4.15.1060">HL7 RoleCodeNL Care provider type (organizations)</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|BeginDatumTijd |
| + | |style="background-color: white;"|T + 5 dagen om 10:00 uur | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|EindDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 5 dagen om 10:30 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|RedenContact |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Probleem |
| − | |style="background-color: white;"|Zie [[#eovd-1- | + | |style="background-color: white;"|Zie [[#eovd-val-1-1-probleem-01|Probleem: eovd-val-1-1-probleem-01]] |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Contact |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="23"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|ContactType |
| + | |style="background-color: white;"|Thuis (code = 'HH' in codeSystem '<span title="2.16.840.1.113883.5.4">HL7 ActCode</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|ContactMet |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgverlener |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="14"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ZorgverlenerIdentificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|88131313 (in identificerend systeem: AGB-Z) |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Naamgegevens |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|Initialen |
| + | |style="background-color: white;"|W. | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |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;"|Bloem | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Specialisme |
| + | |style="background-color: white;"|Ergotherapeuten (code = '8800' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Contactgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="4"|EmailAdressen | ||
|-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"|EmailAdres |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|bloem@ergotherapie.nl |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BeginDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 12 dagen om 15:15 uur |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|RedenContact | ||
|-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=" | + | |colspan="5"|RedenContactTekst |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Controle voortgang revalidatie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Wensen en behoeften patiënt en/of naasten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|mevrouw wil zo snel mogelijk weer zelfstandig kunnen functioneren en haar kat kunnen verzorgen |
| − | |} | + | |} |
| − | + | === Verpleegkundige context: specificatie gezondheidstoestand=== | |
| − | == | ||
| − | |||
| − | |||
{| class="wikitable" width="85%" | {| class="wikitable" width="85%" | ||
| − | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan=" | + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="9" | Verpleegkundige context: specificatie gezondheidstoestand |
|-style="background-color: #1F497D;; color: white; text-align:left;" | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| − | |colspan=" | + | |colspan="8" width="30%"| Gegevenselement |
|| Waarde | || Waarde | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Zelfzorg | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="103"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotDrinken |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Drinken |
| − | | | + | |style="background-color: white;"|Hulp nodig (code = '16681000146102' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DrinkBeperkingen |
| + | |style="background-color: white;"|Bereiden (openen/uitschenken) (code = '286506008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotDrinken |
|-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=" | + | |colspan="6"|Drinken |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '19841000146104' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DrinkBeperkingen |
| − | | | + | |style="background-color: white;"|Vastpakken (code = '307071002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | | | ||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotEten |
|-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=" | + | |colspan="6"|Eten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '129033007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|EetBeperkingen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Snijden/openen (code = '289078003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotEten | ||
|-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=" | + | |colspan="6"|Eten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '165224005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|EetBeperkingen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Eetgerei hanteren (code = '289046006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotMondverzorging | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="18"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VerzorgenTanden |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '16671000146104' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Prothese | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Product |
|-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="3"|ProductType |
| + | |style="background-color: white;"|Gebitsprothese (code = '27606000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gebitsprothese bovenkaak |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Prothese | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gebitsprothese (code = '27606000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gebitsprothese onderkaak |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotZichWassen |
|-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="6"|ZichWassen |
| + | |style="background-color: white;"|Hulp nodig (code = '16621000146103' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TeWassenLichaamsdeel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onderlichaam (code = '362875007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotZichWassen |
|-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="6"|ZichWassen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '16621000146103' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|TeWassenLichaamsdeel | ||
| + | |style="background-color: white;"|Bovenlichaam (code = '362874006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotZichKleden |
|-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="6"|ZichKleden |
| + | |style="background-color: white;"|Hulp nodig (code = '129039006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TeKledenLichaamsdeel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onderlichaam (code = '362875007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotZichKleden | ||
|-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=" | + | |colspan="6"|ZichKleden |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '129035000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|TeKledenLichaamsdeel |
| + | |style="background-color: white;"|Bovenlichaam (code = '362874006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotUiterlijkeVerzorging |
|-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=" | + | |colspan="6"|UiterlijkeVerzorging |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '27941000146109' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotToiletgang | ||
|-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=" | + | |colspan="6"|Toiletgebruik |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '129062008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotZelfstandigMedicatiegebruik |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="17"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ZelfstandigMedicatiegebruik |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '27921000146103' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|HulpBijToediening | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="14"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VerpleegkundigeInterventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="12"| | |rowspan="12"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Interventie | ||
| + | |style="background-color: white;"|bevorderen van therapietrouw met behulp van medicijndispenser (code = '710153008' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Behandeldoel |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|GewenstZorgresultaat |
| + | |style="background-color: white;"|therapietrouw | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Frequentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 /d |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Product |
|-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"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|medicatierol (code = '713308004' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|baxterrol |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|VermogenTotVerpleegtechnischeHandelingen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="15"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|VerpleegkundigeInterventie |
|-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="6"| | + | |colspan="6"|VerpleegkundigeInterventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Stoma care procedure (code = '225194008' in codeSystem 'SNOMED Clinical Terms') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Behandeldoel | ||
|-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="4"| | + | |colspan="3"|GewenstZorgresultaat |
| − | |style="background-color: white;"|T - 5 | + | |style="background-color: white;"|goede hygiene met betrekking tot stoma |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|ActieStartDatumTijd | ||
| + | |style="background-color: white;"|T - 6 dagen | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Uitvoerder | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="3"|Patient | ||
| + | |style="background-color: white;"|Ja | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|toezicht bij uitvoer, en instructie hygiënisch werken |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VerrichtenVPKHandeling |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '27931000146101' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|VermogenTotVerpleegtechnischeHandelingen |
|-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="7"|VerpleegkundigeInterventie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="6"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|VerpleegkundigeInterventie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|vervangen van verband (code = '18949003' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ActieStartDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 dag |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Interval |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VerrichtenVPKHandeling |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '27931000146101' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Toelichting zelfzorg |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|kan zich steeds beter redden met wassen en kleden, knoopjes dichtdoen en schoenen met hulp. |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="9"|Mobiliteit | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="28"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Mobiliteit |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="26"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lopen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '16581000146103' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Traplopen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Volledig afhankelijk (code = '301589003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|HoudingVeranderen |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '19821000146105' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|HoudingHandhaven |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '19811000146100' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|UitvoerenTransfer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Hulp nodig (code = '714917003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|MedischHulpmiddel |
|-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="5"| | + | |colspan="5"|Product |
|-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="3"| | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|rollator (code = '404946006' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|rollator |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="9"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|MedischHulpmiddel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|rolstoel (code = '58938008' in codeSystem 'SNOMED Clinical Terms') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ProductOmschrijving |
| + | |style="background-color: white;"|rolstoel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 maand |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Toelichting |
| − | | | + | |style="background-color: white;"|voor langere afstanden |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | + | |colspan="6"|Toelichting | |
| − | + | |style="background-color: white;"|lopen is stuk verbeterd, rechter been minder krachtig | |
| − | |colspan=" | ||
| − | |style="background-color: white;"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Voeding/vocht |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="127"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Voedingsadvies |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DieetType |
| − | | | + | |style="background-color: white;"|suikervrij, diabetes dieet |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Consistentie |
| + | |style="background-color: white;"|dik vloeibaar | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|eet naar eigen keuze minder vlees |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Voedingsadvies |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|DieetType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|geen varkensvlees |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|SNAQScore |
|-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="6"|GewichtsverliesScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|LossAverage (code = 'G1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.1 (ordinal = '2') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|EetlustScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.2 (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VoedingsScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|GeenVoeding (code = 'Z0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.3 (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TotaalScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|SNAQScoreDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 6 dagen om 17 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|geen verminderde eetlust ondanks chemotherapie |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|SNAQrcScore |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|GewichtsverliesScore |
| − | | | + | |style="background-color: white;"|LossHigh (code = 'G2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.1 (ordinal = '2') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|EetlustScore |
| + | |style="background-color: white;"|Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.2 (ordinal = '0') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BMIScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gezond (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.3 (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|HulpBijEten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Onafhankelijk (code = '165224005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '0') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TotaalScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|SNAQrcScoreDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 6 dagen om 17 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|geen verminderde eetlust ondanks chemotherapie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|SNAQ65+Score |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |-style="vertical-align:top; background-color: #E3E3E3;;" | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | |colspan="6"| | + | |colspan="6"|GewichtsverliesScore |
| + | |style="background-color: white;"|LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.1 (ordinal = '0') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|BovenarmOmtrekScore | ||
| + | |style="background-color: white;"|Normaal (code = 'A0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.4 (ordinal = '0') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|EetlustScore | ||
| + | |style="background-color: white;"|Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.2 (ordinal = '0') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|InspanningsScore |
| + | |style="background-color: white;"|Mogelijk (code = 'In0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.3 (ordinal = '0') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TotaalScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|0 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|SNAQ65+ScoreDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 6 dagen om 17 uur |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|geen verminderde eetlust ondanks chemotherapie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|MUSTScore |
|-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="6"|BMIScore |
| + | |style="background-color: white;"|BMIHigh (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.1 (ordinal = '0') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|GewichtsverliesScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.2 (ordinal = '0') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|ZiekteScore |
| + | |style="background-color: white;"|Ziek (code = 'Z1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.3 (ordinal = '2') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|TotaalScore |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|MUSTScoreDatumTijd |
| + | |style="background-color: white;"|T - 12 dagen om 17 uur | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Vochtbalans |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VochtTotaalIn |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1400 ml |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VochtTotaalUit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1000 ml |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|VochtbalansStarttijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 6 dagen om 07 uur |
| − | | | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | + | |colspan="6"|VochtbalansStoptijd | |
| − | + | |style="background-color: white;"|T - 5 dagen om 07 uur | |
| − | + | |-style="vertical-align:top; background-color: #E3E3E3;;" | |
| − | |style="background- | + | |colspan="8"|SondeSysteem |
| − | |-style="background-color: # | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | |colspan=" | + | |rowspan="15"| |
| − | || | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | + | |colspan="7"|Sonde | |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="11"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="9"| | |rowspan="9"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|ProductType |
| + | |style="background-color: white;"|Neus-maagsonde (code = '17102003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|neus- maagsonde |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|BeginDatum |
|style="background-color: white;"|T - 5 dagen | |style="background-color: white;"|T - 5 dagen | ||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|AnatomischeLocatie |
| + | |style="background-color: white;"|neusgat (code = '363538002' in codeSystem 'SNOMED Clinical Terms') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Lateraliteit | ||
| + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Zorgverlener | ||
| + | |style="background-color: white;"|Zie [[#eovd-val-1-1-behandelaar-02|Zorgverlener: eovd-val-1-1-behandelaar-02]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|SondeLengte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|575 mm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | + | |style="background-color: white;"|wegens misselijkheid door chemotherapie | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | | | ||
| − | | | ||
| − | | | ||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|SondeSysteem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="17"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Sonde |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|PEJ sonde (code = '8911000146104' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|PEJ sonde |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|MedischHulpmiddel |
|-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="6"| | + | |colspan="6"|Product |
|-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="4"| | + | |colspan="4"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|enterale voedingspomp (code = '468664004' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|enterale voedingspomp |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|BeginDatum |
| − | |style="background-color: white;"|T - | + | |style="background-color: white;"|T - 5 dagen |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Infuus | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="27"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Infuuskatheter |
|-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="6"| | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Product | ||
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Centraal veneuze katheter (code = '52124006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|centraal veneuze katheter |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 20 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|onder sleutelbeen links |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|structuur van vena subclavia (code = '9454009' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|Zorgverlener |
| + | |style="background-color: white;"|Zie [[#eovd-val-1-1-behandelaar-02|Zorgverlener: eovd-val-1-1-behandelaar-02]] | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|voor voeding |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|LumenOfLijn | ||
|-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=" | + | |colspan="5"|LijnStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|LumenLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Distaal (code = '46053002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|LumenOfLijn | ||
|-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=" | + | |colspan="5"|LijnStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Afgedopt (code = 'DOP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|LumenLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Mediaal (code = '255561001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|LumenOfLijn |
|-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="5"|LijnStatus |
| + | |style="background-color: white;"|Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|LumenLocatie | ||
| + | |style="background-color: white;"|Distaal (code = '46053002' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Infuus |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="16"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Infuuskatheter | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="8"| | |rowspan="8"| | ||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Perifeer intraveneus infuus (code = '82449006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|ProductOmschrijving | ||
| + | |style="background-color: white;"|Perifeer intraveneus infuus | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|BeginDatum | ||
| + | |style="background-color: white;"|T - 15 dagen | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|AnatomischeLocatie | ||
| + | |style="background-color: white;"|onderarm (code = '14975008' in codeSystem 'SNOMED Clinical Terms') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|Lateraliteit | ||
| + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Toelichting | ||
| + | |style="background-color: white;"|voor medicatie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|LumenOfLijn |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|LijnStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Uitscheiding |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="41"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Blaasfunctie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="13"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|UrineContinentie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Af en toe een ongelukje (max. 1 keer per 24 uur) (code = '165233007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Urostoma |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Stoma |
| − | |style="background-color: white;"|Zie [[#eovd-1- | + | |style="background-color: white;"|Zie [[#eovd-val-1-1-stoma-02|Stoma: eovd-val-1-1-stoma-02]] |
| − | | | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| − | + | |colspan="7"|Incontinentiemateriaal | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |colspan=" | ||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|Product |
|-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="3"|ProductType |
| + | |style="background-color: white;"|inlegger voor incontinentiebroek (code = '470713005' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|inlegger |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Darmfunctie |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Stoma |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Zie [[#eovd-val-1-1-stoma-01|Stoma: eovd-val-1-1-stoma-01]] |
| − | |- | ||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DefecatieConsistentie |
| + | |style="background-color: white;"|Helemaal vloeibaar (code = 'Type 7' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.3.1') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|stoma na subtotale darmresectie wegens coloncarcinoom |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|<span id="eovd-val-1-1-stoma-01" title="Intern ID = eovd-val-1-1-stoma-01">Stoma eovd-val-1-1-stoma-01</span> | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="14"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|StomaType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|eindstandige ileostoma (code = '311412005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|StomaMateriaal | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="7"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="6"|MedischHulpmiddel | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="5"| |
| − | |style="background-color: | + | |-style="vertical-align:top; background-color: #E3E3E3;;" |
| + | |colspan="5"|Product | ||
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ileostomy bag (code = '417136005' in codeSystem 'SNOMED Clinical Terms') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ProductOmschrijving |
| − | | | + | |style="background-color: white;"|stomazak voor ileostoma |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| − | | | + | |style="background-color: white;"|onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Lateraliteit |
| + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AanlegDatum |
| − | |style="background-color: white;"|T | + | |style="background-color: white;"|T - 12 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|na subtotale darmresectie wegens coloncarcinoom |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|<span id="eovd-val-1-1-stoma-02" title="Intern ID = eovd-val-1-1-stoma-02">Stoma eovd-val-1-1-stoma-02</span> |
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|StomaType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|urostoma (code = '281601009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AanlegDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 4 jaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Huid |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="91"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Brandwond |
|-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="6"|OntstaansDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 2 dagen |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Uitgebreidheid |
| + | |style="background-color: white;"|1 % | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|BrandwondSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Thermische brandwond (code = '105594005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| − | | | + | |style="background-color: white;"|onderarm (code = '362741001' in codeSystem 'SNOMED Clinical Terms') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Lateraliteit |
| + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Dieptegraad |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1e graad (code = '77140003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Mevrouw kreeg hete thee over zich heen, wond is ongeveer 2 bij 2 cm; geen verband nodig. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|DatumLaatsteVerbandwissel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 dag |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Brandwond |
|-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="6"|OntstaansDatum |
| + | |style="background-color: white;"|T - 2 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Uitgebreidheid |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 % |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|BrandwondSoort |
| + | |style="background-color: white;"|Thermische brandwond (code = '105594005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|handrug (code = '63125000' in codeSystem 'SNOMED Clinical Terms') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Lateraliteit |
| + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Dieptegraad |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2e graad, oppervlakkig (code = '262587005' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|DecubitusWond | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="10"| |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DecubitusCategorie |
| − | | | + | |style="background-color: white;"|Decubitus categorie 2 (code = '420324007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '2') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|OntstaansDatum |
| + | |style="background-color: white;"|T - 2 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|hiel (code = '76853006' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DatumLaatsteVerbandwissel |
| − | | | + | |style="background-color: white;"|T - 1 dag |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondlengte |
| − | | | + | |style="background-color: white;"|2 cm |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondbreedte |
| + | |style="background-color: white;"|2 cm | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wonddiepte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|0.5 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Wond is niet geïnfecteerd. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|DecubitusWond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|DecubitusCategorie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Decubitus categorie 1 (code = '421076008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span> (ordinal = '1') |
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|OntstaansDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 20 dagen |
| − | + | |-style="vertical-align:top; background-color: #E3E3E3;;" | |
| − | + | |colspan="6"|AnatomischeLocatie | |
| − | + | |style="background-color: white;"|stuitje (code = '182028002' in codeSystem 'SNOMED Clinical Terms') | |
| − | + | |-style="vertical-align:top; background-color: #E3E3E3;;" | |
| − | + | |colspan="6"|DatumLaatsteVerbandwissel | |
| − | | | + | |style="background-color: white;"|T - 1 dag |
| − | | | ||
| − | |||
| − | |||
| − | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondlengte |
| − | | | + | |style="background-color: white;"|3 cm |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondbreedte |
| − | | | + | |style="background-color: white;"|1 cm |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wonddiepte |
| + | |style="background-color: white;"|0.2 cm | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Huidaandoening |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|SoortAandoening |
| + | |style="background-color: white;"|Intertrigo/smetten (code = '58759008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|OntstaansDatum | ||
| + | |style="background-color: white;"|T - 6 dagen | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|lies (code = '26893007' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Rechts (code = '24028007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Smetten zonder natten of infectie, inmiddels genezen. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Wond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="13"| | |rowspan="13"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Traumatische wond (code = '416462003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondWeefsel |
| − | |style="background-color: white;"|2 | + | |style="background-color: white;"|Rode wond (code = 'ROOD' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.2') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondInfectie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Nee |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondVochtigheid |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Droge wond (code = 'DROOG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondlengte |
| − | | | + | |style="background-color: white;"|2 cm |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondbreedte |
| − | | | + | |style="background-color: white;"|4 cm |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wonddiepte |
| + | |style="background-color: white;"|0.1 cm | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|knie (code = '72696002' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | < | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|WondOntstaansdatum |
| − | |style="background-color: white;"|T | + | |style="background-color: white;"|T - 5 dagen |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|DatumLaatsteVerbandwissel |
| − | | | + | |style="background-color: white;"|T - 1 dag |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Toelichting |
| + | |style="background-color: white;"|oppervlakkige schaafwond na CVA, geen verband nodig | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Wond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="18"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondSoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Chirurgische wond (code = '112633009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|WondInfectie |
| + | |style="background-color: white;"|Nee | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondVochtigheid |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Vochtige wond (code = 'VOCHTIG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondRand |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Ondermijning (code = '449752001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wondlengte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|5 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wondbreedte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 cm |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wonddiepte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|4 cm |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| + | |style="background-color: white;"|onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Drain |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="8"| | |rowspan="8"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="6"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="5"|Product | ||
|-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=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wonddrain (code = '258646005' in codeSystem 'SNOMED Clinical Terms') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|wonddrain |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|BeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 12 dagen |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Wond |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="11"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|WondSoort |
| + | |style="background-color: white;"|Oncologische ulcer (code = '94579000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondWeefsel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Graad II (code = 'GRAAD2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.1') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|WondInfectie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Nee |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wondlengte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|1 cm |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|Wondbreedte |
| + | |style="background-color: white;"|1 cm | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Wonddiepte |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 cm |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|AnatomischeLocatie |
| + | |style="background-color: white;"|buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Lateraliteit |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Links (code = '7771000' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|WondOntstaansdatum |
| + | |style="background-color: white;"|T - 1 maand | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|DatumLaatsteVerbandwissel |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 1 dag |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Zintuigen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="32"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|FunctieHoren |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="18"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|HoorFunctie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Verminderde gehoorfunctie (code = '15188001' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|HorenHulpmiddel | ||
|-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="6"|MedischHulpmiddel |
|-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="5"|Product |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|ProductID |
| + | |style="background-color: white;"|012345678905 (code = '012345678905Global Trade Item Number (GTIN)') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gehoorapparaat (code = '6012004' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="4"|ProductOmschrijving |
| + | |style="background-color: white;"|Gehoorapparaat | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|AnatomischeLocatie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Linkeroor (code = '89644007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | + | |colspan="7"|HorenHulpmiddel | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |colspan="7"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="5"| | |rowspan="5"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="3"| | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Gehoorapparaat |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="4"|AnatomischeLocatie | ||
| + | |style="background-color: white;"|Rechteroor (code = '25577004' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|FunctieZien | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="11"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|VisueleFunctie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Verminderd gezichtsvermogen (code = '397540003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|ZienHulpmiddel |
|-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="6"| | + | |colspan="6"|MedischHulpmiddel |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Product |
|-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="3"| | + | |colspan="3"|ProductType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|bril (code = '50121007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|ProductOmschrijving |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|bril |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | + | |colspan="6"|Toelichting | |
| − | + | |style="background-color: white;"|zonder bril bestaat verhoogd valrisico | |
| − | |colspan=" | ||
| − | |style="background-color: white;"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Ziektebeleving |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="6"| | |rowspan="6"| | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="8"|Ziektebeleving | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |rowspan="4"| |
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ZiekteInzichtVanPatiënt |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|mevrouw kan niet overzien wat de ziekte betekent in het dagelijkse leven |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|OmgaanMetZiekteprocesDoorPatiënt |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|mevrouw wil niet praten over de toekomst. |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|OmgaanMetZiekteprocesDoorNaasten |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|echtgenoot maakt zich zorgen of hij de zorg voor mevrouw wel aan kan, omdat hij zelf ook slecht ter been is |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="9"|Mentale status |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="15"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Probleem |
|-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=" | + | |colspan="6"|ProbleemType |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Symptoom (code = '418799008' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|ProbleemNaam |
| + | |style="background-color: white;"|gedaald bewustzijn (code = '443371007' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemBeginDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 22 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Toelichting |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|sinds cva, verminderde alertheid |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="8"|Probleem |
|-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="6"|ProbleemType |
| − | | | + | |style="background-color: white;"|Klacht (code = '409586006' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="6"|ProbleemNaam |
| + | |style="background-color: white;"|toestand van verwardheid (code = '286933003' in codeSystem 'SNOMED Clinical Terms') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemBeginDatum |
| − | |style="background-color: white;"|T | + | |style="background-color: white;"|T - 22 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemEindDatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T - 5 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Niet actueel (code = '73425007' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| + | |}<section end=eOvd-SOV-val-1.1-alle_zibs /> | ||
| + | <section begin=eOvd-SOV-val-1.2-minimaal /> | ||
| + | ==Validatie Overdracht 1.2 == | ||
| + | |||
| + | === 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;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Datum overplaatsing |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 6 dagen |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Persoonsgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="27"| |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Patient | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="14"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
| Regel 9.730: | Regel 9.666: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="2"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|XXX-Aansluittest-B |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Adresgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan | + | |rowspan="4"| |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|Huisnummer |
| + | |style="background-color: white;"|1000 | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|Postcode |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|9999XA |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|AdresSoort |
| + | |style="background-color: white;"|Woon-/verblijfadres (code = 'PHYS' in codeSystem '<span title="2.16.840.1.113883.5.1119">HL7 AddressUse</span>') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|Identificatienummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|999990019 (in identificerend systeem: BSN) |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Geboortedatum |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|2 feb 1950 |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Geslacht |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Vrouw (code = 'F' in codeSystem '<span title="2.16.840.1.113883.5.1">HL7 AdministrativeGender</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Betaler |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Verzekeraar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Verzekering |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="3"| | |rowspan="3"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|EindDatumTijd |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|T + 250 dagen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Verzekeringssoort |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Basis (code = 'B' in codeSystem '<span title="2.16.840.1.113883.2.4.3.11.60.101.5.1">ZIB Verzekeringssoort</span>') |
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|IdentificatieNummer |
| − | | | + | |style="background-color: white;"|9664 (in identificerend systeem: UZOVI) |
| − | | | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | | | + | |colspan="3"|OrganisatieNaam |
| + | |style="background-color: white;"|Trias | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="3"|VerzekerdeNummer |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|12345687 |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="7"|Sturende organisatie | |colspan="7"|Sturende organisatie | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="11"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Zorgaanbieder | |colspan="6"|Zorgaanbieder | ||
|-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="4"| | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|HomeCare |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="6"|Zorgverlener | ||
|-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="5"| | + | |colspan="5"|Naamgegevens |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|Geslachtsnaam |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Achternaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Moorman |
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |colspan="7"|Ontvangende organisatie | ||
| + | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| + | |rowspan="4"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgaanbieder |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|OrganisatieNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|St. Zonnehof |
| + | |} | ||
| + | === Medische context=== | ||
| + | |||
| + | {| class="wikitable" width="85%" | ||
| + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="7" | Medische context | ||
| + | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
| + | |colspan="6" width="30%"| Gegevenselement | ||
| + | || Waarde | ||
| + | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="7"|Behandelaar |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
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| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="6"|Zorgverlener | |colspan="6"|Zorgverlener | ||
|-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="5"|Naamgegevens | |colspan="5"|Naamgegevens | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|colspan="4"|Geslachtsnaam | |colspan="4"|Geslachtsnaam | ||
|-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"|Achternaam | |colspan="2"|Achternaam | ||
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Curaçao |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="7"| | + | |colspan="7"|Medische diagnose |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="5"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Probleem |
|-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="4"| | + | |colspan="4"|ProbleemNaam |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|toxisch delier (code = '231439009' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|} | |} | ||
| − | === | + | === Verpleegkundige context: zorgplan=== |
{| class="wikitable" width="85%" | {| class="wikitable" width="85%" | ||
| − | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="6" | | + | |style="background-color: #1F497D;; color: white; font-weight: bold; text-align:center;" colspan="6" | Verpleegkundige context: zorgplan |
|-style="background-color: #1F497D;; color: white; text-align:left;" | |-style="background-color: #1F497D;; color: white; text-align:left;" | ||
|colspan="5" width="30%"| Gegevenselement | |colspan="5" width="30%"| Gegevenselement | ||
| Regel 9.916: | Regel 9.805: | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="6"| | + | |colspan="6"|Actuele patiëntproblemen |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="10"| |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="5"| | + | |colspan="5"|Patiëntprobleem |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="8"| |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="4"|<span id="eovd-val-1-2-probleem-01" title="Intern ID = eovd-val-1-2-probleem-01">Probleem eovd-val-1-2-probleem-01</span> |
|-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"|ProbleemNaam |
| + | |style="background-color: white;"|acute verwardheid (code = '130987000' in codeSystem 'Referentieset Nationale kernset patientproblemen') | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="2"|ProbleemStatus |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|Actueel (code = '55561003' in codeSystem '<span title="2.16.840.1.113883.6.96">SNOMED CT</span>') |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="4"| | + | |colspan="4"|<span id="eovd-val-1-2-interventie-01" title="Intern ID = eovd-val-1-2-interventie-01">VerpleegkundigeInterventie eovd-val-1-2-interventie-01</span> |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
|rowspan="2"| | |rowspan="2"| | ||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan="2"| | + | |colspan="2"|Interventie |
| − | |style="background-color: white;"| | + | |style="background-color: white;"|omgevingsstimuli minimaliseren (code = '710978006' in codeSystem 'SNOMED Clinical Terms') |
| − | |||
| − | |||
| − | |||
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="6"|Zorgresultaat |
|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |rowspan=" | + | |rowspan="4"| |
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|-style="vertical-align:top; background-color: #E3E3E3;;" | |-style="vertical-align:top; background-color: #E3E3E3;;" | ||
| − | |colspan=" | + | |colspan="5"|UitkomstVanZorg |
|-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="3"|Zorgresultaat | |
| − | + | |style="background-color: white;"|DOSS = 2 | |
| − | + | |}<section end=eOvd-SOV-val-1.2-minimaal /> | |
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Huidige versie van 16 feb 2026 om 17:39
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Dit is een tijdelijke pagina met wijzigingen voor issue EOVDR-832. De gepubliceerde versie vind je hier. |
Inhoud
1 Addenda voor inhoudelijke gegevens
1.1 Kwalificatie Overdracht 1.1
1.1.1 Administratieve gegevens
| Administratieve gegevens | ||||||
| Gegevenselement | Waarde | |||||
| Datum overplaatsing | T + 1 dag | |||||
| Persoonsgegevens | ||||||
| Patient | ||||||
| Naamgegevens | ||||||
| Voornamen | Julius | |||||
| Initialen | J. | |||||
| Geslachtsnaam | ||||||
| Achternaam | XXX_Zonnenberg | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1002 | |||||
| Postcode | 9999ZZ | |||||
| Woonplaats | Stitswerd | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +316-99990109 | |||||
| EmailAdressen | ||||||
| EmailAdres | juliuszonnenberg1954@gmail.com | |||||
| Identificatienummer | 999910358 (in identificerend systeem: BSN) | |||||
| Geboortedatum | 28 jul 1954 | |||||
| Geslacht | Man (code = 'M' in codeSystem 'HL7 AdministrativeGender') | |||||
| Betaler | ||||||
| Verzekeraar | ||||||
| Verzekering | ||||||
| EindDatumTijd | T + 1 jaar | |||||
| Verzekeringssoort | Basis (code = 'B' in codeSystem 'ZIB Verzekeringssoort') | |||||
| IdentificatieNummer | 9665 (in identificerend systeem: UZOVI) | |||||
| OrganisatieNaam | Trias | |||||
| VerzekerdeNummer | 12345679 | |||||
| Contactpersoon eovd-1-1-contactpersoon-01 | ||||||
| Naamgegevens | ||||||
| Voornamen | Helena | |||||
| Initialen | H. | |||||
| Roepnaam | Lenie | |||||
| Geslachtsnaam | ||||||
| Achternaam | Slager | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +316-99990009 | |||||
| EmailAdressen | ||||||
| EmailAdres | lenie@123net.nl | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1003 | |||||
| AdditioneleInformatie | ingang via achtertuin | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Rol | Eerste relatie/contactpersoon (code = '1' in codeSystem 'Vektis Rolcode COD472-VEKT') | |||||
| Relatie | Kleindochter (code = 'GRNDDAU' in codeSystem 'HL7 RoleCode') | |||||
| Contactpersoon | ||||||
| Naamgegevens | ||||||
| Voornamen | Pleun | |||||
| Geslachtsnaam | ||||||
| Achternaam | Bloemist | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +316-99990008 | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1003 | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Rol | Buur (code = '19' in codeSystem 'Vektis Rolcode COD472-VEKT') | |||||
| Relatie | Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor') | |||||
| Sturende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | AB-zkh | |||||
| OrganisatieLocatie | Noord | |||||
| AfdelingSpecialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +31182435770 | |||||
| EmailAdressen | ||||||
| EmailAdres | neurologie@ABZ.nl | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 10 | |||||
| Postcode | 9999PO | |||||
| Woonplaats | Stitswerd | |||||
| AdresSoort | Werkadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||
| OrganisatieType | Algemeen ziekenhuis (code = 'V6' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Voornamen | Charlotte Maria | |||||
| Initialen | C. M. | |||||
| Roepnaam | Lotte | |||||
| Geslachtsnaam | ||||||
| Achternaam | Bruinsma | |||||
| Specialisme | Verpleegkundigen, niet nader gespecificeerd (code = '9100' in codeSystem 'Vektis AGB-medische specialismen') | |||||
| Ontvangende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 75131313 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | ThuiszorgOrg | |||||
| OrganisatieLocatie | Noord | |||||
| AfdelingSpecialisme | Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| OrganisatieType | Thuiszorg (code = 'T2' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
1.1.2 Algemene patiënten context
| Algemene patiënten context | |||||||||
| Gegevenselement | Waarde | ||||||||
| Gezinssituatie | |||||||||
| Gezinssituatie | |||||||||
| BurgerlijkeStaat | |||||||||
| BurgerlijkeStaatRC | |||||||||
| BurgerlijkeStaat | Gehuwd (code = 'M' in codeSystem 'HL7 MaritalStatus') | ||||||||
| Gezinssamenstelling | Alleenwonend (code = '105529008' in codeSystem 'SNOMED CT') | ||||||||
| Zorgtaak | zorgt voor zijn kat | ||||||||
| Juridische situatie | |||||||||
| JuridischeSituatie eovd-kwa-1-1-juridischesituatie-01 | |||||||||
| Vertegenwoordiging | Bewindvoering (code = '7' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3') | ||||||||
| DatumAanvang | T - 1 jaar | ||||||||
| Woonomgeving | |||||||||
| Woonsituatie | |||||||||
| WoningType | Aanleunwoning (code = 'AANLW' in codeSystem 'ZIB WoningType') | ||||||||
| Levensovertuiging | |||||||||
| LevensovertuigingRC | |||||||||
| Levensovertuiging | Protestant (code = '309885004' in codeSystem 'SNOMED CT') | ||||||||
| Wilsverklaring | |||||||||
| WilsverklaringType | Niet reanimeren verklaring (code = 'NR' in codeSystem 'ZIB WilsverklaringType') | ||||||||
| WilsverklaringDatum | T - 4 jaar | ||||||||
| Vertegenwoordiger | |||||||||
| Contactpersoon | Zie Contactpersoon: eovd-1-1-contactpersoon-01 | ||||||||
| Toelichting | wilsverklaring bevindt zich in de portemonnee. | ||||||||
| Sociale omgeving | |||||||||
| ParticipatieInMaatschappij | |||||||||
| SociaalNetwerk | heeft veel contact met buren | ||||||||
| Vrijetijdsbesteding | viool spelen | ||||||||
| Arbeidssituatie | Gepensioneerd | ||||||||
| HulpVanAnderen | |||||||||
| Hulpverlener | |||||||||
| Mantelzorger | |||||||||
| Contactpersoon | |||||||||
| Naamgegevens | |||||||||
| Voornamen | Marriet | ||||||||
| Initialen | M. | ||||||||
| Naamgebruik | Eigen geslachtsnaam (code = 'NL1' in codeSystem 'ZIB Naamgebruik') | ||||||||
| Geslachtsnaam | |||||||||
| Achternaam | Blauw | ||||||||
| Rol | Buur (code = '19' in codeSystem 'Vektis Rolcode COD472-VEKT') | ||||||||
| Aard | helpt met ondersteuning echtgenote als meneer er niet is | ||||||||
| Frequentie | zo vaak als nodig | ||||||||
| SoortHulp | Mantelzorg (code = '386229000' in codeSystem 'SNOMED CT') | ||||||||
| HulpVanAnderen | |||||||||
| Hulpverlener | |||||||||
| Zorgaanbieder | |||||||||
| OrganisatieNaam | WijZorgen | ||||||||
| OrganisatieLocatie | Stitswerd | ||||||||
| OrganisatieType | Thuiszorg (code = 'T2' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | ||||||||
| Aard | ondersteuning bij wassen | ||||||||
| Frequentie | dagelijks | ||||||||
| SoortHulp | Professionele thuiszorg (code = '60689008' in codeSystem 'SNOMED CT') | ||||||||
| Toelichting | niet in het weekend | ||||||||
| Communicatie | |||||||||
| Taalvaardigheid | |||||||||
| CommunicatieTaal | Nederlands (code = 'nl' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') | ||||||||
| TaalvaardigheidBegrijpen | Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| TaalvaardigheidSpreken | Slecht (code = 'P' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| TaalvaardigheidLezen | Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| Toelichting | t.g.v. CVA nu moeite met begrijpen, spreken gaat ook moeilijk i.v.m. afasie | ||||||||
| Taalvaardigheid | |||||||||
| CommunicatieTaal | Limburgs (code = 'li' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') | ||||||||
| TaalvaardigheidBegrijpen | Goed (code = 'G' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| TaalvaardigheidSpreken | Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| Toelichting | opgegroeid in Zuid-Limburg | ||||||||
1.1.3 Medische context
| Medische context | ||||||||
| Gegevenselement | Waarde | |||||||
| Behandelaar | ||||||||
| Zorgverlener eovdv-kwa-1-1-behandelaar-01 | ||||||||
| Naamgegevens | ||||||||
| Voornamen | Joshua Pieter | |||||||
| Initialen | J. P. | |||||||
| Geslachtsnaam | ||||||||
| Achternaam | Helmond | |||||||
| Specialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| Zorgaanbieder | ||||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||||
| OrganisatieNaam | AB-zkh | |||||||
| OrganisatieLocatie | Noord | |||||||
| Behandelaar | ||||||||
| Zorgverlener eovdv-kwa-1-1-behandelaar-02 | ||||||||
| ZorgverlenerIdentificatienummer | 03898989 (in identificerend systeem: AGB-Z) | |||||||
| Naamgegevens | ||||||||
| Initialen | G. | |||||||
| Geslachtsnaam | ||||||||
| Achternaam | Spijkerman | |||||||
| Specialisme | Medisch specialisten, gastro-enterologie (maag-darm-lever-arts) (code = '0318' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| Zorgaanbieder | ||||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||||
| OrganisatieNaam | AB-zkh | |||||||
| OrganisatieLocatie | Noord | |||||||
| Medische diagnose | ||||||||
| Probleem eovd-kwa-1-1-probleem-01 | ||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | ischemisch cerebrovasculair accident (code = '422504002' in codeSystem 'SNOMED CT') | |||||||
| ProbleemBeginDatum | T - 100 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| VerificatieStatus | Bevestigd (code = '410605003' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | niet bekend met neurologische klachten | |||||||
| Probleem eovd-kwa-1-1-probleem-02 | ||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | neoplasma van colon (code = '126838000') | |||||||
| ProbleemBeginDatum | T - 150 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Probleem eovd-kwa-1-1-probleem-03 | ||||||||
| ProbleemLateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | polsfractuur (code = '31641000146105' in codeSystem 'SNOMED CT') | |||||||
| ProbleemBeginDatum | T - 5 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Voorgeschiedenis | ||||||||
| Probleem | ||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | diabetes mellitus (code = '73211009') | |||||||
| ProbleemBeginDatum | T - 12 jaar | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Allergie | ||||||||
| AllergieIntolerantie | ||||||||
| VeroorzakendeStof | nikkelsulfaat (code = '255848005' in codeSystem 'SNOMED CT') | |||||||
| AllergieCategorie | Stof of product (code = '419199007' in codeSystem 'SNOMED CT') | |||||||
| AllergieStatus | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||||||
| BeginDatumTijd | T - 10 jaar | |||||||
| MateVanKritiekZijn | 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') | |||||||
| ReactieBeschrijving | last van jeuk, roodheid en irritatie op de contactplek van nikkel bevattende sieraden. | |||||||
| WijzeVanBlootstelling | intra-epidermale route (code = '448077001' in codeSystem 'SNOMED Clinical Terms') | |||||||
| AllergieIntolerantie | ||||||||
| VeroorzakendeStof | pollen (code = '256259004') | |||||||
| AllergieCategorie | Omgeving (code = '426232007' in codeSystem 'SNOMED CT') | |||||||
| AllergieStatus | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||||||
| BeginDatumTijd | T - 500 dagen | |||||||
| MateVanKritiekZijn | Matig (code = '6736007' in codeSystem 'SNOMED CT') | |||||||
| LaatsteReactieDatumTijd | T - 99 dagen | |||||||
| Reactie | ||||||||
| Symptoom | Overgevoeligheidsreactie van de bovenste luchtwegen (code = '490008' in codeSystem 'SNOMED CT') | |||||||
| SpecifiekeStof | graspollen (code = '256277009') | |||||||
| ReactieBeschrijving | veelvuldig niezen | |||||||
| Ernst | Matig (code = '6736007' in codeSystem 'SNOMED CT') | |||||||
| ReactieTijdstip | T - 99 dagen | |||||||
| Reactie | ||||||||
| Symptoom | Kortademigheid (code = '267036007' in codeSystem 'SNOMED CT') | |||||||
| Symptoom | Koorts (code = '386661006' in codeSystem 'SNOMED CT') | |||||||
| SpecifiekeStof | pollen van paprikaplant (code = '110181000146104') | |||||||
| ReactieBeschrijving | ernstige benauwdheid en koorts | |||||||
| Ernst | Ernstig (code = '24484000' in codeSystem 'SNOMED CT') | |||||||
| ReactieTijdstip | T - 200 dagen | |||||||
| Let op | ||||||||
| Alert | ||||||||
| AlertNaam | Drager MRSA (code = '432415000' in codeSystem 'SNOMED CT') | |||||||
| BeginDatumTijd | T - 20 dagen | |||||||
| AlertType | waarschuwing (code = '74018-3' in codeSystem 'LOINC') | |||||||
| Alert | ||||||||
| AlertNaam | Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): ernstige claustrofobie | |||||||
| BeginDatumTijd | T - 10 jaar | |||||||
| Vrijheidsbeperking | ||||||||
| VrijheidsbeperkendeInterventie | ||||||||
| Wilsbekwaam | Ja | |||||||
| JuridischeSituatie | Zie JuridischeSituatie: eovd-kwa-1-1-juridischesituatie-01 | |||||||
| SoortInterventie | geforceerd toedienen van voeding bij patiënt (code = '37041007' in codeSystem 'SNOMED CT') | |||||||
| RedenVanToepassen | bevorderen van fysieke gezondheid (code = '121581000146106' in codeSystem 'SNOMED CT') | |||||||
| Instemming | Instemming patiënt (code = '2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') | |||||||
| Begin | T - 50 dagen | |||||||
| Meetwaarden | ||||||||
| Bloeddruk | ||||||||
| Meetmethode | Niet-invasief (code = '22762002' in codeSystem 'SNOMED CT') | |||||||
| ManchetType | Standaard (code = 'STD' in codeSystem 'ZIB ManchetType') | |||||||
| MeetLocatie | Rechter bovenarm (code = '368209003' in codeSystem 'SNOMED CT') | |||||||
| DiastolischEindpunt | Fase V (code = '255272007' in codeSystem 'SNOMED CT') | |||||||
| SystolischeBloeddruk | 170 mm[Hg] | |||||||
| DiastolischeBloeddruk | 90 mm[Hg] | |||||||
| GemiddeldeBloeddruk | 110 mm[Hg] | |||||||
| BloeddrukDatumTijd | T - 20 dagen om 14:45 uur | |||||||
| Toelichting | meneer gebruikt medicatie | |||||||
| Houding | Liggende positie (code = '102538003' in codeSystem 'SNOMED CT') | |||||||
| Polsfrequentie | ||||||||
| PolsfrequentieWaarde | 90 | |||||||
| PolsfrequentieDatumTijd | T - 5 dagen om 14:45 uur | |||||||
| Toelichting | is altijd sportief geweest | |||||||
| PolsRegelmatigheid | Polsslag regelmatig (code = '271636001' in codeSystem 'SNOMED CT') | |||||||
| Lichaamstemperatuur | ||||||||
| TemperatuurWaarde | 36.8 Cel | |||||||
| TemperatuurDatumTijd | T - 4 dagen om 07 uur | |||||||
| Toelichting | voeten voelen heel koud aan | |||||||
| TemperatuurType | Tympanische temperatuur (code = '415974002' in codeSystem 'SNOMED CT') | |||||||
| Ademhaling | ||||||||
| Ademfrequentie | 18 /min | |||||||
| AdemhalingDatumTijd | T - 3 dagen om 14:45 uur | |||||||
| Ritme | Abnormaal ademhalingsritme (code = '85617008' in codeSystem 'SNOMED CT') | |||||||
| Diepte | Normale ademhalingsdiepte (code = '301284009' in codeSystem 'SNOMED CT') | |||||||
| AfwijkendAdemhalingspatroon | Apneu (code = '1023001' in codeSystem 'SNOMED CT') | |||||||
| ExtraZuurstofToediening | Ja | |||||||
| Toelichting | meneer lijkt angstig | |||||||
| ToegediendeZuurstof | ||||||||
| FlowRate | 2 l/min | |||||||
| FiO2 | 0.29 l | |||||||
| ToedieningHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Neusbril (code = '336623009' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | neusbril | |||||||
| Lichaamsgewicht | ||||||||
| GewichtWaarde | 74 kg | |||||||
| Toelichting | meneer volgt afvaldieet | |||||||
| GewichtDatumTijd | T - 5 dagen om 14:30 uur | |||||||
| Kleding | Volledig gekleed, inclusief schoenen (code = 'FULL' in codeSystem 'ZIB ContextKleding') | |||||||
| Lichaamslengte | ||||||||
| LengteWaarde | 170 cm | |||||||
| LengteDatumTijd | T - 5 dagen om 14:30 uur | |||||||
| Toelichting | zonder schoenen aan | |||||||
| Pijnscore | ||||||||
| PijnScore | ||||||||
| PijnscoreWaarde | 2 | |||||||
| PijnscoreDatumTijd | T - 5 dagen om 14:45 uur | |||||||
| PijnMeetmethode | NRS (code = 'NRS' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.9.1') | |||||||
| AnatomischeLocatie | gehele voet (code = '302545001' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | Af en toe pijn, maar niet belemmerend bij het lopen | |||||||
1.1.4 Verpleegkundige context: zorgplan
| Verpleegkundige context: zorgplan | ||||||||||
| Gegevenselement | Waarde | |||||||||
| Actuele patiëntproblemen | ||||||||||
| Patiëntprobleem | ||||||||||
| Probleem eovd-kwa-1-1-patientprobleem-01 | ||||||||||
| ProbleemNaam | probleem met zichzelf wassen en afdrogen (code = '288552005' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||||||
| ProbleemBeginDatum | T - 100 dagen | |||||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||||
| Toelichting | meneer kan niet buigen | |||||||||
| VerpleegkundigeInterventie eovd-kwa-1-1-interventie-01 | ||||||||||
| Interventie | ondersteunen bij wassen en/of persoonlijke hygiëne (code = '386420003' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| Indicatie | ||||||||||
| Probleem | Zie Probleem: eovd-kwa-1-1-patientprobleem-01 | |||||||||
| Behandeldoel | ||||||||||
| GewenstZorgresultaat | wassen onafhankelijk | |||||||||
| ActieStartDatumTijd | T - 90 dagen | |||||||||
| Frequentie | 1 /dag | |||||||||
| Instructie | let op: valrisico | |||||||||
| Uitvoerder | ||||||||||
| Zorgverlener | Ja | |||||||||
| Patiëntprobleem | ||||||||||
| Probleem eovd-kwa-1-1-patientprobleem-02 | ||||||||||
| ProbleemNaam | probleem met zichzelf kleden (code = '284972002' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||||||
| ProbleemBeginDatum | T - 90 dagen | |||||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||||
| VerpleegkundigeInterventie eovd-kwa-1-1-interventie-02 | ||||||||||
| Interventie | ondersteunen bij aankleden (code = '313332003' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| Indicatie | ||||||||||
| Probleem | Zie Probleem: eovd-kwa-1-1-patientprobleem-02 | |||||||||
| Behandeldoel | ||||||||||
| GewenstZorgresultaat | kleden onafhankelijk | |||||||||
| Frequentie | 3 /dag | |||||||||
| Patiëntprobleem | ||||||||||
| Probleem eovd-kwa-1-1-patientprobleem-04 | ||||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||||
| ProbleemNaam | loopt risico op delier (code = '430794006' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||||||
| ProbleemBeginDatum | T - 5 dagen | |||||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||||
| Toelichting | vastgesteld met DOS score | |||||||||
| VerpleegkundigeInterventie | ||||||||||
| Interventie | bevorderen van vochtinname (code = '113148007' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| Indicatie | ||||||||||
| Probleem | Zie Probleem: eovd-kwa-1-1-patientprobleem-04 | |||||||||
| Behandeldoel | ||||||||||
| GewenstZorgresultaat | vochtinname > 1,5 liter/dag | |||||||||
| Instructie | Graag er op toezien dat meneer > 1,5 liter per dag drinkt | |||||||||
| Uitvoerder | ||||||||||
| Verzorger | ||||||||||
| Contactpersoon | ||||||||||
| Naamgegevens | ||||||||||
| Voornamen | Gerda | |||||||||
| Naamgebruik | Geslachtsnaam partner (code = 'NL2' in codeSystem 'ZIB Naamgebruik') | |||||||||
| GeslachtsnaamPartner | ||||||||||
| AchternaamPartner | XXX_Altenborg | |||||||||
| Contactgegevens | ||||||||||
| Telefoonnummers | ||||||||||
| Telefoonnummer | +31662626262 | |||||||||
| Relatie | Echtgenoot (code = 'HUSB' in codeSystem 'HL7 RoleCode') | |||||||||
| Zorgresultaat | ||||||||||
| UitkomstVanZorg | ||||||||||
| Zorgresultaat | doel deels behaald: kan nog niet rug wassen | |||||||||
| Interventie | ||||||||||
| VerpleegkundigeInterventie | Zie VerpleegkundigeInterventie: eovd-kwa-1-1-interventie-01 | |||||||||
| UitkomstVanZorg | ||||||||||
| Zorgresultaat | doel deels behaald, kan nog niet zelf veters strikken | |||||||||
| Interventie | ||||||||||
| VerpleegkundigeInterventie | Zie VerpleegkundigeInterventie: eovd-kwa-1-1-interventie-02 | |||||||||
| Afspraken patiënt | ||||||||||
| Contact | ||||||||||
| ContactType | Poliklinisch (code = 'AMB' in codeSystem 'HL7 ActCode') | |||||||||
| ContactMet | ||||||||||
| Zorgverlener | ||||||||||
| Naamgegevens | ||||||||||
| Voornamen | Joshua Pieter | |||||||||
| Initialen | J.P. | |||||||||
| Geslachtsnaam | ||||||||||
| Achternaam | Helmond | |||||||||
| Specialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||||
| ContactMet | ||||||||||
| Zorgverlener | ||||||||||
| ZorgverlenerIdentificatienummer | 03686868 (in identificerend systeem: AGB-Z) | |||||||||
| Naamgegevens | ||||||||||
| Initialen | F. | |||||||||
| Geslachtsnaam | ||||||||||
| Achternaam | Snijder | |||||||||
| Specialisme | Medisch specialisten, neurochirurgie (code = '0308' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||||
| Locatie | ||||||||||
| Zorgaanbieder | ||||||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||||||
| OrganisatieNaam | AB-zkh | |||||||||
| OrganisatieLocatie | Noord | |||||||||
| AfdelingSpecialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||||
| Contactgegevens | ||||||||||
| Telefoonnummers | ||||||||||
| Telefoonnummer | +31182435770 | |||||||||
| EmailAdressen | ||||||||||
| EmailAdres | neurologie@ABZ.nl | |||||||||
| Adresgegevens | ||||||||||
| Straat | Knolweg | |||||||||
| Huisnummer | 10 | |||||||||
| Postcode | 9999PO | |||||||||
| Woonplaats | Stitswerd | |||||||||
| AdresSoort | Werkadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||||||
| OrganisatieType | Algemeen ziekenhuis (code = 'V6' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||||||
| BeginDatumTijd | T + 5 dagen om 10:00 uur | |||||||||
| EindDatumTijd | T + 5 dagen om 10:30 uur | |||||||||
| RedenContact | ||||||||||
| Probleem | Zie Probleem: eovd-kwa-1-1-probleem-01 | |||||||||
| Contact | ||||||||||
| ContactType | Thuis (code = 'HH' in codeSystem 'HL7 ActCode') | |||||||||
| ContactMet | ||||||||||
| Zorgverlener | ||||||||||
| ZorgverlenerIdentificatienummer | 88131313 (in identificerend systeem: AGB-Z) | |||||||||
| Naamgegevens | ||||||||||
| Initialen | W. | |||||||||
| Geslachtsnaam | ||||||||||
| Achternaam | Bloem | |||||||||
| Specialisme | Ergotherapeuten (code = '8800' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||||
| Contactgegevens | ||||||||||
| EmailAdressen | ||||||||||
| EmailAdres | bloem@ergotherapie.nl | |||||||||
| BeginDatumTijd | T + 12 dagen om 15:15 uur | |||||||||
| RedenContact | ||||||||||
| RedenContactTekst | Controle voortgang revalidatie | |||||||||
| Wensen en behoeften patiënt en/of naasten | meneer wil zo snel mogelijk weer zelfstandig kunnen functioneren en zijn vrouw kunnen verzorgen | |||||||||
1.1.5 Verpleegkundige context: specificatie gezondheidstoestand
| Verpleegkundige context: specificatie gezondheidstoestand | ||||||||
| Gegevenselement | Waarde | |||||||
| Zelfzorg | ||||||||
| VermogenTotDrinken | ||||||||
| Drinken | Hulp nodig (code = '16681000146102' in codeSystem 'SNOMED CT | |||||||
| DrinkBeperkingen | Bereiden (openen/uitschenken) (code = '286506008' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotDrinken | ||||||||
| Drinken | Onafhankelijk (code = '19841000146104' in codeSystem 'SNOMED CT | |||||||
| DrinkBeperkingen | Vastpakken (code = '307071002' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotEten | ||||||||
| Eten | Hulp nodig (code = '129033007' in codeSystem 'SNOMED CT (ordinal = '1') | |||||||
| EetBeperkingen | Snijden/openen (code = '289078003' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotEten | ||||||||
| Eten | Onafhankelijk (code = '165224005' in codeSystem 'SNOMED CT (ordinal = '0') | |||||||
| EetBeperkingen | Eetgerei hanteren (code = '289046006' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotMondverzorging | ||||||||
| VerzorgenTanden | Hulp nodig (code = '16671000146104' in codeSystem 'SNOMED CT') | |||||||
| Prothese | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Gebitsprothese (code = '27606000' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Gebitsprothese bovenkaak | |||||||
| Prothese | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Gebitsprothese (code = '27606000' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Gebitsprothese onderkaak | |||||||
| VermogenTotZichWassen | ||||||||
| ZichWassen | Hulp nodig (code = '16621000146103' in codeSystem 'SNOMED CT | |||||||
| TeWassenLichaamsdeel | Onderlichaam (code = '362875007' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotZichWassen | ||||||||
| ZichWassen | Hulp nodig (code = '16621000146103' in codeSystem 'SNOMED CT | |||||||
| TeWassenLichaamsdeel | Bovenlichaam (code = '362874006' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotZichKleden | ||||||||
| ZichKleden | Hulp nodig (code = '129039006' in codeSystem 'SNOMED CT | |||||||
| TeKledenLichaamsdeel | Onderlichaam (code = '362875007' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotZichKleden | ||||||||
| ZichKleden | Onafhankelijk (code = '129035000' in codeSystem 'SNOMED CT | |||||||
| TeKledenLichaamsdeel | Bovenlichaam (code = '362874006' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotUiterlijkeVerzorging | ||||||||
| UiterlijkeVerzorging | Hulp nodig (code = '27941000146109' in codeSystem 'SNOMED CT | |||||||
| VermogenTotToiletgang | ||||||||
| Toiletgebruik | Onafhankelijk (code = '129062008' in codeSystem 'SNOMED CT (ordinal = '0') | |||||||
| VermogenTotZelfstandigMedicatiegebruik | ||||||||
| ZelfstandigMedicatiegebruik | Hulp nodig (code = '27921000146103' in codeSystem 'SNOMED CT') | |||||||
| HulpBijToediening | ||||||||
| VerpleegkundigeInterventie | ||||||||
| Interventie | bevorderen van therapietrouw met behulp van medicijndispenser (code = '710153008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Behandeldoel | ||||||||
| GewenstZorgresultaat | therapietrouw | |||||||
| Frequentie | 2 /d | |||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | medicatierol (code = '713308004' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | baxterrol | |||||||
| VermogenTotVerpleegtechnischeHandelingen | ||||||||
| VerpleegkundigeInterventie | ||||||||
| VerpleegkundigeInterventie | ||||||||
| Interventie | Stoma care procedure (code = '225194008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Behandeldoel | ||||||||
| GewenstZorgresultaat | goede hygiene met betrekking tot stoma | |||||||
| ActieStartDatumTijd | T - 6 dagen | |||||||
| Uitvoerder | ||||||||
| Patient | Ja | |||||||
| Toelichting | toezicht bij uitvoer, en instructie hygiënisch werken | |||||||
| VerrichtenVPKHandeling | Hulp nodig (code = '27931000146101' in codeSystem 'SNOMED CT | |||||||
| VermogenTotVerpleegtechnischeHandelingen | ||||||||
| VerpleegkundigeInterventie | ||||||||
| VerpleegkundigeInterventie | ||||||||
| Interventie | vervangen van verband (code = '18949003' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ActieStartDatumTijd | T - 1 dag | |||||||
| Interval | 2 dagen | |||||||
| VerrichtenVPKHandeling | Hulp nodig (code = '27931000146101' in codeSystem 'SNOMED CT | |||||||
| Toelichting zelfzorg | kan zich steeds beter redden met wassen en kleden, knoopjes dichtdoen en schoenen met hulp. Ileostoma instructies gestart. | |||||||
| Mobiliteit | ||||||||
| Mobiliteit | ||||||||
| Lopen | Hulp nodig (code = '16581000146103' in codeSystem 'SNOMED CT | |||||||
| Traplopen | Volledig afhankelijk (code = '301589003' in codeSystem 'SNOMED CT | |||||||
| HoudingVeranderen | Onafhankelijk (code = '19821000146105' in codeSystem 'SNOMED CT | |||||||
| HoudingHandhaven | Onafhankelijk (code = '19811000146100' in codeSystem 'SNOMED CT | |||||||
| UitvoerenTransfer | Hulp nodig (code = '714917003' in codeSystem 'SNOMED CT | |||||||
| MedischHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | rollator (code = '404946006' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | rollator | |||||||
| BeginDatum | T - 1 jaar | |||||||
| MedischHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | rolstoel (code = '58938008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | rolstoel | |||||||
| BeginDatum | T - 1 maand | |||||||
| Toelichting | voor langere afstanden | |||||||
| Toelichting | lopen is stuk verbeterd, rechter been minder krachtig | |||||||
| Voeding/vocht | ||||||||
| Voedingsadvies | ||||||||
| DieetType | suikervrij, diabetes dieet | |||||||
| Consistentie | dik vloeibaar | |||||||
| Toelichting | eet naar eigen keuze minder vlees | |||||||
| Voedingsadvies | ||||||||
| DieetType | geen varkensvlees | |||||||
| SNAQScore | ||||||||
| GewichtsverliesScore | LossAverage (code = 'G1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.1 (ordinal = '2') | |||||||
| EetlustScore | Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.2 (ordinal = '0') | |||||||
| VoedingsScore | GeenVoeding (code = 'Z0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.3 (ordinal = '0') | |||||||
| TotaalScore | 2 | |||||||
| SNAQScoreDatumTijd | T - 6 dagen om 17 uur | |||||||
| Toelichting | geen verminderde eetlust ondanks chemotherapie | |||||||
| SNAQrcScore | ||||||||
| GewichtsverliesScore | LossHigh (code = 'G2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.1 (ordinal = '2') | |||||||
| EetlustScore | Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.2 (ordinal = '0') | |||||||
| BMIScore | Gezond (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.3 (ordinal = '0') | |||||||
| HulpBijEten | Onafhankelijk (code = '165224005' in codeSystem 'SNOMED CT (ordinal = '0') | |||||||
| TotaalScore | 2 | |||||||
| SNAQrcScoreDatumTijd | T - 6 dagen om 17 uur | |||||||
| Toelichting | geen verminderde eetlust ondanks chemotherapie | |||||||
| SNAQ65+Score | ||||||||
| GewichtsverliesScore | LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.1 (ordinal = '0') | |||||||
| BovenarmOmtrekScore | Normaal (code = 'A0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.4 (ordinal = '0') | |||||||
| EetlustScore | Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.2 (ordinal = '0') | |||||||
| InspanningsScore | Mogelijk (code = 'In0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.3 (ordinal = '0') | |||||||
| TotaalScore | 0 | |||||||
| SNAQ65+ScoreDatumTijd | T - 6 dagen om 17 uur | |||||||
| Toelichting | geen verminderde eetlust ondanks chemotherapie | |||||||
| MUSTScore | ||||||||
| BMIScore | BMIHigh (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.1 (ordinal = '0') | |||||||
| GewichtsverliesScore | LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.2 (ordinal = '0') | |||||||
| ZiekteScore | Ziek (code = 'Z1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.3 (ordinal = '2') | |||||||
| TotaalScore | 2 | |||||||
| MUSTScoreDatumTijd | T - 12 dagen om 17 uur | |||||||
| Vochtbalans | ||||||||
| VochtTotaalIn | 1400 ml | |||||||
| VochtTotaalUit | 1000 ml | |||||||
| VochtbalansStarttijd | T - 6 dagen om 07 uur | |||||||
| VochtbalansStoptijd | T - 5 dagen om 07 uur | |||||||
| SondeSysteem | ||||||||
| Sonde | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Neus-maagsonde (code = '17102003' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | neus- maagsonde | |||||||
| BeginDatum | T - 5 dagen | |||||||
| AnatomischeLocatie | neusgat (code = '363538002' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Zorgverlener | Zie Zorgverlener: eovdv-kwa-1-1-behandelaar-02 | |||||||
| SondeLengte | 575 mm | |||||||
| Toelichting | wegens misselijkheid door chemotherapie | |||||||
| SondeSysteem | ||||||||
| Sonde | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | PEJ sonde (code = '8911000146104' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | PEJ sonde | |||||||
| BeginDatum | T - 5 dagen | |||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | enterale voedingspomp (code = '468664004' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | enterale voedingspomp | |||||||
| BeginDatum | T - 5 dagen | |||||||
| Infuus | ||||||||
| Infuuskatheter | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Centraal veneuze katheter (code = '52124006' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | centraal veneuze katheter | |||||||
| BeginDatum | T - 20 dagen | |||||||
| Toelichting | onder sleutelbeen links | |||||||
| AnatomischeLocatie | structuur van vena subclavia (code = '9454009' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Zorgverlener | Zie Zorgverlener: eovdv-kwa-1-1-behandelaar-02 | |||||||
| Toelichting | voor voeding | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| LumenLocatie | Distaal (code = '46053002' in codeSystem 'SNOMED CT') | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Afgedopt (code = 'DOP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| LumenLocatie | Mediaal (code = '255561001' in codeSystem 'SNOMED CT') | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| LumenLocatie | Distaal (code = '46053002' in codeSystem 'SNOMED CT') | |||||||
| Infuus | ||||||||
| Infuuskatheter | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Perifeer intraveneus infuus (code = '82449006' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Perifeer intraveneus infuus | |||||||
| BeginDatum | T - 15 dagen | |||||||
| AnatomischeLocatie | onderarm (code = '14975008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | voor medicatie | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| Uitscheiding | ||||||||
| Blaasfunctie | ||||||||
| UrineContinentie | Af en toe een ongelukje (max. 1 keer per 24 uur) (code = '165233007' in codeSystem 'SNOMED CT (ordinal = '1') | |||||||
| Urostoma | ||||||||
| Stoma | Zie Stoma: eovd-kwa-1-1-stoma-02 | |||||||
| Incontinentiemateriaal | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | inlegger voor incontinentiebroek (code = '470713005' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | inlegger | |||||||
| Darmfunctie | ||||||||
| Stoma | Zie Stoma: eovd-kwa-1-1-stoma-01 | |||||||
| DefecatieConsistentie | Helemaal vloeibaar (code = 'Type 7' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.3.1') | |||||||
| Toelichting | stoma na subtotale darmresectie wegens coloncarcinoom | |||||||
| Stoma eovd-kwa-1-1-stoma-01 | ||||||||
| StomaType | eindstandige ileostoma (code = '311412005' in codeSystem 'SNOMED CT') | |||||||
| StomaMateriaal | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Ileostomy bag (code = '417136005' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | stomazak voor ileostoma | |||||||
| AnatomischeLocatie | onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| AanlegDatum | T - 12 dagen | |||||||
| Toelichting | na subtotale darmresectie wegens coloncarcinoom | |||||||
| Stoma eovd-kwa-1-1-stoma-02 | ||||||||
| StomaType | urostoma (code = '281601009' in codeSystem 'SNOMED CT') | |||||||
| AnatomischeLocatie | buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| AanlegDatum | T - 4 jaar | |||||||
| Huid | ||||||||
| Brandwond | ||||||||
| OntstaansDatum | T - 2 dagen | |||||||
| Uitgebreidheid | 1 % | |||||||
| BrandwondSoort | Thermische brandwond (code = '105594005' in codeSystem 'SNOMED CT') | |||||||
| AnatomischeLocatie | onderarm (code = '362741001' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| Dieptegraad | 1e graad (code = '77140003' in codeSystem 'SNOMED CT | |||||||
| Toelichting | Meneer kreeg hete thee over zich heen, wond is ongeveer 2 bij 2 cm; geen verband nodig. | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Brandwond | ||||||||
| OntstaansDatum | T - 2 dagen | |||||||
| Uitgebreidheid | 1 % | |||||||
| BrandwondSoort | Thermische brandwond (code = '105594005' in codeSystem 'SNOMED CT') | |||||||
| AnatomischeLocatie | handrug (code = '63125000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| Dieptegraad | 2e graad, oppervlakkig (code = '262587005' in codeSystem 'SNOMED CT | |||||||
| DecubitusWond | ||||||||
| DecubitusCategorie | Decubitus categorie 2 (code = '420324007' in codeSystem 'SNOMED CT (ordinal = '2') | |||||||
| OntstaansDatum | T - 2 dagen | |||||||
| AnatomischeLocatie | hiel (code = '76853006' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Wondlengte | 2 cm | |||||||
| Wondbreedte | 2 cm | |||||||
| Wonddiepte | 0.5 cm | |||||||
| Toelichting | Wond is niet geïnfecteerd. | |||||||
| DecubitusWond | ||||||||
| DecubitusCategorie | Decubitus categorie 1 (code = '421076008' in codeSystem 'SNOMED CT (ordinal = '1') | |||||||
| OntstaansDatum | T - 20 dagen | |||||||
| AnatomischeLocatie | stuitje (code = '182028002' in codeSystem 'SNOMED Clinical Terms') | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Wondlengte | 3 cm | |||||||
| Wondbreedte | 1 cm | |||||||
| Wonddiepte | 0.2 cm | |||||||
| Huidaandoening | ||||||||
| SoortAandoening | Intertrigo/smetten (code = '58759008' in codeSystem 'SNOMED CT') | |||||||
| OntstaansDatum | T - 6 dagen | |||||||
| AnatomischeLocatie | lies (code = '26893007' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | Smetten zonder natten of infectie, inmiddels genezen. | |||||||
| Wond | ||||||||
| WondSoort | Traumatische wond (code = '416462003' in codeSystem 'SNOMED CT') | |||||||
| WondWeefsel | Rode wond (code = 'ROOD' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.2') | |||||||
| WondInfectie | Nee | |||||||
| WondVochtigheid | Droge wond (code = 'DROOG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') | |||||||
| Wondlengte | 2 cm | |||||||
| Wondbreedte | 4 cm | |||||||
| Wonddiepte | 0.1 cm | |||||||
| AnatomischeLocatie | knie (code = '72696002' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| WondOntstaansdatum | T - 5 dagen | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Toelichting | oppervlakkige schaafwond na CVA, geen verband nodig | |||||||
| Wond | ||||||||
| WondSoort | Chirurgische wond (code = '112633009' in codeSystem 'SNOMED CT') | |||||||
| WondInfectie | Nee | |||||||
| WondVochtigheid | Vochtige wond (code = 'VOCHTIG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') | |||||||
| WondRand | Ondermijning (code = '449752001' in codeSystem 'SNOMED CT') | |||||||
| Wondlengte | 5 cm | |||||||
| Wondbreedte | 1 cm | |||||||
| Wonddiepte | 4 cm | |||||||
| AnatomischeLocatie | onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Drain | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | wonddrain (code = '258646005' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | wonddrain | |||||||
| BeginDatum | T - 12 dagen | |||||||
| Wond | ||||||||
| WondSoort | Oncologische ulcer (code = '94579000' in codeSystem 'SNOMED CT') | |||||||
| WondWeefsel | Graad II (code = 'GRAAD2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.1') | |||||||
| WondInfectie | Nee | |||||||
| Wondlengte | 1 cm | |||||||
| Wondbreedte | 1 cm | |||||||
| Wonddiepte | 2 cm | |||||||
| AnatomischeLocatie | buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| WondOntstaansdatum | T - 1 maand | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Zintuigen | ||||||||
| FunctieHoren | ||||||||
| HoorFunctie | Verminderde gehoorfunctie (code = '15188001' in codeSystem 'SNOMED CT') | |||||||
| HorenHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductID | 012345678905 (code = '012345678905Global Trade Item Number (GTIN)') | |||||||
| ProductType | Gehoorapparaat (code = '6012004' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Gehoorapparaat | |||||||
| AnatomischeLocatie | Linkeroor (code = '89644007' in codeSystem 'SNOMED CT') | |||||||
| HorenHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| ProductOmschrijving | Gehoorapparaat | |||||||
| AnatomischeLocatie | Rechteroor (code = '25577004' in codeSystem 'SNOMED CT') | |||||||
| FunctieZien | ||||||||
| VisueleFunctie | Verminderd gezichtsvermogen (code = '397540003' in codeSystem 'SNOMED CT') | |||||||
| ZienHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | bril (code = '50121007' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | bril | |||||||
| Toelichting | zonder bril bestaat verhoogd valrisico | |||||||
| Ziektebeleving | ||||||||
| Ziektebeleving | ||||||||
| ZiekteInzichtVanPatiënt | meneer kan niet overzien wat de ziekte betekent in het dagelijkse leven | |||||||
| OmgaanMetZiekteprocesDoorPatiënt | meneer wil niet praten over de toekomst. | |||||||
| OmgaanMetZiekteprocesDoorNaasten | echtgenote maakt zich zorgen of zij de zorg voor meneer wel aan kan, omdat zij zelf ook slecht ter been is | |||||||
| Mentale status | ||||||||
| Probleem | ||||||||
| ProbleemType | Symptoom (code = '418799008' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | gedaald bewustzijn (code = '443371007' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProbleemBeginDatum | T - 22 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | sinds cva, verminderde alertheid | |||||||
| Probleem | ||||||||
| ProbleemType | Klacht (code = '409586006' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | toestand van verwardheid (code = '286933003' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProbleemBeginDatum | T - 22 dagen | |||||||
| ProbleemEindDatum | T - 5 dagen | |||||||
| ProbleemStatus | Niet actueel (code = '73425007' in codeSystem 'SNOMED CT') | |||||||
1.2 Kwalificatie Overdracht 1.2
1.2.1 Administratieve gegevens
| Administratieve gegevens | ||||||
| Gegevenselement | Waarde | |||||
| Datum overplaatsing | T + 5 dagen | |||||
| Persoonsgegevens | ||||||
| Patient | ||||||
| Naamgegevens | ||||||
| Geslachtsnaam | ||||||
| Achternaam | XXX_Zuidwijker | |||||
| Adresgegevens | ||||||
| Huisnummer | 1002 | |||||
| Postcode | 9999ZZ | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Identificatienummer | 999910346 (in identificerend systeem: BSN) | |||||
| Geboortedatum | 27 jul 1954 | |||||
| Geslacht | Vrouw (code = 'F' in codeSystem 'HL7 AdministrativeGender') | |||||
| Betaler | ||||||
| Verzekeraar | ||||||
| Verzekering | ||||||
| EindDatumTijd | T + 250 dagen | |||||
| Verzekeringssoort | Basis (code = 'B' in codeSystem 'ZIB Verzekeringssoort') | |||||
| IdentificatieNummer | 9664 (in identificerend systeem: UZOVI) | |||||
| OrganisatieNaam | Trias | |||||
| VerzekerdeNummer | 12345678 | |||||
| Sturende organisatie | ||||||
| Zorgaanbieder | ||||||
| OrganisatieNaam | HomeCare | |||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Geslachtsnaam | ||||||
| Achternaam | Moorman | |||||
| Ontvangende organisatie | ||||||
| Zorgaanbieder | ||||||
| OrganisatieNaam | St. Zonnehof | |||||
1.2.2 Medische context
| Medische context | ||||||
| Gegevenselement | Waarde | |||||
| Behandelaar | ||||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Geslachtsnaam | ||||||
| Achternaam | Köln | |||||
| Medische diagnose | ||||||
| Probleem | ||||||
| ProbleemNaam | delier (code = '2776000' in codeSystem 'SNOMED CT') | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
1.2.3 Verpleegkundige context: zorgplan
| Verpleegkundige context: zorgplan | |||||
| Gegevenselement | Waarde | ||||
| Actuele patiëntproblemen | |||||
| Patiëntprobleem | |||||
| Probleem eovd-kwa-1-2-probleem-01 | |||||
| ProbleemNaam | acute verwardheid (code = '130987000' in codeSystem 'Referentieset Nationale kernset patientproblemen') | ||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||||
| VerpleegkundigeInterventie eovd-kwa-1-2-interventie-01 | |||||
| Interventie | omgevingsstimuli minimaliseren (code = '710978006' in codeSystem 'SNOMED Clinical Terms') | ||||
| Zorgresultaat | |||||
| UitkomstVanZorg | |||||
| Zorgresultaat | DOSS = 2 | ||||
1.3 Test Overdracht 1.1
1.3.1 Administratieve gegevens
| Administratieve gegevens | ||||||
| Gegevenselement | Waarde | |||||
| Datum overplaatsing | T + 1 dag | |||||
| Persoonsgegevens | ||||||
| Patient | ||||||
| Naamgegevens | ||||||
| Voornamen | Erik | |||||
| Initialen | E. | |||||
| Geslachtsnaam | ||||||
| Achternaam | XXX_Altenborg | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1000 | |||||
| Postcode | 9999XA | |||||
| Woonplaats | Stitswerd | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +31634567891 | |||||
| EmailAdressen | ||||||
| EmailAdres | evertaltenborg@hotmail.com | |||||
| Identificatienummer | 999911612 (in identificerend systeem: BSN) | |||||
| Geboortedatum | 14 aug 1964 | |||||
| Geslacht | Man (code = 'M' in codeSystem 'HL7 AdministrativeGender') | |||||
| Betaler | ||||||
| Verzekeraar | ||||||
| Verzekering | ||||||
| EindDatumTijd | T + 1 jaar | |||||
| Verzekeringssoort | Basis (code = 'B' in codeSystem 'ZIB Verzekeringssoort') | |||||
| IdentificatieNummer | 9664 (in identificerend systeem: UZOVI) | |||||
| OrganisatieNaam | Trias | |||||
| VerzekerdeNummer | 12345678 | |||||
| Contactpersoon eovd-1-1-contactpersoon-01 | ||||||
| Naamgegevens | ||||||
| Voornamen | Johanna | |||||
| Initialen | J. | |||||
| Roepnaam | Hanna | |||||
| Geslachtsnaam | ||||||
| Achternaam | Bakker | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +31645678912 | |||||
| EmailAdressen | ||||||
| EmailAdres | jbakker@123net.nl | |||||
| Rol | Eerste relatie/contactpersoon (code = '1' in codeSystem 'Vektis Rolcode COD472-VEKT') | |||||
| Relatie | Dochter (code = 'DAUC' in codeSystem 'HL7 RoleCode') | |||||
| Contactpersoon | ||||||
| Naamgegevens | ||||||
| Voornamen | Johannes | |||||
| Roepnaam | Hans | |||||
| Geslachtsnaam | ||||||
| Voorvoegsels | van | |||||
| Achternaam | Dijk | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +31612121212 | |||||
| Relatie | Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): achterneef | |||||
| Sturende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | AB-zkh | |||||
| OrganisatieLocatie | Noord | |||||
| AfdelingSpecialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +31182435770 | |||||
| EmailAdressen | ||||||
| EmailAdres | neurologie@ABZ.nl | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 10 | |||||
| Postcode | 9999PO | |||||
| Woonplaats | Stitswerd | |||||
| AdresSoort | Werkadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||
| OrganisatieType | Algemeen ziekenhuis (code = 'V6' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Voornamen | Charlotte Maria | |||||
| Initialen | C. M. | |||||
| Roepnaam | Lotte | |||||
| Geslachtsnaam | ||||||
| Achternaam | Bruinsma | |||||
| Specialisme | Verpleegkundigen, niet nader gespecificeerd (code = '9100' in codeSystem 'Vektis AGB-medische specialismen') | |||||
| Ontvangende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 75131313 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | ThuiszorgOrg | |||||
| OrganisatieLocatie | Noord | |||||
| AfdelingSpecialisme | Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| OrganisatieType | Thuiszorg (code = 'T2' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
1.3.2 Algemene patiënten context
| Algemene patiënten context | |||||||||
| Gegevenselement | Waarde | ||||||||
| Gezinssituatie | |||||||||
| Gezinssituatie | |||||||||
| BurgerlijkeStaat | |||||||||
| BurgerlijkeStaatRC | |||||||||
| BurgerlijkeStaat | Gehuwd (code = 'M' in codeSystem 'HL7 MaritalStatus') | ||||||||
| Gezinssamenstelling | Samenwonend met partner (code = '408821002' in codeSystem 'SNOMED CT') | ||||||||
| AantalKinderen | 3 | ||||||||
| AantalKinderenInwonend | 0 | ||||||||
| Zorgtaak | zorgt voor zijn vrouw die slecht ter been is | ||||||||
| Zorgtaak | zorgt voor de hond | ||||||||
| Kind | |||||||||
| Geboortedatum | T - 30 jaar | ||||||||
| Inwonend | Nee | ||||||||
| Kind | |||||||||
| Geboortedatum | T - 25 jaar | ||||||||
| Inwonend | Nee | ||||||||
| Toelichting | kinderen wonen ver weg en kunnen niet helpen bij dagelijkse zorg aan echtgenote | ||||||||
| Juridische situatie | |||||||||
| JuridischeSituatie eovd-1-1-juridischesituatie-01 | |||||||||
| Vertegenwoordiging | Onder curatele stelling (code = '9' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3') | ||||||||
| DatumAanvang | T - 1 jaar | ||||||||
| Woonomgeving | |||||||||
| Woonsituatie | |||||||||
| Toelichting | woning is op derde verdieping, is gelijkvloers en er is een lift aanwezig | ||||||||
| WoningType | Appartement of flatwoning (code = 'FLATW' in codeSystem 'ZIB WoningType') | ||||||||
| Levensovertuiging | |||||||||
| LevensovertuigingRC | |||||||||
| Levensovertuiging | Geen geloof (code = 'GeenGeloof' in codeSystem 'ZIB NL-CM-CS Algemeen') | ||||||||
| Wilsverklaring | |||||||||
| WilsverklaringType | Verklaring donorschap (code = 'DO' in codeSystem 'ZIB WilsverklaringType') | ||||||||
| WilsverklaringDatum | T - 4 jaar | ||||||||
| Vertegenwoordiger | |||||||||
| Contactpersoon | Zie Contactpersoon: eovd-1-1-contactpersoon-01 | ||||||||
| Toelichting | wilsverklaring bevindt zich in de portemonnee. | ||||||||
| Wilsverklaring | |||||||||
| WilsverklaringType | Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): Wil niet gevaccineerd worden | ||||||||
| WilsverklaringDatum | T - 1 jaar | ||||||||
| Sociale omgeving | |||||||||
| ParticipatieInMaatschappij | |||||||||
| SociaalNetwerk | heeft veel contact met collega's en buren | ||||||||
| Vrijetijdsbesteding | gitaar spelen | ||||||||
| Arbeidssituatie | werkt als administratief medewerker bij gemeente | ||||||||
| Toelichting | heeft tijdelijk contract | ||||||||
| HulpVanAnderen | |||||||||
| Hulpverlener | |||||||||
| Mantelzorger | |||||||||
| Contactpersoon | |||||||||
| Naamgegevens | |||||||||
| Voornamen | Marriet | ||||||||
| Initialen | M. | ||||||||
| Naamgebruik | Eigen geslachtsnaam (code = 'NL1' in codeSystem 'ZIB Naamgebruik') | ||||||||
| Geslachtsnaam | |||||||||
| Achternaam | Blauw | ||||||||
| Rol | Buur (code = '19' in codeSystem 'Vektis Rolcode COD472-VEKT') | ||||||||
| Aard | helpt met ondersteuning echtgenote als meneer er niet is | ||||||||
| Frequentie | zo vaak als nodig | ||||||||
| SoortHulp | Mantelzorg (code = '386229000' in codeSystem 'SNOMED CT') | ||||||||
| HulpVanAnderen | |||||||||
| Hulpverlener | |||||||||
| Zorgaanbieder | |||||||||
| OrganisatieNaam | WijZorgen | ||||||||
| OrganisatieLocatie | Stitswerd | ||||||||
| OrganisatieType | Thuiszorg (code = 'T2' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | ||||||||
| Aard | ondersteuning bij wassen | ||||||||
| Frequentie | dagelijks | ||||||||
| SoortHulp | Professionele thuiszorg (code = '60689008' in codeSystem 'SNOMED CT') | ||||||||
| Toelichting | niet in het weekend | ||||||||
| HulpVanAnderen | |||||||||
| Hulpverlener | |||||||||
| Zorgverlener | |||||||||
| Naamgegevens | |||||||||
| Voornamen | Therese | ||||||||
| Geslachtsnaam | |||||||||
| Achternaam | Roep | ||||||||
| Contactgegevens | |||||||||
| EmailAdressen | |||||||||
| EmailAdres | thereseroep@zzp.nl | ||||||||
| Aard | ondersteuning bij wassen | ||||||||
| Frequentie | dagelijks | ||||||||
| SoortHulp | Professionele thuiszorg (code = '60689008' in codeSystem 'SNOMED CT') | ||||||||
| Toelichting | alleen in het weekend | ||||||||
| Communicatie | |||||||||
| Taalvaardigheid | |||||||||
| CommunicatieTaal | Nederlands (code = 'nl' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') | ||||||||
| TaalvaardigheidBegrijpen | Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| TaalvaardigheidSpreken | Slecht (code = 'P' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| TaalvaardigheidLezen | Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| Toelichting | t.g.v. CVA nu moeite met begrijpen, spreken gaat ook moeilijk i.v.m. afasie | ||||||||
| Taalvaardigheid | |||||||||
| CommunicatieTaal | Limburgs (code = 'li' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') | ||||||||
| TaalvaardigheidBegrijpen | Goed (code = 'G' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| TaalvaardigheidSpreken | Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| Toelichting | opgegroeid in Zuid-Limburg | ||||||||
1.3.3 Medische context
| Medische context | ||||||||
| Gegevenselement | Waarde | |||||||
| Behandelaar | ||||||||
| Zorgverlener eovdv-1-1-behandelaar-01 | ||||||||
| Naamgegevens | ||||||||
| Voornamen | Joshua Pieter | |||||||
| Initialen | J. P. | |||||||
| Geslachtsnaam | ||||||||
| Achternaam | Helmond | |||||||
| Specialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| Zorgaanbieder | ||||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||||
| OrganisatieNaam | AB-zkh | |||||||
| OrganisatieLocatie | Noord | |||||||
| Behandelaar | ||||||||
| Zorgverlener eovdv-1-1-behandelaar-02 | ||||||||
| ZorgverlenerIdentificatienummer | 03898989 (in identificerend systeem: AGB-Z) | |||||||
| Naamgegevens | ||||||||
| Initialen | G. | |||||||
| Geslachtsnaam | ||||||||
| Achternaam | Spijkerman | |||||||
| Specialisme | Medisch specialisten, gastro-enterologie (maag-darm-lever-arts) (code = '0318' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| Zorgaanbieder | ||||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||||
| OrganisatieNaam | AB-zkh | |||||||
| OrganisatieLocatie | Noord | |||||||
| Medische diagnose | ||||||||
| Probleem eovd-1-1-probleem-01 | ||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | ischemisch cerebrovasculair accident (code = '422504002' in codeSystem 'SNOMED CT') | |||||||
| ProbleemBeginDatum | T - 100 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| VerificatieStatus | Bevestigd (code = '410605003' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | niet bekend met neurologische klachten | |||||||
| Probleem eovd-1-1-probleem-02 | ||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | neoplasma van colon (code = '126838000') | |||||||
| ProbleemBeginDatum | T - 150 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Probleem eovd-1-1-probleem-03 | ||||||||
| ProbleemAnatomischeLocatie | oksel (code = '91470000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProbleemLateraliteit | Rechts en links (code = '51440002' in codeSystem 'SNOMED CT') | |||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | inverse psoriasis (code = '238600001') | |||||||
| ProbleemBeginDatum | T - 10 jaar | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Voorgeschiedenis | ||||||||
| Probleem | ||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | diabetes mellitus (code = '73211009') | |||||||
| ProbleemBeginDatum | T - 12 jaar | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Allergie | ||||||||
| AllergieIntolerantie | ||||||||
| VeroorzakendeStof | nikkelsulfaat (code = '255848005' in codeSystem 'SNOMED CT') | |||||||
| AllergieCategorie | Stof of product (code = '419199007' in codeSystem 'SNOMED CT') | |||||||
| AllergieStatus | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||||||
| BeginDatumTijd | T - 10 jaar | |||||||
| MateVanKritiekZijn | 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') | |||||||
| ReactieBeschrijving | last van jeuk, roodheid en irritatie op de contactplek van nikkel bevattende sieraden. | |||||||
| WijzeVanBlootstelling | intra-epidermale route (code = '448077001' in codeSystem 'SNOMED Clinical Terms') | |||||||
| AllergieIntolerantie | ||||||||
| VeroorzakendeStof | pollen (code = '256259004') | |||||||
| AllergieCategorie | Omgeving (code = '426232007' in codeSystem 'SNOMED CT') | |||||||
| AllergieStatus | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||||||
| BeginDatumTijd | T - 500 dagen | |||||||
| MateVanKritiekZijn | Matig (code = '6736007' in codeSystem 'SNOMED CT') | |||||||
| LaatsteReactieDatumTijd | T - 99 dagen | |||||||
| Reactie | ||||||||
| Symptoom | Overgevoeligheidsreactie van de bovenste luchtwegen (code = '490008' in codeSystem 'SNOMED CT') | |||||||
| SpecifiekeStof | graspollen (code = '256277009') | |||||||
| ReactieBeschrijving | veelvuldig niezen | |||||||
| Ernst | Matig (code = '6736007' in codeSystem 'SNOMED CT') | |||||||
| ReactieTijdstip | T - 99 dagen | |||||||
| Reactie | ||||||||
| Symptoom | Kortademigheid (code = '267036007' in codeSystem 'SNOMED CT') | |||||||
| Symptoom | Koorts (code = '386661006' in codeSystem 'SNOMED CT') | |||||||
| SpecifiekeStof | pollen van paprikaplant (code = '110181000146104') | |||||||
| ReactieBeschrijving | ernstige benauwdheid en koorts | |||||||
| Ernst | Ernstig (code = '24484000' in codeSystem 'SNOMED CT') | |||||||
| ReactieTijdstip | T - 200 dagen | |||||||
| Let op | ||||||||
| Alert | ||||||||
| AlertNaam | Drager MRSA (code = '432415000' in codeSystem 'SNOMED CT') | |||||||
| BeginDatumTijd | T - 20 dagen | |||||||
| AlertType | waarschuwing (code = '74018-3' in codeSystem 'LOINC') | |||||||
| Alert | ||||||||
| AlertNaam | Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): ernstige claustrofobie | |||||||
| BeginDatumTijd | T - 10 jaar | |||||||
| Vrijheidsbeperking | ||||||||
| VrijheidsbeperkendeInterventie | ||||||||
| Wilsbekwaam | Ja | |||||||
| JuridischeSituatie | Zie JuridischeSituatie: eovd-1-1-juridischesituatie-01 | |||||||
| SoortInterventie | geforceerd toedienen van voeding bij patiënt (code = '37041007' in codeSystem 'SNOMED CT') | |||||||
| RedenVanToepassen | bevorderen van fysieke gezondheid (code = '121581000146106' in codeSystem 'SNOMED CT') | |||||||
| Instemming | Instemming patiënt (code = '2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') | |||||||
| Begin | T - 50 dagen | |||||||
| Meetwaarden | ||||||||
| Bloeddruk | ||||||||
| Meetmethode | Niet-invasief (code = '22762002' in codeSystem 'SNOMED CT') | |||||||
| ManchetType | Standaard (code = 'STD' in codeSystem 'ZIB ManchetType') | |||||||
| MeetLocatie | Rechter bovenarm (code = '368209003' in codeSystem 'SNOMED CT') | |||||||
| DiastolischEindpunt | Fase V (code = '255272007' in codeSystem 'SNOMED CT') | |||||||
| SystolischeBloeddruk | 170 mm[Hg] | |||||||
| DiastolischeBloeddruk | 90 mm[Hg] | |||||||
| GemiddeldeBloeddruk | 110 mm[Hg] | |||||||
| BloeddrukDatumTijd | T - 20 dagen om 14:45 uur | |||||||
| Toelichting | meneer gebruikt medicatie | |||||||
| Houding | Liggende positie (code = '102538003' in codeSystem 'SNOMED CT') | |||||||
| Polsfrequentie | ||||||||
| PolsfrequentieWaarde | 90 | |||||||
| PolsfrequentieDatumTijd | T - 5 dagen om 14:45 uur | |||||||
| Toelichting | is altijd sportief geweest | |||||||
| PolsRegelmatigheid | Polsslag regelmatig (code = '271636001' in codeSystem 'SNOMED CT') | |||||||
| Lichaamstemperatuur | ||||||||
| TemperatuurWaarde | 36.8 Cel | |||||||
| TemperatuurDatumTijd | T - 4 dagen om 07 uur | |||||||
| Toelichting | voeten voelen heel koud aan | |||||||
| TemperatuurType | Tympanische temperatuur (code = '415974002' in codeSystem 'SNOMED CT') | |||||||
| Ademhaling | ||||||||
| Ademfrequentie | 18 /min | |||||||
| AdemhalingDatumTijd | T - 3 dagen om 14:45 uur | |||||||
| Ritme | Abnormaal ademhalingsritme (code = '85617008' in codeSystem 'SNOMED CT') | |||||||
| Diepte | Normale ademhalingsdiepte (code = '301284009' in codeSystem 'SNOMED CT') | |||||||
| AfwijkendAdemhalingspatroon | Apneu (code = '1023001' in codeSystem 'SNOMED CT') | |||||||
| ExtraZuurstofToediening | Ja | |||||||
| Toelichting | meneer lijkt angstig | |||||||
| ToegediendeZuurstof | ||||||||
| FlowRate | 2 l/min | |||||||
| FiO2 | 0.29 l | |||||||
| ToedieningHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Neusbril (code = '336623009' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | neusbril | |||||||
| Lichaamsgewicht | ||||||||
| GewichtWaarde | 74 kg | |||||||
| Toelichting | meneer volgt afvaldieet | |||||||
| GewichtDatumTijd | T - 5 dagen om 14:30 uur | |||||||
| Kleding | Volledig gekleed, inclusief schoenen (code = 'FULL' in codeSystem 'ZIB ContextKleding') | |||||||
| Lichaamslengte | ||||||||
| LengteWaarde | 170 cm | |||||||
| LengteDatumTijd | T - 5 dagen om 14:30 uur | |||||||
| Toelichting | zonder schoenen aan | |||||||
| Pijnscore | ||||||||
| PijnScore | ||||||||
| PijnscoreWaarde | 2 | |||||||
| PijnscoreDatumTijd | T - 5 dagen om 14:45 uur | |||||||
| PijnMeetmethode | NRS (code = 'NRS' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.9.1') | |||||||
| AnatomischeLocatie | gehele voet (code = '302545001' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | Af en toe pijn, maar niet belemmerend bij het lopen | |||||||
1.3.4 Verpleegkundige context: zorgplan
| Verpleegkundige context: zorgplan | ||||||||||
| Gegevenselement | Waarde | |||||||||
| Actuele patiëntproblemen | ||||||||||
| Patiëntprobleem | ||||||||||
| Probleem eovd-1-1-patientprobleem-01 | ||||||||||
| ProbleemNaam | probleem met zichzelf wassen en afdrogen (code = '288552005' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||||||
| ProbleemBeginDatum | T - 100 dagen | |||||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||||
| Toelichting | meneer kan niet buigen | |||||||||
| VerpleegkundigeInterventie eovd-1-1-interventie-01 | ||||||||||
| Interventie | ondersteunen bij wassen en/of persoonlijke hygiëne (code = '386420003' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| Indicatie | ||||||||||
| Probleem | Zie Probleem: eovd-1-1-patientprobleem-01 | |||||||||
| Behandeldoel | ||||||||||
| GewenstZorgresultaat | wassen onafhankelijk | |||||||||
| ActieStartDatumTijd | T - 90 dagen | |||||||||
| Frequentie | 1 /dag | |||||||||
| Instructie | let op: valrisico | |||||||||
| Uitvoerder | ||||||||||
| Zorgverlener | Ja | |||||||||
| Patiëntprobleem | ||||||||||
| Probleem eovd-1-1-patientprobleem-02 | ||||||||||
| ProbleemNaam | probleem met zichzelf kleden (code = '284972002' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||||||
| ProbleemBeginDatum | T - 90 dagen | |||||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||||
| VerpleegkundigeInterventie eovd-1-1-interventie-02 | ||||||||||
| Interventie | ondersteunen bij aankleden (code = '313332003' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| Indicatie | ||||||||||
| Probleem | Zie Probleem: eovd-1-1-patientprobleem-02 | |||||||||
| Behandeldoel | ||||||||||
| GewenstZorgresultaat | kleden onafhankelijk | |||||||||
| Frequentie | 3 /dag | |||||||||
| Patiëntprobleem | ||||||||||
| Probleem eovd-1-1-patientprobleem-03 | ||||||||||
| ProbleemAnatomischeLocatie | hiel (code = '76853006' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| ProbleemLateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||||
| ProbleemNaam | decubitus (code = '399912005' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||||||
| ProbleemBeginDatum | T - 90 dagen | |||||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||||
| VerpleegkundigeInterventie | ||||||||||
| Interventie | aanleggen van verband op wond (code = '182531007' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| Indicatie | ||||||||||
| Probleem | Zie Probleem: eovd-1-1-patientprobleem-03 | |||||||||
| Frequentie | 1 /dag | |||||||||
| MedischHulpmiddel | ||||||||||
| Product | ||||||||||
| ProductType | schuimverband (code = '448416005' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| MedischHulpmiddel | ||||||||||
| Product | ||||||||||
| ProductType | huidvervangende wondbedekkers (code = '465239008' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| VerpleegkundigeInterventie | ||||||||||
| Interventie | wisselen van positie van patiënt (code = '225286008' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| Indicatie | ||||||||||
| Probleem | Zie Probleem: eovd-1-1-patientprobleem-03 | |||||||||
| Behandeldoel | ||||||||||
| GewenstZorgresultaat | wondlengte < 1cm, wondbreedte < 1 cm | |||||||||
| ActieStartDatumTijd | T - 10 dagen | |||||||||
| ActieEindDatumTijd | T - 1 dag | |||||||||
| Interval | 4 uur | |||||||||
| Uitvoerder | ||||||||||
| Zorgverlener | Ja | |||||||||
| Patiëntprobleem | ||||||||||
| Probleem eovd-1-1-patientprobleem-04 | ||||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||||
| ProbleemNaam | loopt risico op delier (code = '430794006' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||||||
| ProbleemBeginDatum | T - 5 dagen | |||||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||||
| Toelichting | vastgesteld met DOS score | |||||||||
| VerpleegkundigeInterventie | ||||||||||
| Interventie | bevorderen van vochtinname (code = '113148007' in codeSystem 'SNOMED Clinical Terms') | |||||||||
| Indicatie | ||||||||||
| Probleem | Zie Probleem: eovd-1-1-patientprobleem-04 | |||||||||
| Behandeldoel | ||||||||||
| GewenstZorgresultaat | vochtinname > 1,5 liter/dag | |||||||||
| Instructie | Graag er op toezien dat meneer > 1,5 liter per dag drinkt | |||||||||
| Uitvoerder | ||||||||||
| Verzorger | ||||||||||
| Contactpersoon | ||||||||||
| Naamgegevens | ||||||||||
| Voornamen | Gerda | |||||||||
| Naamgebruik | Geslachtsnaam partner (code = 'NL2' in codeSystem 'ZIB Naamgebruik') | |||||||||
| GeslachtsnaamPartner | ||||||||||
| AchternaamPartner | XXX_Altenborg | |||||||||
| Contactgegevens | ||||||||||
| Telefoonnummers | ||||||||||
| Telefoonnummer | +31662626262 | |||||||||
| Relatie | Echtgenoot (code = 'HUSB' in codeSystem 'HL7 RoleCode') | |||||||||
| Zorgresultaat | ||||||||||
| UitkomstVanZorg | ||||||||||
| Zorgresultaat | doel deels behaald: kan nog niet rug wassen | |||||||||
| Interventie | ||||||||||
| VerpleegkundigeInterventie | Zie VerpleegkundigeInterventie: eovd-1-1-interventie-01 | |||||||||
| UitkomstVanZorg | ||||||||||
| Zorgresultaat | doel deels behaald, kan nog niet zelf veters strikken | |||||||||
| Interventie | ||||||||||
| VerpleegkundigeInterventie | Zie VerpleegkundigeInterventie: eovd-1-1-interventie-02 | |||||||||
| Afspraken patiënt | ||||||||||
| Contact | ||||||||||
| ContactType | Poliklinisch (code = 'AMB' in codeSystem 'HL7 ActCode') | |||||||||
| ContactMet | ||||||||||
| Zorgverlener | ||||||||||
| Naamgegevens | ||||||||||
| Voornamen | Joshua Pieter | |||||||||
| Initialen | J.P. | |||||||||
| Geslachtsnaam | ||||||||||
| Achternaam | Helmond | |||||||||
| Specialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||||
| ContactMet | ||||||||||
| Zorgverlener | ||||||||||
| ZorgverlenerIdentificatienummer | 03686868 (in identificerend systeem: AGB-Z) | |||||||||
| Naamgegevens | ||||||||||
| Initialen | F. | |||||||||
| Geslachtsnaam | ||||||||||
| Achternaam | Snijder | |||||||||
| Specialisme | Medisch specialisten, neurochirurgie (code = '0308' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||||
| Locatie | ||||||||||
| Zorgaanbieder | ||||||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||||||
| OrganisatieNaam | AB-zkh | |||||||||
| OrganisatieLocatie | Noord | |||||||||
| AfdelingSpecialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||||
| Contactgegevens | ||||||||||
| Telefoonnummers | ||||||||||
| Telefoonnummer | +31182435770 | |||||||||
| EmailAdressen | ||||||||||
| EmailAdres | neurologie@ABZ.nl | |||||||||
| Adresgegevens | ||||||||||
| Straat | Knolweg | |||||||||
| Huisnummer | 10 | |||||||||
| Postcode | 9999PO | |||||||||
| Woonplaats | Stitswerd | |||||||||
| AdresSoort | Werkadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||||||
| OrganisatieType | Algemeen ziekenhuis (code = 'V6' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||||||
| BeginDatumTijd | T + 5 dagen om 10:00 uur | |||||||||
| EindDatumTijd | T + 5 dagen om 10:30 uur | |||||||||
| RedenContact | ||||||||||
| Probleem | Zie Probleem: eovd-1-1-probleem-01 | |||||||||
| Contact | ||||||||||
| ContactType | Thuis (code = 'HH' in codeSystem 'HL7 ActCode') | |||||||||
| ContactMet | ||||||||||
| Zorgverlener | ||||||||||
| ZorgverlenerIdentificatienummer | 88131313 (in identificerend systeem: AGB-Z) | |||||||||
| Naamgegevens | ||||||||||
| Initialen | W. | |||||||||
| Geslachtsnaam | ||||||||||
| Achternaam | Bloem | |||||||||
| Specialisme | Ergotherapeuten (code = '8800' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||||
| Contactgegevens | ||||||||||
| EmailAdressen | ||||||||||
| EmailAdres | bloem@ergotherapie.nl | |||||||||
| BeginDatumTijd | T + 12 dagen om 15:15 uur | |||||||||
| RedenContact | ||||||||||
| RedenContactTekst | Controle voortgang revalidatie | |||||||||
| Wensen en behoeften patiënt en/of naasten | meneer wil zo snel mogelijk weer zelfstandig kunnen functioneren en zijn vrouw kunnen verzorgen | |||||||||
1.3.5 Verpleegkundige context: specificatie gezondheidstoestand
| Verpleegkundige context: specificatie gezondheidstoestand | ||||||||
| Gegevenselement | Waarde | |||||||
| Zelfzorg | ||||||||
| VermogenTotDrinken | ||||||||
| Drinken | Hulp nodig (code = '16681000146102' in codeSystem 'SNOMED CT | |||||||
| DrinkBeperkingen | Bereiden (openen/uitschenken) (code = '286506008' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotDrinken | ||||||||
| Drinken | Onafhankelijk (code = '19841000146104' in codeSystem 'SNOMED CT | |||||||
| DrinkBeperkingen | Vastpakken (code = '307071002' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotEten | ||||||||
| Eten | Hulp nodig (code = '129033007' in codeSystem 'SNOMED CT (ordinal = '1') | |||||||
| EetBeperkingen | Snijden/openen (code = '289078003' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotEten | ||||||||
| Eten | Onafhankelijk (code = '165224005' in codeSystem 'SNOMED CT (ordinal = '0') | |||||||
| EetBeperkingen | Eetgerei hanteren (code = '289046006' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotMondverzorging | ||||||||
| VerzorgenTanden | Hulp nodig (code = '16671000146104' in codeSystem 'SNOMED CT') | |||||||
| Prothese | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Gebitsprothese (code = '27606000' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Gebitsprothese bovenkaak | |||||||
| Prothese | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Gebitsprothese (code = '27606000' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Gebitsprothese onderkaak | |||||||
| VermogenTotZichWassen | ||||||||
| ZichWassen | Hulp nodig (code = '16621000146103' in codeSystem 'SNOMED CT | |||||||
| TeWassenLichaamsdeel | Onderlichaam (code = '362875007' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotZichWassen | ||||||||
| ZichWassen | Hulp nodig (code = '16621000146103' in codeSystem 'SNOMED CT | |||||||
| TeWassenLichaamsdeel | Bovenlichaam (code = '362874006' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotZichKleden | ||||||||
| ZichKleden | Hulp nodig (code = '129039006' in codeSystem 'SNOMED CT | |||||||
| TeKledenLichaamsdeel | Onderlichaam (code = '362875007' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotZichKleden | ||||||||
| ZichKleden | Onafhankelijk (code = '129035000' in codeSystem 'SNOMED CT | |||||||
| TeKledenLichaamsdeel | Bovenlichaam (code = '362874006' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotUiterlijkeVerzorging | ||||||||
| UiterlijkeVerzorging | Hulp nodig (code = '27941000146109' in codeSystem 'SNOMED CT | |||||||
| VermogenTotToiletgang | ||||||||
| Toiletgebruik | Onafhankelijk (code = '129062008' in codeSystem 'SNOMED CT (ordinal = '0') | |||||||
| VermogenTotZelfstandigMedicatiegebruik | ||||||||
| ZelfstandigMedicatiegebruik | Hulp nodig (code = '27921000146103' in codeSystem 'SNOMED CT') | |||||||
| HulpBijToediening | ||||||||
| VerpleegkundigeInterventie | ||||||||
| Interventie | bevorderen van therapietrouw met behulp van medicijndispenser (code = '710153008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Behandeldoel | ||||||||
| GewenstZorgresultaat | therapietrouw | |||||||
| Frequentie | 2 /d | |||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | medicatierol (code = '713308004' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | baxterrol | |||||||
| VermogenTotVerpleegtechnischeHandelingen | ||||||||
| VerpleegkundigeInterventie | ||||||||
| VerpleegkundigeInterventie | ||||||||
| Interventie | Stoma care procedure (code = '225194008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Behandeldoel | ||||||||
| GewenstZorgresultaat | goede hygiene met betrekking tot stoma | |||||||
| ActieStartDatumTijd | T - 6 dagen | |||||||
| Uitvoerder | ||||||||
| Patient | Ja | |||||||
| Toelichting | toezicht bij uitvoer, en instructie hygiënisch werken | |||||||
| VerrichtenVPKHandeling | Hulp nodig (code = '27931000146101' in codeSystem 'SNOMED CT | |||||||
| VermogenTotVerpleegtechnischeHandelingen | ||||||||
| VerpleegkundigeInterventie | ||||||||
| VerpleegkundigeInterventie | ||||||||
| Interventie | vervangen van verband (code = '18949003' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ActieStartDatumTijd | T - 1 dag | |||||||
| Interval | 2 dagen | |||||||
| VerrichtenVPKHandeling | Hulp nodig (code = '27931000146101' in codeSystem 'SNOMED CT | |||||||
| Toelichting zelfzorg | kan zich steeds beter redden met wassen en kleden, knoopjes dichtdoen en schoenen met hulp. Ileostoma instructies gestart. | |||||||
| Mobiliteit | ||||||||
| Mobiliteit | ||||||||
| Lopen | Hulp nodig (code = '16581000146103' in codeSystem 'SNOMED CT | |||||||
| Traplopen | Volledig afhankelijk (code = '301589003' in codeSystem 'SNOMED CT | |||||||
| HoudingVeranderen | Onafhankelijk (code = '19821000146105' in codeSystem 'SNOMED CT | |||||||
| HoudingHandhaven | Onafhankelijk (code = '19811000146100' in codeSystem 'SNOMED CT | |||||||
| UitvoerenTransfer | Hulp nodig (code = '714917003' in codeSystem 'SNOMED CT | |||||||
| MedischHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | rollator (code = '404946006' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | rollator | |||||||
| BeginDatum | T - 1 jaar | |||||||
| MedischHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | rolstoel (code = '58938008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | rolstoel | |||||||
| BeginDatum | T - 1 maand | |||||||
| Toelichting | voor langere afstanden | |||||||
| Toelichting | lopen is stuk verbeterd, rechter been minder krachtig | |||||||
| Voeding/vocht | ||||||||
| Voedingsadvies | ||||||||
| DieetType | suikervrij, diabetes dieet | |||||||
| Consistentie | dik vloeibaar | |||||||
| Toelichting | eet naar eigen keuze minder vlees | |||||||
| Voedingsadvies | ||||||||
| DieetType | geen varkensvlees | |||||||
| SNAQScore | ||||||||
| GewichtsverliesScore | LossAverage (code = 'G1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.1 (ordinal = '2') | |||||||
| EetlustScore | Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.2 (ordinal = '0') | |||||||
| VoedingsScore | GeenVoeding (code = 'Z0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.3 (ordinal = '0') | |||||||
| TotaalScore | 2 | |||||||
| SNAQScoreDatumTijd | T - 6 dagen om 17 uur | |||||||
| Toelichting | geen verminderde eetlust ondanks chemotherapie | |||||||
| SNAQrcScore | ||||||||
| GewichtsverliesScore | LossHigh (code = 'G2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.1 (ordinal = '2') | |||||||
| EetlustScore | Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.2 (ordinal = '0') | |||||||
| BMIScore | Gezond (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.3 (ordinal = '0') | |||||||
| HulpBijEten | Onafhankelijk (code = '165224005' in codeSystem 'SNOMED CT (ordinal = '0') | |||||||
| TotaalScore | 2 | |||||||
| SNAQrcScoreDatumTijd | T - 6 dagen om 17 uur | |||||||
| Toelichting | geen verminderde eetlust ondanks chemotherapie | |||||||
| SNAQ65+Score | ||||||||
| GewichtsverliesScore | LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.1 (ordinal = '0') | |||||||
| BovenarmOmtrekScore | Normaal (code = 'A0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.4 (ordinal = '0') | |||||||
| EetlustScore | Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.2 (ordinal = '0') | |||||||
| InspanningsScore | Mogelijk (code = 'In0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.3 (ordinal = '0') | |||||||
| TotaalScore | 0 | |||||||
| SNAQ65+ScoreDatumTijd | T - 6 dagen om 17 uur | |||||||
| Toelichting | geen verminderde eetlust ondanks chemotherapie | |||||||
| MUSTScore | ||||||||
| BMIScore | BMIHigh (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.1 (ordinal = '0') | |||||||
| GewichtsverliesScore | LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.2 (ordinal = '0') | |||||||
| ZiekteScore | Ziek (code = 'Z1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.3 (ordinal = '2') | |||||||
| TotaalScore | 2 | |||||||
| MUSTScoreDatumTijd | T - 12 dagen om 17 uur | |||||||
| Vochtbalans | ||||||||
| VochtTotaalIn | 1400 ml | |||||||
| VochtTotaalUit | 1000 ml | |||||||
| VochtbalansStarttijd | T - 6 dagen om 07 uur | |||||||
| VochtbalansStoptijd | T - 5 dagen om 07 uur | |||||||
| SondeSysteem | ||||||||
| Sonde | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Neus-maagsonde (code = '17102003' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | neus- maagsonde | |||||||
| BeginDatum | T - 5 dagen | |||||||
| AnatomischeLocatie | neusgat (code = '363538002' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Zorgverlener | Zie Zorgverlener: eovdv-1-1-behandelaar-02 | |||||||
| SondeLengte | 575 mm | |||||||
| Toelichting | wegens misselijkheid door chemotherapie | |||||||
| SondeSysteem | ||||||||
| Sonde | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | PEJ sonde (code = '8911000146104' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | PEJ sonde | |||||||
| BeginDatum | T - 5 dagen | |||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | enterale voedingspomp (code = '468664004' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | enterale voedingspomp | |||||||
| BeginDatum | T - 5 dagen | |||||||
| Infuus | ||||||||
| Infuuskatheter | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Centraal veneuze katheter (code = '52124006' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | centraal veneuze katheter | |||||||
| BeginDatum | T - 20 dagen | |||||||
| Toelichting | onder sleutelbeen links | |||||||
| AnatomischeLocatie | structuur van vena subclavia (code = '9454009' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Zorgverlener | Zie Zorgverlener: eovdv-1-1-behandelaar-02 | |||||||
| Toelichting | voor voeding | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| LumenLocatie | Distaal (code = '46053002' in codeSystem 'SNOMED CT') | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Afgedopt (code = 'DOP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| LumenLocatie | Mediaal (code = '255561001' in codeSystem 'SNOMED CT') | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| LumenLocatie | Distaal (code = '46053002' in codeSystem 'SNOMED CT') | |||||||
| Infuus | ||||||||
| Infuuskatheter | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Perifeer intraveneus infuus (code = '82449006' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Perifeer intraveneus infuus | |||||||
| BeginDatum | T - 15 dagen | |||||||
| AnatomischeLocatie | onderarm (code = '14975008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | voor medicatie | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| Uitscheiding | ||||||||
| Blaasfunctie | ||||||||
| UrineContinentie | Af en toe een ongelukje (max. 1 keer per 24 uur) (code = '165233007' in codeSystem 'SNOMED CT (ordinal = '1') | |||||||
| Urostoma | ||||||||
| Stoma | Zie Stoma: eovd-1-1-stoma-02 | |||||||
| Incontinentiemateriaal | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | inlegger voor incontinentiebroek (code = '470713005' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | inlegger | |||||||
| Darmfunctie | ||||||||
| Stoma | Zie Stoma: eovd-1-1-stoma-01 | |||||||
| DefecatieConsistentie | Helemaal vloeibaar (code = 'Type 7' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.3.1') | |||||||
| Toelichting | stoma na subtotale darmresectie wegens coloncarcinoom | |||||||
| Stoma eovd-1-1-stoma-01 | ||||||||
| StomaType | eindstandige ileostoma (code = '311412005' in codeSystem 'SNOMED CT') | |||||||
| StomaMateriaal | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Ileostomy bag (code = '417136005' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | stomazak voor ileostoma | |||||||
| AnatomischeLocatie | onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| AanlegDatum | T - 12 dagen | |||||||
| Toelichting | na subtotale darmresectie wegens coloncarcinoom | |||||||
| Stoma eovd-1-1-stoma-02 | ||||||||
| StomaType | urostoma (code = '281601009' in codeSystem 'SNOMED CT') | |||||||
| AnatomischeLocatie | buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| AanlegDatum | T - 4 jaar | |||||||
| Huid | ||||||||
| Brandwond | ||||||||
| OntstaansDatum | T - 2 dagen | |||||||
| Uitgebreidheid | 1 % | |||||||
| BrandwondSoort | Thermische brandwond (code = '105594005' in codeSystem 'SNOMED CT') | |||||||
| AnatomischeLocatie | onderarm (code = '362741001' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| Dieptegraad | 1e graad (code = '77140003' in codeSystem 'SNOMED CT | |||||||
| Toelichting | Meneer kreeg hete thee over zich heen, wond is ongeveer 2 bij 2 cm; geen verband nodig. | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Brandwond | ||||||||
| OntstaansDatum | T - 2 dagen | |||||||
| Uitgebreidheid | 1 % | |||||||
| BrandwondSoort | Thermische brandwond (code = '105594005' in codeSystem 'SNOMED CT') | |||||||
| AnatomischeLocatie | handrug (code = '63125000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| Dieptegraad | 2e graad, oppervlakkig (code = '262587005' in codeSystem 'SNOMED CT | |||||||
| DecubitusWond | ||||||||
| DecubitusCategorie | Decubitus categorie 2 (code = '420324007' in codeSystem 'SNOMED CT (ordinal = '2') | |||||||
| OntstaansDatum | T - 2 dagen | |||||||
| AnatomischeLocatie | hiel (code = '76853006' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Wondlengte | 2 cm | |||||||
| Wondbreedte | 2 cm | |||||||
| Wonddiepte | 0.5 cm | |||||||
| Toelichting | Wond is niet geïnfecteerd. | |||||||
| DecubitusWond | ||||||||
| DecubitusCategorie | Decubitus categorie 1 (code = '421076008' in codeSystem 'SNOMED CT (ordinal = '1') | |||||||
| OntstaansDatum | T - 20 dagen | |||||||
| AnatomischeLocatie | stuitje (code = '182028002' in codeSystem 'SNOMED Clinical Terms') | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Wondlengte | 3 cm | |||||||
| Wondbreedte | 1 cm | |||||||
| Wonddiepte | 0.2 cm | |||||||
| Huidaandoening | ||||||||
| SoortAandoening | Intertrigo/smetten (code = '58759008' in codeSystem 'SNOMED CT') | |||||||
| OntstaansDatum | T - 6 dagen | |||||||
| AnatomischeLocatie | lies (code = '26893007' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | Smetten zonder natten of infectie, inmiddels genezen. | |||||||
| Huidaandoening | ||||||||
| SoortAandoening | Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): Inverse psoriasis | |||||||
| OntstaansDatum | T - 10 jaar | |||||||
| Oorzaak | ||||||||
| Probleem | Zie Probleem: eovd-1-1-probleem-03 | |||||||
| AnatomischeLocatie | oksel (code = '91470000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts en links (code = '51440002' in codeSystem 'SNOMED CT') | |||||||
| Wond | ||||||||
| WondSoort | Traumatische wond (code = '416462003' in codeSystem 'SNOMED CT') | |||||||
| WondWeefsel | Rode wond (code = 'ROOD' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.2') | |||||||
| WondInfectie | Nee | |||||||
| WondVochtigheid | Droge wond (code = 'DROOG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') | |||||||
| Wondlengte | 2 cm | |||||||
| Wondbreedte | 4 cm | |||||||
| Wonddiepte | 0.1 cm | |||||||
| AnatomischeLocatie | knie (code = '72696002' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| WondOntstaansdatum | T - 12 dagen | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Toelichting | oppervlakkige schaafwond na CVA, geen verband nodig | |||||||
| Wond | ||||||||
| WondSoort | Chirurgische wond (code = '112633009' in codeSystem 'SNOMED CT') | |||||||
| WondInfectie | Nee | |||||||
| WondVochtigheid | Vochtige wond (code = 'VOCHTIG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') | |||||||
| WondRand | Ondermijning (code = '449752001' in codeSystem 'SNOMED CT') | |||||||
| Wondlengte | 5 cm | |||||||
| Wondbreedte | 1 cm | |||||||
| Wonddiepte | 4 cm | |||||||
| AnatomischeLocatie | onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Drain | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | wonddrain (code = '258646005' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | wonddrain | |||||||
| BeginDatum | T - 12 dagen | |||||||
| Wond | ||||||||
| WondSoort | Oncologische ulcer (code = '94579000' in codeSystem 'SNOMED CT') | |||||||
| WondWeefsel | Graad II (code = 'GRAAD2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.1') | |||||||
| WondInfectie | Nee | |||||||
| Wondlengte | 1 cm | |||||||
| Wondbreedte | 1 cm | |||||||
| Wonddiepte | 2 cm | |||||||
| AnatomischeLocatie | buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| WondOntstaansdatum | T - 1 maand | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Zintuigen | ||||||||
| FunctieHoren | ||||||||
| HoorFunctie | Verminderde gehoorfunctie (code = '15188001' in codeSystem 'SNOMED CT') | |||||||
| HorenHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductID | 012345678905 (code = '012345678905Global Trade Item Number (GTIN)') | |||||||
| ProductType | Gehoorapparaat (code = '6012004' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Gehoorapparaat | |||||||
| AnatomischeLocatie | Linkeroor (code = '89644007' in codeSystem 'SNOMED CT') | |||||||
| HorenHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| ProductOmschrijving | Gehoorapparaat | |||||||
| AnatomischeLocatie | Rechteroor (code = '25577004' in codeSystem 'SNOMED CT') | |||||||
| FunctieZien | ||||||||
| VisueleFunctie | Verminderd gezichtsvermogen (code = '397540003' in codeSystem 'SNOMED CT') | |||||||
| ZienHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | bril (code = '50121007' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | bril | |||||||
| Toelichting | zonder bril bestaat verhoogd valrisico | |||||||
| Ziektebeleving | ||||||||
| Ziektebeleving | ||||||||
| ZiekteInzichtVanPatiënt | meneer kan niet overzien wat de ziekte betekent in het dagelijkse leven | |||||||
| OmgaanMetZiekteprocesDoorPatiënt | meneer wil niet praten over de toekomst. | |||||||
| OmgaanMetZiekteprocesDoorNaasten | echtgenote maakt zich zorgen of zij de zorg voor meneer wel aan kan, omdat zij zelf ook slecht ter been is | |||||||
| Mentale status | ||||||||
| Probleem | ||||||||
| ProbleemType | Symptoom (code = '418799008' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | gedaald bewustzijn (code = '443371007' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProbleemBeginDatum | T - 22 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | sinds cva, verminderde alertheid | |||||||
| Probleem | ||||||||
| ProbleemType | Klacht (code = '409586006' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | toestand van verwardheid (code = '286933003' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProbleemBeginDatum | T - 22 dagen | |||||||
| ProbleemEindDatum | T - 5 dagen | |||||||
| ProbleemStatus | Niet actueel (code = '73425007' in codeSystem 'SNOMED CT') | |||||||
1.4 Test Overdracht 1.5
1.4.1 Administratieve gegevens
| Administratieve gegevens | ||||||
| Gegevenselement | Waarde | |||||
| Datum overplaatsing | T + 2 dagen | |||||
| Persoonsgegevens | ||||||
| Patient | ||||||
| Naamgegevens | ||||||
| Initialen | M. | |||||
| Geslachtsnaam | ||||||
| Voorvoegsels | van de | |||||
| Achternaam | XXX_Quigleys | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1000 | |||||
| Postcode | 9999ZA | |||||
| Woonplaats | Stitswerd | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Identificatienummer | 999900912 (in identificerend systeem: BSN) | |||||
| Geboortedatum | 5 nov 1963 | |||||
| Geslacht | Vrouw (code = 'F' in codeSystem 'HL7 AdministrativeGender') | |||||
| Betaler | ||||||
| Verzekeraar | ||||||
| Verzekering | ||||||
| EindDatumTijd | T + 250 dagen | |||||
| Verzekeringssoort | Basis (code = 'B' in codeSystem 'ZIB Verzekeringssoort') | |||||
| IdentificatieNummer | 9664 (in identificerend systeem: UZOVI) | |||||
| OrganisatieNaam | Trias | |||||
| VerzekerdeNummer | 12345678 | |||||
| Sturende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 75616161 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | HomeCare | |||||
| OrganisatieType | Thuiszorg (code = 'T2' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Voornamen | Bart | |||||
| Geslachtsnaam | ||||||
| Achternaam | Moorman | |||||
| Specialisme | Verpleegkundigen, niet nader gespecificeerd (code = '9100' in codeSystem 'Vektis AGB-medische specialismen') | |||||
| Ontvangende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 06121212 (in identificerend systeem: URA) | |||||
| OrganisatieNaam | AB-zkh | |||||
| AfdelingSpecialisme | Medisch specialisten, obstetrie en gynaecologie (code = '0307' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| OrganisatieType | Algemeen ziekenhuis (code = 'V6' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
1.4.2 Medische context
| Medische context | ||||||
| Gegevenselement | Waarde | |||||
| Behandelaar | ||||||
| Zorgverlener | ||||||
| ZorgverlenerIdentificatienummer | 03171717 (in identificerend systeem: AGB-Z) | |||||
| Naamgegevens | ||||||
| Initialen | K. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Oosterhout | |||||
| Specialisme | Medisch specialisten, obstetrie en gynaecologie (code = '0307' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| Medische diagnose | ||||||
| Probleem | ||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||
| ProbleemNaam | zwangerschapsgeïnduceerde hypertensie (code = '48194001' in codeSystem 'SNOMED CT') | |||||
| ProbleemBeginDatum | T - 10 dagen | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
| VerificatieStatus | Bevestigd (code = '410605003' in codeSystem 'SNOMED CT') | |||||
| Pijnscore | ||||||
| PijnScore | ||||||
| PijnscoreWaarde | 2 | |||||
| PijnscoreDatumTijd | T - 1 dag om 12:30 uur | |||||
| PijnMeetmethode | VAS10 (code = 'VAS10' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.9.1') | |||||
| AnatomischeLocatie | structuur van rug exclusief nek (code = '77568009' in codeSystem 'SNOMED Clinical Terms') | |||||
1.4.3 Verpleegkundige context: zorgplan
| Verpleegkundige context: zorgplan | ||||||
| Gegevenselement | Waarde | |||||
| Actuele patiëntproblemen | ||||||
| Patiëntprobleem | ||||||
| Probleem eovd-1-5-probleem-01 | ||||||
| ProbleemAnatomischeLocatie | structuur van rug exclusief nek (code = '77568009' in codeSystem 'SNOMED Clinical Terms') | |||||
| ProbleemNaam | pijn (bevinding) (code = '22253000' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||
| ProbleemBeginDatum | T - 10 dagen | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
| Toelichting | bij lopen | |||||
| VerpleegkundigeInterventie eovd-1-5-interventie-01 | ||||||
| Interventie | afleiden (code = '414039005' in codeSystem 'SNOMED Clinical Terms') | |||||
| Indicatie | ||||||
| Probleem | Zie Probleem: eovd-1-5-probleem-01 | |||||
| Zorgresultaat | ||||||
| UitkomstVanZorg | ||||||
| Zorgresultaat | zie pijnscore | |||||
| Interventie | ||||||
| VerpleegkundigeInterventie | Zie VerpleegkundigeInterventie: eovd-1-5-interventie-01 | |||||
1.4.4 Verpleegkundige context: specificatie gezondheidstoestand
| Verpleegkundige context: specificatie gezondheidstoestand | ||||
| Gegevenselement | Waarde | |||
| Voortplanting | ||||
| Zwangerschap | ||||
| Zwanger | Ja | |||
| ATermeDatum | T + 120 dagen | |||
| DatumLaatsteMenstruatie | T - 170 dagen | |||
| Zwangerschapsduur | 160 dagen | |||
| Graviditeit | 1 | |||
| Pariteit | 0 | |||
| Toelichting | Mevrouw is vaak misselijk in de ochtend. | |||
1.5 Test Overdracht 1.6
1.5.1 Administratieve gegevens
| Administratieve gegevens | ||||||
| Gegevenselement | Waarde | |||||
| Datum overplaatsing | T + 1 dag | |||||
| Persoonsgegevens | ||||||
| Patient | ||||||
| Naamgegevens | ||||||
| Initialen | M. | |||||
| Geslachtsnaam | ||||||
| Achternaam | XXX_Arcken | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1000 | |||||
| Postcode | 9999XA | |||||
| Woonplaats | Stitswerd | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Identificatienummer | 999900043 (in identificerend systeem: BSN) | |||||
| Geboortedatum | 18 sep 1963 | |||||
| Geslacht | Vrouw (code = 'F' in codeSystem 'HL7 AdministrativeGender') | |||||
| Betaler | ||||||
| Verzekeraar | ||||||
| Verzekering | ||||||
| EindDatumTijd | T + 250 dagen | |||||
| Verzekeringssoort | Basis (code = 'B' in codeSystem 'ZIB Verzekeringssoort') | |||||
| IdentificatieNummer | 9664 (in identificerend systeem: UZOVI) | |||||
| OrganisatieNaam | Trias | |||||
| VerzekerdeNummer | 12345678 | |||||
| Sturende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 75616161 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | HomeCare | |||||
| OrganisatieType | Thuiszorg (code = 'T2' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Voornamen | Bart | |||||
| Geslachtsnaam | ||||||
| Achternaam | Moorman | |||||
| Ontvangende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 75727272 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | St. Geestelijk Welzijn | |||||
| OrganisatieType | Geestelijke Gezondheidszorg (code = 'G5' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
1.5.2 Algemene patiënten context
| Algemene patiënten context | ||||
| Gegevenselement | Waarde | |||
| Juridische situatie | ||||
| JuridischeSituatie eovd-1-6-juridischesituatie-01 | ||||
| JuridischeStatus | Rechterlijke machtiging (code = 'RM' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.2') | |||
| DatumAanvang | T - 3 dagen | |||
| DatumEinde | T + 3 maanden | |||
| JuridischeSituatie | ||||
| Vertegenwoordiging | Mentorschap (code = '8' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3') | |||
| DatumAanvang | T - 6 maanden | |||
1.5.3 Medische context
| Medische context | ||||||
| Gegevenselement | Waarde | |||||
| Behandelaar | ||||||
| Zorgverlener | ||||||
| ZorgverlenerIdentificatienummer | 01171717 (in identificerend systeem: AGB-Z) | |||||
| Naamgegevens | ||||||
| Initialen | K. | |||||
| Geslachtsnaam | ||||||
| Voorvoegsels | van | |||||
| Achternaam | Eindhoven | |||||
| Specialisme | Huisartspraktijk (code = '0100' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| Medische diagnose | ||||||
| Probleem | ||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||
| ProbleemNaam | niet-organische psychose (code = '191525009' in codeSystem 'SNOMED CT') | |||||
| ProbleemBeginDatum | T - 5 dagen | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
| VerificatieStatus | Bevestigd (code = '410605003' in codeSystem 'SNOMED CT') | |||||
| Vrijheidsbeperking | ||||||
| VrijheidsbeperkendeInterventie | ||||||
| Wilsbekwaam | Nee | |||||
| WilsbekwaamToelichting | wegens psychose | |||||
| JuridischeSituatie | Zie JuridischeSituatie: eovd-1-6-juridischesituatie-01 | |||||
| SoortInterventie | geslotendeurprocedure (code = '225210009' in codeSystem 'SNOMED CT') | |||||
| RedenVanToepassen | afwenden van situatie die kan resulteren in toebrengen van schade aan zichzelf of aan anderen (code = '121481000146105' in codeSystem 'SNOMED CT') | |||||
| Instemming | Geen instemming patiënt (code = '1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') | |||||
| Begin | T + 1 dag | |||||
| VrijheidsbeperkendeInterventie | ||||||
| Wilsbekwaam | Nee | |||||
| WilsbekwaamToelichting | wegens psychose | |||||
| JuridischeSituatie | Zie JuridischeSituatie: eovd-1-6-juridischesituatie-01 | |||||
| SoortInterventie | separeren in extra beveiligde kamer (code = '124041000146108' in codeSystem 'SNOMED CT') | |||||
| RedenVanToepassen | afwenden van situatie die kan resulteren in toebrengen van schade aan zichzelf of aan anderen (code = '121481000146105' in codeSystem 'SNOMED CT') | |||||
| Instemming | Geen instemming patiënt (code = '1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') | |||||
| Begin | T + 1 dag | |||||
| Einde | T + 3 dagen | |||||
1.5.4 Verpleegkundige context: zorgplan
| Verpleegkundige context: zorgplan | ||||||
| Gegevenselement | Waarde | |||||
| Actuele patiëntproblemen | ||||||
| Patiëntprobleem | ||||||
| Probleem eovd-1-6-probleem-01 | ||||||
| ProbleemNaam | fysieke agressie (code = '248004009' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||
| ProbleemBeginDatum | T - 5 dagen | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
| VerpleegkundigeInterventie eovd-1-6-interventie-01 | ||||||
| Interventie | rustige en geruststellende houding aannemen (code = '225980008' in codeSystem 'SNOMED Clinical Terms') | |||||
| Indicatie | ||||||
| Probleem | Zie Probleem: eovd-1-6-probleem-01 | |||||
| Behandeldoel | ||||||
| GewenstZorgresultaat | Veilige omgeving is gerealiseerd voor patient/ naasten; duur VBI beperken | |||||
| Zorgresultaat | ||||||
| UitkomstVanZorg | ||||||
| Zorgresultaat | doel is behaald | |||||
| Interventie | ||||||
| VerpleegkundigeInterventie | Zie VerpleegkundigeInterventie: eovd-1-6-interventie-01 | |||||
1.6 Test Overdracht 1.7
1.6.1 Administratieve gegevens
| Administratieve gegevens | ||||||
| Gegevenselement | Waarde | |||||
| Datum overplaatsing | T + 5 dagen | |||||
| Persoonsgegevens | ||||||
| Patient | ||||||
| Naamgegevens | ||||||
| Initialen | M. | |||||
| Geslachtsnaam | ||||||
| Achternaam | XXX_Schouten-Baak | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1001 | |||||
| Postcode | 9999XX | |||||
| Woonplaats | Stitswerd | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Identificatienummer | 999900055 (in identificerend systeem: BSN) | |||||
| Geboortedatum | 18 sep 1963 | |||||
| Geslacht | Man (code = 'M' in codeSystem 'HL7 AdministrativeGender') | |||||
| Betaler | ||||||
| Verzekeraar | ||||||
| Verzekering | ||||||
| EindDatumTijd | T + 250 dagen | |||||
| Verzekeringssoort | Basis (code = 'B' in codeSystem 'ZIB Verzekeringssoort') | |||||
| IdentificatieNummer | 9664 (in identificerend systeem: UZOVI) | |||||
| OrganisatieNaam | Trias | |||||
| VerzekerdeNummer | 12345678 | |||||
| Sturende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 75616161 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | HomeCare | |||||
| OrganisatieType | Thuiszorg (code = 'T2' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Voornamen | Bart | |||||
| Geslachtsnaam | ||||||
| Achternaam | Moorman | |||||
| Ontvangende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 47707070 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | St. Zonnehof | |||||
| OrganisatieType | Verpleeghuis (code = 'R5' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
1.6.2 Algemene patiënten context
| Algemene patiënten context | ||||
| Gegevenselement | Waarde | |||
| Juridische situatie | ||||
| JuridischeSituatie eovd-1-7-juridischesituatie-01 | ||||
| JuridischeStatus | Besluit tot opname en verblijf (code = 'OPM' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.2') | |||
| DatumAanvang | T - 5 dagen | |||
| JuridischeSituatie | ||||
| Vertegenwoordiging | Zaakwaarneming (code = '10' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3') | |||
| DatumAanvang | T - 6 maanden | |||
1.6.3 Medische context
| Medische context | ||||||
| Gegevenselement | Waarde | |||||
| Behandelaar | ||||||
| Zorgverlener | ||||||
| ZorgverlenerIdentificatienummer | 01171717 (in identificerend systeem: AGB-Z) | |||||
| Naamgegevens | ||||||
| Initialen | K. | |||||
| Geslachtsnaam | ||||||
| Voorvoegsels | van | |||||
| Achternaam | Eindhoven | |||||
| Specialisme | Huisartspraktijk (code = '0100' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| Medische diagnose | ||||||
| Probleem | ||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||
| ProbleemNaam | delier (code = '2776000' in codeSystem 'SNOMED CT') | |||||
| ProbleemBeginDatum | T - 10 dagen | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
| Vrijheidsbeperking | ||||||
| VrijheidsbeperkendeInterventie | ||||||
| Wilsbekwaam | Nee | |||||
| WilsbekwaamToelichting | Kan eigen situatie niet beoordelen | |||||
| JuridischeSituatie | Zie JuridischeSituatie: eovd-1-7-juridischesituatie-01 | |||||
| SoortInterventie | constante supervisie met camera (code = '121411000146104' in codeSystem 'SNOMED CT') | |||||
| RedenVanToepassen | afwenden van crisissituatie (code = '121491000146107' in codeSystem 'SNOMED CT') | |||||
| Instemming | Instemming wettelijke vertegenwoordiger (code = '4' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') | |||||
| Begin | T - 4 dagen | |||||
| VrijheidsbeperkendeInterventie | ||||||
| Wilsbekwaam | Nee | |||||
| WilsbekwaamToelichting | Kan zich niet orienteren | |||||
| JuridischeSituatie | Zie JuridischeSituatie: eovd-1-7-juridischesituatie-01 | |||||
| SoortInterventie | constante supervisie met elektronisch traceringsmiddel (code = '121451000146100' in codeSystem 'SNOMED CT') | |||||
| RedenVanToepassen | afwenden van situatie die kan resulteren in toebrengen van schade aan zichzelf of aan anderen (code = '121481000146105' in codeSystem 'SNOMED CT') | |||||
| Instemming | Instemming wettelijke vertegenwoordiger (code = '4' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') | |||||
| Begin | T - 4 dagen | |||||
1.6.4 Verpleegkundige context: zorgplan
| Verpleegkundige context: zorgplan | ||||||
| Gegevenselement | Waarde | |||||
| Actuele patiëntproblemen | ||||||
| Patiëntprobleem | ||||||
| Probleem eovd-1-7-probleem-01 | ||||||
| ProbleemNaam | acute verwardheid (code = '130987000' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||
| ProbleemBeginDatum | T - 5 dagen | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
| VerpleegkundigeInterventie eovd-1-7-interventie-01 | ||||||
| Interventie | omgevingsstimuli minimaliseren (code = '710978006' in codeSystem 'SNOMED Clinical Terms') | |||||
| Indicatie | ||||||
| Probleem | Zie Probleem: eovd-1-7-probleem-01 | |||||
| Behandeldoel | ||||||
| GewenstZorgresultaat | DOSS < 3 | |||||
| Zorgresultaat | ||||||
| UitkomstVanZorg | ||||||
| Zorgresultaat | DOSS = 2 | |||||
| Interventie | ||||||
| VerpleegkundigeInterventie | Zie VerpleegkundigeInterventie: eovd-1-7-interventie-01 | |||||
1.7 Test Overdracht 1.8
1.7.1 Administratieve gegevens
| Administratieve gegevens | ||||||
| Gegevenselement | Waarde | |||||
| Datum overplaatsing | T + 2 dagen | |||||
| Persoonsgegevens | ||||||
| Patient | ||||||
| Naamgegevens | ||||||
| Initialen | M. | |||||
| Geslachtsnaam | ||||||
| Achternaam | XXX_Koutrik | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1002 | |||||
| Postcode | 9999ZZ | |||||
| Woonplaats | STITSWERD | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Identificatienummer | 999900067 (in identificerend systeem: BSN) | |||||
| Geboortedatum | 18 sep 1963 | |||||
| Betaler | ||||||
| Verzekeraar | ||||||
| Verzekering | ||||||
| EindDatumTijd | T + 1 jaar | |||||
| Verzekeringssoort | Basis (code = 'B' in codeSystem 'ZIB Verzekeringssoort') | |||||
| IdentificatieNummer | 9664 (in identificerend systeem: UZOVI) | |||||
| OrganisatieNaam | Trias | |||||
| VerzekerdeNummer | 12345678 | |||||
| Sturende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 06121212 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | EF-zkh | |||||
| AfdelingSpecialisme | Medisch specialisten, urologie (code = '0306' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| OrganisatieType | Algemeen ziekenhuis (code = 'V6' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Voornamen | Bart | |||||
| Geslachtsnaam | ||||||
| Achternaam | Moorman | |||||
| Ontvangende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 47707070 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | St. Zonnehof | |||||
| OrganisatieType | Verpleeghuis (code = 'R5' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
1.7.2 Medische context
| Medische context | ||||||
| Gegevenselement | Waarde | |||||
| Behandelaar | ||||||
| Zorgverlener | ||||||
| ZorgverlenerIdentificatienummer | 03848484 (in identificerend systeem: AGB-Z) | |||||
| Naamgegevens | ||||||
| Initialen | P. | |||||
| Geslachtsnaam | ||||||
| Achternaam | Boomsma | |||||
| Specialisme | Medisch specialisten, urologie (code = '0306' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| Medische diagnose | ||||||
| Probleem | ||||||
| ProbleemNaam | fistel tussen blaas en sigmoïd (code = '197861003') | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
1.7.3 Verpleegkundige context: zorgplan
| Verpleegkundige context: zorgplan | ||||||
| Gegevenselement | Waarde | |||||
| Actuele patiëntproblemen | ||||||
| Patiëntprobleem | ||||||
| Probleem eovd-1.8-patientprobleem-01 | ||||||
| ProbleemNaam | incontinentie voor feces (code = '72042002' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
| VerpleegkundigeInterventie | ||||||
| Interventie | zorg bij fecale incontinentie (code = '386223004' in codeSystem 'SNOMED Clinical Terms') | |||||
| Indicatie | ||||||
| Probleem | Zie Probleem: eovd-1.8-patientprobleem-01 | |||||
1.7.4 Verpleegkundige context: specificatie gezondheidstoestand
| Verpleegkundige context: specificatie gezondheidstoestand | |||||||
| Gegevenselement | Waarde | ||||||
| Uitscheiding | |||||||
| Blaasfunctie | |||||||
| UrineKatheter | |||||||
| MedischHulpmiddel | |||||||
| Product | |||||||
| ProductType | Verblijfskatheter (code = '23973005' in codeSystem 'SNOMED CT') | ||||||
| ProductOmschrijving | Verblijfskatheter | ||||||
| BeginDatum | T - 5 dagen | ||||||
| Darmfunctie | |||||||
| FecesContinentie | Incontinent (code = '72042002' in codeSystem 'SNOMED CT (ordinal = '0') | ||||||
| Frequentie | 2 per dag | ||||||
| DefecatieConsistentie | Zachte stukjes met gehavende randen (code = 'Type 6' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.3.1') | ||||||
| DefecatieKleur | Grijswit (code = '267056008' in codeSystem 'SNOMED CT') | ||||||
| Incontinentiemateriaal | |||||||
| MedischHulpmiddel | |||||||
| Product | |||||||
| ProductType | opvangzak voor fecesincontinentie (code = '469627000' in codeSystem 'SNOMED Clinical Terms') | ||||||
| ProductOmschrijving | opvangzak voor fecesincontinentie | ||||||
1.8 Validatie Overdracht 1.1
1.8.1 Administratieve gegevens
| Administratieve gegevens | ||||||
| Gegevenselement | Waarde | |||||
| Datum overplaatsing | T + 2 dagen | |||||
| Persoonsgegevens | ||||||
| Patient | ||||||
| Naamgegevens | ||||||
| Voornamen | Rihanna | |||||
| Initialen | R. | |||||
| Geslachtsnaam | ||||||
| Voorvoegsels | van | |||||
| Achternaam | XXX_Zelst | |||||
| GeslachtsnaamPartner | ||||||
| AchternaamPartner | Asaroğlu | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1003 | |||||
| Postcode | 9999ZA | |||||
| Woonplaats | Stitswerd | |||||
| AdresSoort | Officieel adres (code = 'HP' in codeSystem 'HL7 AddressUse') | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +316-99990108 | |||||
| EmailAdressen | ||||||
| EmailAdres | rzelst195407@gmail.com | |||||
| Identificatienummer | 999910371 (in identificerend systeem: BSN) | |||||
| Geboortedatum | 29 jul 1954 | |||||
| Geslacht | Vrouw (code = 'F' in codeSystem 'HL7 AdministrativeGender') | |||||
| Betaler | ||||||
| Verzekeraar | ||||||
| Verzekering | ||||||
| EindDatumTijd | T + 1 jaar | |||||
| Verzekeringssoort | Basis (code = 'B' in codeSystem 'ZIB Verzekeringssoort') | |||||
| IdentificatieNummer | 9665 (in identificerend systeem: UZOVI) | |||||
| OrganisatieNaam | Trias | |||||
| VerzekerdeNummer | 12345679 | |||||
| Contactpersoon eovd-1-1-contactpersoon-01 | ||||||
| Naamgegevens | ||||||
| Voornamen | Helena | |||||
| Initialen | H | |||||
| Roepnaam | Lenie | |||||
| Geslachtsnaam | ||||||
| Achternaam | Slager | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +316-99990009 | |||||
| EmailAdressen | ||||||
| EmailAdres | lenie@123net.nl | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1003 | |||||
| AdditioneleInformatie | ingang via achtertuin | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Rol | Eerste relatie/contactpersoon (code = '1' in codeSystem 'Vektis Rolcode COD472-VEKT') | |||||
| Relatie | Schoondochter (code = 'DAUINLAW' in codeSystem 'HL7 RoleCode') | |||||
| Contactpersoon | ||||||
| Naamgegevens | ||||||
| Voornamen | Pleun | |||||
| Geslachtsnaam | ||||||
| Achternaam | Bloemist | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +316-99990008 | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 1003 | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Rol | Buur (code = '19' in codeSystem 'Vektis Rolcode COD472-VEKT') | |||||
| Relatie | Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): Rechter buurman | |||||
| Sturende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | AB-zkh | |||||
| OrganisatieLocatie | Noord | |||||
| AfdelingSpecialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| Contactgegevens | ||||||
| Telefoonnummers | ||||||
| Telefoonnummer | +31182435770 | |||||
| EmailAdressen | ||||||
| EmailAdres | neurologie@ABZ.nl | |||||
| Adresgegevens | ||||||
| Straat | Knolweg | |||||
| Huisnummer | 10 | |||||
| Postcode | 9999PO | |||||
| Woonplaats | Stitswerd | |||||
| AdresSoort | Werkadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||
| OrganisatieType | Algemeen ziekenhuis (code = 'V6' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Voornamen | Charlotte Maria | |||||
| Initialen | C. M. | |||||
| Roepnaam | Lotte | |||||
| Geslachtsnaam | ||||||
| Achternaam | Bruinsma | |||||
| Specialisme | Verpleegkundigen, niet nader gespecificeerd (code = '9100' in codeSystem 'Vektis AGB-medische specialismen') | |||||
| Ontvangende organisatie | ||||||
| Zorgaanbieder | ||||||
| ZorgaanbiederIdentificatienummer | 75131313 (in identificerend systeem: AGB-Z) | |||||
| OrganisatieNaam | ThuiszorgOrg | |||||
| OrganisatieLocatie | Noord | |||||
| AfdelingSpecialisme | Thuiszorg, kruiswerk en gezinsverzorging (code = '7500' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||
| OrganisatieType | Thuiszorg (code = 'T2' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||
1.8.2 Algemene patiënten context
| Algemene patiënten context | |||||||||
| Gegevenselement | Waarde | ||||||||
| Gezinssituatie | |||||||||
| Gezinssituatie | |||||||||
| BurgerlijkeStaat | |||||||||
| BurgerlijkeStaatRC | |||||||||
| BurgerlijkeStaat | Gehuwd (code = 'M' in codeSystem 'HL7 MaritalStatus') | ||||||||
| Gezinssamenstelling | Alleenwonend (code = '105529008' in codeSystem 'SNOMED CT') | ||||||||
| Zorgtaak | zorgt voor zijn kat | ||||||||
| Juridische situatie | |||||||||
| JuridischeSituatie eovd-val-1-1-juridischesituatie-01 | |||||||||
| Vertegenwoordiging | Bewindvoering (code = '7' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.23.3') | ||||||||
| DatumAanvang | T - 1 jaar | ||||||||
| Woonomgeving | |||||||||
| Woonsituatie | |||||||||
| WoningType | Aanleunwoning (code = 'AANLW' in codeSystem 'ZIB WoningType') | ||||||||
| Levensovertuiging | |||||||||
| LevensovertuigingRC | |||||||||
| Levensovertuiging | Protestant (code = '309885004' in codeSystem 'SNOMED CT') | ||||||||
| Wilsverklaring | |||||||||
| WilsverklaringType | Niet reanimeren verklaring (code = 'NR' in codeSystem 'ZIB WilsverklaringType') | ||||||||
| WilsverklaringDatum | T - 4 jaar | ||||||||
| Vertegenwoordiger | |||||||||
| Contactpersoon | Zie Contactpersoon: eovd-1-1-contactpersoon-01 | ||||||||
| Toelichting | wilsverklaring bevindt zich in de portemonnee. | ||||||||
| Sociale omgeving | |||||||||
| ParticipatieInMaatschappij | |||||||||
| SociaalNetwerk | heeft veel contact met buren | ||||||||
| Vrijetijdsbesteding | viool spelen | ||||||||
| Arbeidssituatie | Gepensioneerd | ||||||||
| HulpVanAnderen | |||||||||
| Hulpverlener | |||||||||
| Mantelzorger | |||||||||
| Contactpersoon | |||||||||
| Naamgegevens | |||||||||
| Voornamen | Marriet | ||||||||
| Initialen | M. | ||||||||
| Naamgebruik | Eigen geslachtsnaam (code = 'NL1' in codeSystem 'ZIB Naamgebruik') | ||||||||
| Geslachtsnaam | |||||||||
| Achternaam | Blauw | ||||||||
| Rol | Buur (code = '19' in codeSystem 'Vektis Rolcode COD472-VEKT') | ||||||||
| Aard | helpt met ondersteuning echtgenoot als mevrouw er niet is | ||||||||
| Frequentie | zo vaak als nodig | ||||||||
| SoortHulp | Mantelzorg (code = '386229000' in codeSystem 'SNOMED CT') | ||||||||
| HulpVanAnderen | |||||||||
| Hulpverlener | |||||||||
| Zorgaanbieder | |||||||||
| OrganisatieNaam | WijZorgen | ||||||||
| OrganisatieLocatie | Stitswerd | ||||||||
| OrganisatieType | Thuiszorg (code = 'T2' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | ||||||||
| Aard | ondersteuning bij wassen | ||||||||
| Frequentie | dagelijks | ||||||||
| SoortHulp | Professionele thuiszorg (code = '60689008' in codeSystem 'SNOMED CT') | ||||||||
| Toelichting | niet in het weekend | ||||||||
| Communicatie | |||||||||
| Taalvaardigheid | |||||||||
| CommunicatieTaal | Nederlands (code = 'nl' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') | ||||||||
| TaalvaardigheidBegrijpen | Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| TaalvaardigheidSpreken | Slecht (code = 'P' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| TaalvaardigheidLezen | Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| Toelichting | t.g.v. CVA nu moeite met begrijpen, spreken gaat ook moeilijk i.v.m. afasie | ||||||||
| Taalvaardigheid | |||||||||
| CommunicatieTaal | Limburgs (code = 'li' in codeSystem 'ISO 639-1: Codes for the representation of names of languages -- Part 1: Alpha-2 code') | ||||||||
| TaalvaardigheidBegrijpen | Goed (code = 'G' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| TaalvaardigheidSpreken | Redelijk (code = 'F' in codeSystem '2.16.840.1.113883.5.61') | ||||||||
| Toelichting | opgegroeid in Zuid-Limburg | ||||||||
1.8.3 Medische context
| Medische context | ||||||||
| Gegevenselement | Waarde | |||||||
| Behandelaar | ||||||||
| Zorgverlener eovd-val-1-1-behandelaar-01 | ||||||||
| Naamgegevens | ||||||||
| Voornamen | Joshua Pieter | |||||||
| Initialen | J. P. | |||||||
| Geslachtsnaam | ||||||||
| Achternaam | Helmond | |||||||
| Specialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| Zorgaanbieder | ||||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||||
| OrganisatieNaam | AB-zkh | |||||||
| OrganisatieLocatie | Noord | |||||||
| Behandelaar | ||||||||
| Zorgverlener eovd-val-1-1-behandelaar-02 | ||||||||
| ZorgverlenerIdentificatienummer | 03898989 (in identificerend systeem: AGB-Z) | |||||||
| Naamgegevens | ||||||||
| Initialen | G. | |||||||
| Geslachtsnaam | ||||||||
| Achternaam | Spijkerman | |||||||
| Specialisme | Medisch specialisten, gastro-enterologie (maag-darm-lever-arts) (code = '0318' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| Zorgaanbieder | ||||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||||
| OrganisatieNaam | AB-zkh | |||||||
| OrganisatieLocatie | Noord | |||||||
| Medische diagnose | ||||||||
| Probleem eovd-val-1-1-probleem-01 | ||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | cardiovasculair letsel (code = '282728007' in codeSystem 'SNOMED CT') | |||||||
| ProbleemBeginDatum | T - 100 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| VerificatieStatus | Bevestigd (code = '410605003' in codeSystem 'SNOMED CT') | |||||||
| Probleem eovd-val-1-1-probleem-02 | ||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | benigne neoplasma van colon (code = '92065004') | |||||||
| ProbleemBeginDatum | T - 150 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Probleem eovd-val-1-1-probleem-03 | ||||||||
| ProbleemLateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | gecompliceerde fractuur van enkel (code = '48187004' in codeSystem 'SNOMED CT') | |||||||
| ProbleemBeginDatum | T - 5 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Voorgeschiedenis | ||||||||
| Probleem | ||||||||
| ProbleemType | Diagnose (code = '282291009' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | diabetes mellitus (code = '73211009') | |||||||
| ProbleemBeginDatum | T - 12 jaar | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Allergie | ||||||||
| AllergieIntolerantie | ||||||||
| VeroorzakendeStof | nikkelsulfaat (code = '255848005' in codeSystem 'SNOMED CT') | |||||||
| AllergieCategorie | Stof of product (code = '419199007' in codeSystem 'SNOMED CT') | |||||||
| AllergieStatus | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||||||
| BeginDatumTijd | T - 10 jaar | |||||||
| MateVanKritiekZijn | 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') | |||||||
| ReactieBeschrijving | last van jeuk, roodheid en irritatie op de contactplek van nikkel bevattende sieraden. | |||||||
| WijzeVanBlootstelling | intra-epidermale route (code = '448077001' in codeSystem 'SNOMED Clinical Terms') | |||||||
| AllergieIntolerantie | ||||||||
| VeroorzakendeStof | pollen (code = '256259004') | |||||||
| AllergieCategorie | Omgeving (code = '426232007' in codeSystem 'SNOMED CT') | |||||||
| AllergieStatus | Actief (code = 'active' in codeSystem 'HL7 ActStatus') | |||||||
| BeginDatumTijd | T - 500 dagen | |||||||
| MateVanKritiekZijn | Matig (code = '6736007' in codeSystem 'SNOMED CT') | |||||||
| LaatsteReactieDatumTijd | T - 99 dagen | |||||||
| Reactie | ||||||||
| Symptoom | Overgevoeligheidsreactie van de bovenste luchtwegen (code = '490008' in codeSystem 'SNOMED CT') | |||||||
| SpecifiekeStof | graspollen (code = '256277009') | |||||||
| ReactieBeschrijving | veelvuldig niezen | |||||||
| Ernst | Matig (code = '6736007' in codeSystem 'SNOMED CT') | |||||||
| ReactieTijdstip | T - 99 dagen | |||||||
| Reactie | ||||||||
| Symptoom | Kortademigheid (code = '267036007' in codeSystem 'SNOMED CT') | |||||||
| Symptoom | Koorts (code = '386661006' in codeSystem 'SNOMED CT') | |||||||
| SpecifiekeStof | pollen van paprikaplant (code = '110181000146104') | |||||||
| ReactieBeschrijving | ernstige benauwdheid en koorts | |||||||
| Ernst | Ernstig (code = '24484000' in codeSystem 'SNOMED CT') | |||||||
| ReactieTijdstip | T - 200 dagen | |||||||
| Let op | ||||||||
| Alert | ||||||||
| AlertNaam | Drager MRSA (code = '432415000' in codeSystem 'SNOMED CT') | |||||||
| BeginDatumTijd | T - 20 dagen | |||||||
| AlertType | waarschuwing (code = '74018-3' in codeSystem 'LOINC') | |||||||
| Alert | ||||||||
| AlertNaam | Anders (code = 'OTH' in codeSystem 'HL7 NullFlavor'): ernstige claustrofobie | |||||||
| BeginDatumTijd | T - 10 jaar | |||||||
| Vrijheidsbeperking | ||||||||
| VrijheidsbeperkendeInterventie | ||||||||
| Wilsbekwaam | Ja | |||||||
| JuridischeSituatie | Zie JuridischeSituatie: eovd-val-1-1-juridischesituatie-01 | |||||||
| SoortInterventie | geforceerd toedienen van voeding bij patiënt (code = '37041007' in codeSystem 'SNOMED CT') | |||||||
| RedenVanToepassen | bevorderen van fysieke gezondheid (code = '121581000146106' in codeSystem 'SNOMED CT') | |||||||
| Instemming | Instemming patiënt (code = '2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.6.1') | |||||||
| Begin | T - 50 dagen | |||||||
| Meetwaarden | ||||||||
| Bloeddruk | ||||||||
| Meetmethode | Niet-invasief (code = '22762002' in codeSystem 'SNOMED CT') | |||||||
| ManchetType | Standaard (code = 'STD' in codeSystem 'ZIB ManchetType') | |||||||
| MeetLocatie | Rechter bovenarm (code = '368209003' in codeSystem 'SNOMED CT') | |||||||
| DiastolischEindpunt | Fase V (code = '255272007' in codeSystem 'SNOMED CT') | |||||||
| SystolischeBloeddruk | 170 mm[Hg] | |||||||
| DiastolischeBloeddruk | 90 mm[Hg] | |||||||
| GemiddeldeBloeddruk | 110 mm[Hg] | |||||||
| BloeddrukDatumTijd | T - 20 dagen om 14:45 uur | |||||||
| Toelichting | mevrouw gebruikt medicatie | |||||||
| Houding | Liggende positie (code = '102538003' in codeSystem 'SNOMED CT') | |||||||
| Polsfrequentie | ||||||||
| PolsfrequentieWaarde | 90 | |||||||
| PolsfrequentieDatumTijd | T - 5 dagen om 14:45 uur | |||||||
| Toelichting | is altijd sportief geweest | |||||||
| PolsRegelmatigheid | Polsslag regelmatig (code = '271636001' in codeSystem 'SNOMED CT') | |||||||
| Lichaamstemperatuur | ||||||||
| TemperatuurWaarde | 36.8 Cel | |||||||
| TemperatuurDatumTijd | T - 4 dagen om 07 uur | |||||||
| Toelichting | voeten voelen heel koud aan | |||||||
| TemperatuurType | Tympanische temperatuur (code = '415974002' in codeSystem 'SNOMED CT') | |||||||
| Ademhaling | ||||||||
| Ademfrequentie | 18 /min | |||||||
| AdemhalingDatumTijd | T - 3 dagen om 14:45 uur | |||||||
| Ritme | Abnormaal ademhalingsritme (code = '85617008' in codeSystem 'SNOMED CT') | |||||||
| Diepte | Normale ademhalingsdiepte (code = '301284009' in codeSystem 'SNOMED CT') | |||||||
| AfwijkendAdemhalingspatroon | Apneu (code = '1023001' in codeSystem 'SNOMED CT') | |||||||
| ExtraZuurstofToediening | Ja | |||||||
| Toelichting | mevrouw lijkt angstig | |||||||
| ToegediendeZuurstof | ||||||||
| FlowRate | 2 l/min | |||||||
| FiO2 | 0.29 l | |||||||
| ToedieningHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Neusbril (code = '336623009' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | neusbril | |||||||
| Lichaamsgewicht | ||||||||
| GewichtWaarde | 74 kg | |||||||
| Toelichting | mevrouw volgt afvaldieet | |||||||
| GewichtDatumTijd | T - 5 dagen om 14:30 uur | |||||||
| Kleding | Volledig gekleed, inclusief schoenen (code = 'FULL' in codeSystem 'ZIB ContextKleding') | |||||||
| Lichaamslengte | ||||||||
| LengteWaarde | 170 cm | |||||||
| LengteDatumTijd | T - 5 dagen om 14:30 uur | |||||||
| Toelichting | zonder schoenen aan | |||||||
| Pijnscore | ||||||||
| PijnScore | ||||||||
| PijnscoreWaarde | 2 | |||||||
| PijnscoreDatumTijd | T - 5 dagen om 14:45 uur | |||||||
| PijnMeetmethode | NRS (code = 'NRS' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.9.1') | |||||||
| AnatomischeLocatie | gehele voet (code = '302545001' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | Af en toe pijn, maar niet belemmerend bij het lopen | |||||||
1.8.4 Verpleegkundige context: zorgplan
| Verpleegkundige context: zorgplan | ||||||||
| Gegevenselement | Waarde | |||||||
| Actuele patiëntproblemen | ||||||||
| Patiëntprobleem | ||||||||
| Probleem eovd-val-1-1-patientprobleem-01 | ||||||||
| ProbleemNaam | probleem met zichzelf wassen en afdrogen (code = '288552005' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||||
| ProbleemBeginDatum | T - 100 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | mevrouw kan niet buigen | |||||||
| VerpleegkundigeInterventie eovd-val-1-1-interventie-01 | ||||||||
| Interventie | ondersteunen bij wassen en/of persoonlijke hygiëne (code = '386420003' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Indicatie | ||||||||
| Probleem | Zie Probleem: eovd-val-1-1-patientprobleem-01 | |||||||
| Behandeldoel | ||||||||
| GewenstZorgresultaat | wassen onafhankelijk | |||||||
| ActieStartDatumTijd | T - 90 dagen | |||||||
| Frequentie | 1 /dag | |||||||
| Instructie | let op: valrisico | |||||||
| Uitvoerder | ||||||||
| Zorgverlener | Ja | |||||||
| Patiëntprobleem | ||||||||
| Probleem eovd-val-1-1-patientprobleem-02 | ||||||||
| ProbleemNaam | probleem met zichzelf kleden (code = '284972002' in codeSystem 'Referentieset Nationale kernset patientproblemen') | |||||||
| ProbleemBeginDatum | T - 90 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| VerpleegkundigeInterventie eovd-val-1-1-interventie-02 | ||||||||
| Interventie | ondersteunen bij aankleden (code = '313332003' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Indicatie | ||||||||
| Probleem | Zie Probleem: eovd-val-1-1-patientprobleem-02 | |||||||
| Behandeldoel | ||||||||
| GewenstZorgresultaat | kleden onafhankelijk | |||||||
| Frequentie | 3 /dag | |||||||
| Zorgresultaat | ||||||||
| UitkomstVanZorg | ||||||||
| Zorgresultaat | doel deels behaald: kan nog niet rug wassen | |||||||
| Interventie | ||||||||
| VerpleegkundigeInterventie | Zie VerpleegkundigeInterventie: eovd-val-1-1-interventie-01 | |||||||
| UitkomstVanZorg | ||||||||
| Zorgresultaat | doel deels behaald, kan nog niet zelf veters strikken | |||||||
| Interventie | ||||||||
| VerpleegkundigeInterventie | Zie VerpleegkundigeInterventie: eovd-val-1-1-interventie-02 | |||||||
| Afspraken patiënt | ||||||||
| Contact | ||||||||
| ContactType | Poliklinisch (code = 'AMB' in codeSystem 'HL7 ActCode') | |||||||
| ContactMet | ||||||||
| Zorgverlener | ||||||||
| Naamgegevens | ||||||||
| Voornamen | Joshua Pieter | |||||||
| Initialen | J.P. | |||||||
| Geslachtsnaam | ||||||||
| Achternaam | Helmond | |||||||
| Specialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| ContactMet | ||||||||
| Zorgverlener | ||||||||
| ZorgverlenerIdentificatienummer | 03686868 (in identificerend systeem: AGB-Z) | |||||||
| Naamgegevens | ||||||||
| Initialen | F. | |||||||
| Geslachtsnaam | ||||||||
| Achternaam | Snijder | |||||||
| Specialisme | Medisch specialisten, neurochirurgie (code = '0308' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| Locatie | ||||||||
| Zorgaanbieder | ||||||||
| ZorgaanbiederIdentificatienummer | 06590457 (in identificerend systeem: AGB-Z) | |||||||
| OrganisatieNaam | AB-zkh | |||||||
| OrganisatieLocatie | Noord | |||||||
| AfdelingSpecialisme | Medisch specialisten, neurologie (code = '0330' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| Contactgegevens | ||||||||
| Telefoonnummers | ||||||||
| Telefoonnummer | +31182435770 | |||||||
| EmailAdressen | ||||||||
| EmailAdres | neurologie@ABZ.nl | |||||||
| Adresgegevens | ||||||||
| Straat | Knolweg | |||||||
| Huisnummer | 10 | |||||||
| Postcode | 9999PO | |||||||
| Woonplaats | Stitswerd | |||||||
| AdresSoort | Werkadres (code = 'WP' in codeSystem 'HL7 AddressUse') | |||||||
| OrganisatieType | Algemeen ziekenhuis (code = 'V6' in codeSystem 'HL7 RoleCodeNL Care provider type (organizations)') | |||||||
| BeginDatumTijd | T + 5 dagen om 10:00 uur | |||||||
| EindDatumTijd | T + 5 dagen om 10:30 uur | |||||||
| RedenContact | ||||||||
| Probleem | Zie Probleem: eovd-val-1-1-probleem-01 | |||||||
| Contact | ||||||||
| ContactType | Thuis (code = 'HH' in codeSystem 'HL7 ActCode') | |||||||
| ContactMet | ||||||||
| Zorgverlener | ||||||||
| ZorgverlenerIdentificatienummer | 88131313 (in identificerend systeem: AGB-Z) | |||||||
| Naamgegevens | ||||||||
| Initialen | W. | |||||||
| Geslachtsnaam | ||||||||
| Achternaam | Bloem | |||||||
| Specialisme | Ergotherapeuten (code = '8800' in codeSystem 'COD016-VEKT Zorgverlenersspecificatie (subberoepsgroep)') | |||||||
| Contactgegevens | ||||||||
| EmailAdressen | ||||||||
| EmailAdres | bloem@ergotherapie.nl | |||||||
| BeginDatumTijd | T + 12 dagen om 15:15 uur | |||||||
| RedenContact | ||||||||
| RedenContactTekst | Controle voortgang revalidatie | |||||||
| Wensen en behoeften patiënt en/of naasten | mevrouw wil zo snel mogelijk weer zelfstandig kunnen functioneren en haar kat kunnen verzorgen | |||||||
1.8.5 Verpleegkundige context: specificatie gezondheidstoestand
| Verpleegkundige context: specificatie gezondheidstoestand | ||||||||
| Gegevenselement | Waarde | |||||||
| Zelfzorg | ||||||||
| VermogenTotDrinken | ||||||||
| Drinken | Hulp nodig (code = '16681000146102' in codeSystem 'SNOMED CT | |||||||
| DrinkBeperkingen | Bereiden (openen/uitschenken) (code = '286506008' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotDrinken | ||||||||
| Drinken | Onafhankelijk (code = '19841000146104' in codeSystem 'SNOMED CT | |||||||
| DrinkBeperkingen | Vastpakken (code = '307071002' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotEten | ||||||||
| Eten | Hulp nodig (code = '129033007' in codeSystem 'SNOMED CT (ordinal = '1') | |||||||
| EetBeperkingen | Snijden/openen (code = '289078003' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotEten | ||||||||
| Eten | Onafhankelijk (code = '165224005' in codeSystem 'SNOMED CT (ordinal = '0') | |||||||
| EetBeperkingen | Eetgerei hanteren (code = '289046006' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotMondverzorging | ||||||||
| VerzorgenTanden | Hulp nodig (code = '16671000146104' in codeSystem 'SNOMED CT') | |||||||
| Prothese | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Gebitsprothese (code = '27606000' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Gebitsprothese bovenkaak | |||||||
| Prothese | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Gebitsprothese (code = '27606000' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Gebitsprothese onderkaak | |||||||
| VermogenTotZichWassen | ||||||||
| ZichWassen | Hulp nodig (code = '16621000146103' in codeSystem 'SNOMED CT | |||||||
| TeWassenLichaamsdeel | Onderlichaam (code = '362875007' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotZichWassen | ||||||||
| ZichWassen | Hulp nodig (code = '16621000146103' in codeSystem 'SNOMED CT | |||||||
| TeWassenLichaamsdeel | Bovenlichaam (code = '362874006' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotZichKleden | ||||||||
| ZichKleden | Hulp nodig (code = '129039006' in codeSystem 'SNOMED CT | |||||||
| TeKledenLichaamsdeel | Onderlichaam (code = '362875007' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotZichKleden | ||||||||
| ZichKleden | Onafhankelijk (code = '129035000' in codeSystem 'SNOMED CT | |||||||
| TeKledenLichaamsdeel | Bovenlichaam (code = '362874006' in codeSystem 'SNOMED CT') | |||||||
| VermogenTotUiterlijkeVerzorging | ||||||||
| UiterlijkeVerzorging | Hulp nodig (code = '27941000146109' in codeSystem 'SNOMED CT | |||||||
| VermogenTotToiletgang | ||||||||
| Toiletgebruik | Onafhankelijk (code = '129062008' in codeSystem 'SNOMED CT (ordinal = '0') | |||||||
| VermogenTotZelfstandigMedicatiegebruik | ||||||||
| ZelfstandigMedicatiegebruik | Hulp nodig (code = '27921000146103' in codeSystem 'SNOMED CT') | |||||||
| HulpBijToediening | ||||||||
| VerpleegkundigeInterventie | ||||||||
| Interventie | bevorderen van therapietrouw met behulp van medicijndispenser (code = '710153008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Behandeldoel | ||||||||
| GewenstZorgresultaat | therapietrouw | |||||||
| Frequentie | 2 /d | |||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | medicatierol (code = '713308004' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | baxterrol | |||||||
| VermogenTotVerpleegtechnischeHandelingen | ||||||||
| VerpleegkundigeInterventie | ||||||||
| VerpleegkundigeInterventie | ||||||||
| Interventie | Stoma care procedure (code = '225194008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Behandeldoel | ||||||||
| GewenstZorgresultaat | goede hygiene met betrekking tot stoma | |||||||
| ActieStartDatumTijd | T - 6 dagen | |||||||
| Uitvoerder | ||||||||
| Patient | Ja | |||||||
| Toelichting | toezicht bij uitvoer, en instructie hygiënisch werken | |||||||
| VerrichtenVPKHandeling | Hulp nodig (code = '27931000146101' in codeSystem 'SNOMED CT | |||||||
| VermogenTotVerpleegtechnischeHandelingen | ||||||||
| VerpleegkundigeInterventie | ||||||||
| VerpleegkundigeInterventie | ||||||||
| Interventie | vervangen van verband (code = '18949003' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ActieStartDatumTijd | T - 1 dag | |||||||
| Interval | 2 dagen | |||||||
| VerrichtenVPKHandeling | Hulp nodig (code = '27931000146101' in codeSystem 'SNOMED CT | |||||||
| Toelichting zelfzorg | kan zich steeds beter redden met wassen en kleden, knoopjes dichtdoen en schoenen met hulp. | |||||||
| Mobiliteit | ||||||||
| Mobiliteit | ||||||||
| Lopen | Hulp nodig (code = '16581000146103' in codeSystem 'SNOMED CT | |||||||
| Traplopen | Volledig afhankelijk (code = '301589003' in codeSystem 'SNOMED CT | |||||||
| HoudingVeranderen | Onafhankelijk (code = '19821000146105' in codeSystem 'SNOMED CT | |||||||
| HoudingHandhaven | Onafhankelijk (code = '19811000146100' in codeSystem 'SNOMED CT | |||||||
| UitvoerenTransfer | Hulp nodig (code = '714917003' in codeSystem 'SNOMED CT | |||||||
| MedischHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | rollator (code = '404946006' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | rollator | |||||||
| BeginDatum | T - 1 jaar | |||||||
| MedischHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | rolstoel (code = '58938008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | rolstoel | |||||||
| BeginDatum | T - 1 maand | |||||||
| Toelichting | voor langere afstanden | |||||||
| Toelichting | lopen is stuk verbeterd, rechter been minder krachtig | |||||||
| Voeding/vocht | ||||||||
| Voedingsadvies | ||||||||
| DieetType | suikervrij, diabetes dieet | |||||||
| Consistentie | dik vloeibaar | |||||||
| Toelichting | eet naar eigen keuze minder vlees | |||||||
| Voedingsadvies | ||||||||
| DieetType | geen varkensvlees | |||||||
| SNAQScore | ||||||||
| GewichtsverliesScore | LossAverage (code = 'G1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.1 (ordinal = '2') | |||||||
| EetlustScore | Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.2 (ordinal = '0') | |||||||
| VoedingsScore | GeenVoeding (code = 'Z0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.5.3 (ordinal = '0') | |||||||
| TotaalScore | 2 | |||||||
| SNAQScoreDatumTijd | T - 6 dagen om 17 uur | |||||||
| Toelichting | geen verminderde eetlust ondanks chemotherapie | |||||||
| SNAQrcScore | ||||||||
| GewichtsverliesScore | LossHigh (code = 'G2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.1 (ordinal = '2') | |||||||
| EetlustScore | Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.2 (ordinal = '0') | |||||||
| BMIScore | Gezond (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.19.3 (ordinal = '0') | |||||||
| HulpBijEten | Onafhankelijk (code = '165224005' in codeSystem 'SNOMED CT (ordinal = '0') | |||||||
| TotaalScore | 2 | |||||||
| SNAQrcScoreDatumTijd | T - 6 dagen om 17 uur | |||||||
| Toelichting | geen verminderde eetlust ondanks chemotherapie | |||||||
| SNAQ65+Score | ||||||||
| GewichtsverliesScore | LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.1 (ordinal = '0') | |||||||
| BovenarmOmtrekScore | Normaal (code = 'A0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.4 (ordinal = '0') | |||||||
| EetlustScore | Eetlust (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.2 (ordinal = '0') | |||||||
| InspanningsScore | Mogelijk (code = 'In0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.18.3 (ordinal = '0') | |||||||
| TotaalScore | 0 | |||||||
| SNAQ65+ScoreDatumTijd | T - 6 dagen om 17 uur | |||||||
| Toelichting | geen verminderde eetlust ondanks chemotherapie | |||||||
| MUSTScore | ||||||||
| BMIScore | BMIHigh (code = 'B0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.1 (ordinal = '0') | |||||||
| GewichtsverliesScore | LossLow (code = 'G0' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.2 (ordinal = '0') | |||||||
| ZiekteScore | Ziek (code = 'Z1' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.4.3 (ordinal = '2') | |||||||
| TotaalScore | 2 | |||||||
| MUSTScoreDatumTijd | T - 12 dagen om 17 uur | |||||||
| Vochtbalans | ||||||||
| VochtTotaalIn | 1400 ml | |||||||
| VochtTotaalUit | 1000 ml | |||||||
| VochtbalansStarttijd | T - 6 dagen om 07 uur | |||||||
| VochtbalansStoptijd | T - 5 dagen om 07 uur | |||||||
| SondeSysteem | ||||||||
| Sonde | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Neus-maagsonde (code = '17102003' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | neus- maagsonde | |||||||
| BeginDatum | T - 5 dagen | |||||||
| AnatomischeLocatie | neusgat (code = '363538002' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Zorgverlener | Zie Zorgverlener: eovd-val-1-1-behandelaar-02 | |||||||
| SondeLengte | 575 mm | |||||||
| Toelichting | wegens misselijkheid door chemotherapie | |||||||
| SondeSysteem | ||||||||
| Sonde | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | PEJ sonde (code = '8911000146104' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | PEJ sonde | |||||||
| BeginDatum | T - 5 dagen | |||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | enterale voedingspomp (code = '468664004' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | enterale voedingspomp | |||||||
| BeginDatum | T - 5 dagen | |||||||
| Infuus | ||||||||
| Infuuskatheter | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Centraal veneuze katheter (code = '52124006' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | centraal veneuze katheter | |||||||
| BeginDatum | T - 20 dagen | |||||||
| Toelichting | onder sleutelbeen links | |||||||
| AnatomischeLocatie | structuur van vena subclavia (code = '9454009' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Zorgverlener | Zie Zorgverlener: eovd-val-1-1-behandelaar-02 | |||||||
| Toelichting | voor voeding | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| LumenLocatie | Distaal (code = '46053002' in codeSystem 'SNOMED CT') | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Afgedopt (code = 'DOP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| LumenLocatie | Mediaal (code = '255561001' in codeSystem 'SNOMED CT') | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| LumenLocatie | Distaal (code = '46053002' in codeSystem 'SNOMED CT') | |||||||
| Infuus | ||||||||
| Infuuskatheter | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Perifeer intraveneus infuus (code = '82449006' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Perifeer intraveneus infuus | |||||||
| BeginDatum | T - 15 dagen | |||||||
| AnatomischeLocatie | onderarm (code = '14975008' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | voor medicatie | |||||||
| LumenOfLijn | ||||||||
| LijnStatus | Lopend (code = 'LNP' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.12.1') | |||||||
| Uitscheiding | ||||||||
| Blaasfunctie | ||||||||
| UrineContinentie | Af en toe een ongelukje (max. 1 keer per 24 uur) (code = '165233007' in codeSystem 'SNOMED CT (ordinal = '1') | |||||||
| Urostoma | ||||||||
| Stoma | Zie Stoma: eovd-val-1-1-stoma-02 | |||||||
| Incontinentiemateriaal | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | inlegger voor incontinentiebroek (code = '470713005' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | inlegger | |||||||
| Darmfunctie | ||||||||
| Stoma | Zie Stoma: eovd-val-1-1-stoma-01 | |||||||
| DefecatieConsistentie | Helemaal vloeibaar (code = 'Type 7' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.3.1') | |||||||
| Toelichting | stoma na subtotale darmresectie wegens coloncarcinoom | |||||||
| Stoma eovd-val-1-1-stoma-01 | ||||||||
| StomaType | eindstandige ileostoma (code = '311412005' in codeSystem 'SNOMED CT') | |||||||
| StomaMateriaal | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | Ileostomy bag (code = '417136005' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | stomazak voor ileostoma | |||||||
| AnatomischeLocatie | onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| AanlegDatum | T - 12 dagen | |||||||
| Toelichting | na subtotale darmresectie wegens coloncarcinoom | |||||||
| Stoma eovd-val-1-1-stoma-02 | ||||||||
| StomaType | urostoma (code = '281601009' in codeSystem 'SNOMED CT') | |||||||
| AnatomischeLocatie | buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| AanlegDatum | T - 4 jaar | |||||||
| Huid | ||||||||
| Brandwond | ||||||||
| OntstaansDatum | T - 2 dagen | |||||||
| Uitgebreidheid | 1 % | |||||||
| BrandwondSoort | Thermische brandwond (code = '105594005' in codeSystem 'SNOMED CT') | |||||||
| AnatomischeLocatie | onderarm (code = '362741001' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| Dieptegraad | 1e graad (code = '77140003' in codeSystem 'SNOMED CT | |||||||
| Toelichting | Mevrouw kreeg hete thee over zich heen, wond is ongeveer 2 bij 2 cm; geen verband nodig. | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Brandwond | ||||||||
| OntstaansDatum | T - 2 dagen | |||||||
| Uitgebreidheid | 1 % | |||||||
| BrandwondSoort | Thermische brandwond (code = '105594005' in codeSystem 'SNOMED CT') | |||||||
| AnatomischeLocatie | handrug (code = '63125000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| Dieptegraad | 2e graad, oppervlakkig (code = '262587005' in codeSystem 'SNOMED CT | |||||||
| DecubitusWond | ||||||||
| DecubitusCategorie | Decubitus categorie 2 (code = '420324007' in codeSystem 'SNOMED CT (ordinal = '2') | |||||||
| OntstaansDatum | T - 2 dagen | |||||||
| AnatomischeLocatie | hiel (code = '76853006' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Wondlengte | 2 cm | |||||||
| Wondbreedte | 2 cm | |||||||
| Wonddiepte | 0.5 cm | |||||||
| Toelichting | Wond is niet geïnfecteerd. | |||||||
| DecubitusWond | ||||||||
| DecubitusCategorie | Decubitus categorie 1 (code = '421076008' in codeSystem 'SNOMED CT (ordinal = '1') | |||||||
| OntstaansDatum | T - 20 dagen | |||||||
| AnatomischeLocatie | stuitje (code = '182028002' in codeSystem 'SNOMED Clinical Terms') | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Wondlengte | 3 cm | |||||||
| Wondbreedte | 1 cm | |||||||
| Wonddiepte | 0.2 cm | |||||||
| Huidaandoening | ||||||||
| SoortAandoening | Intertrigo/smetten (code = '58759008' in codeSystem 'SNOMED CT') | |||||||
| OntstaansDatum | T - 6 dagen | |||||||
| AnatomischeLocatie | lies (code = '26893007' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Rechts (code = '24028007' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | Smetten zonder natten of infectie, inmiddels genezen. | |||||||
| Wond | ||||||||
| WondSoort | Traumatische wond (code = '416462003' in codeSystem 'SNOMED CT') | |||||||
| WondWeefsel | Rode wond (code = 'ROOD' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.2') | |||||||
| WondInfectie | Nee | |||||||
| WondVochtigheid | Droge wond (code = 'DROOG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') | |||||||
| Wondlengte | 2 cm | |||||||
| Wondbreedte | 4 cm | |||||||
| Wonddiepte | 0.1 cm | |||||||
| AnatomischeLocatie | knie (code = '72696002' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| WondOntstaansdatum | T - 5 dagen | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Toelichting | oppervlakkige schaafwond na CVA, geen verband nodig | |||||||
| Wond | ||||||||
| WondSoort | Chirurgische wond (code = '112633009' in codeSystem 'SNOMED CT') | |||||||
| WondInfectie | Nee | |||||||
| WondVochtigheid | Vochtige wond (code = 'VOCHTIG' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.3') | |||||||
| WondRand | Ondermijning (code = '449752001' in codeSystem 'SNOMED CT') | |||||||
| Wondlengte | 5 cm | |||||||
| Wondbreedte | 1 cm | |||||||
| Wonddiepte | 4 cm | |||||||
| AnatomischeLocatie | onderbuik (code = '27033000' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Drain | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | wonddrain (code = '258646005' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProductOmschrijving | wonddrain | |||||||
| BeginDatum | T - 12 dagen | |||||||
| Wond | ||||||||
| WondSoort | Oncologische ulcer (code = '94579000' in codeSystem 'SNOMED CT') | |||||||
| WondWeefsel | Graad II (code = 'GRAAD2' in codeSystem '2.16.840.1.113883.2.4.3.11.60.40.4.7.1') | |||||||
| WondInfectie | Nee | |||||||
| Wondlengte | 1 cm | |||||||
| Wondbreedte | 1 cm | |||||||
| Wonddiepte | 2 cm | |||||||
| AnatomischeLocatie | buikwand (code = '83908009' in codeSystem 'SNOMED Clinical Terms') | |||||||
| Lateraliteit | Links (code = '7771000' in codeSystem 'SNOMED CT') | |||||||
| WondOntstaansdatum | T - 1 maand | |||||||
| DatumLaatsteVerbandwissel | T - 1 dag | |||||||
| Zintuigen | ||||||||
| FunctieHoren | ||||||||
| HoorFunctie | Verminderde gehoorfunctie (code = '15188001' in codeSystem 'SNOMED CT') | |||||||
| HorenHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductID | 012345678905 (code = '012345678905Global Trade Item Number (GTIN)') | |||||||
| ProductType | Gehoorapparaat (code = '6012004' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | Gehoorapparaat | |||||||
| AnatomischeLocatie | Linkeroor (code = '89644007' in codeSystem 'SNOMED CT') | |||||||
| HorenHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| ProductOmschrijving | Gehoorapparaat | |||||||
| AnatomischeLocatie | Rechteroor (code = '25577004' in codeSystem 'SNOMED CT') | |||||||
| FunctieZien | ||||||||
| VisueleFunctie | Verminderd gezichtsvermogen (code = '397540003' in codeSystem 'SNOMED CT') | |||||||
| ZienHulpmiddel | ||||||||
| MedischHulpmiddel | ||||||||
| Product | ||||||||
| ProductType | bril (code = '50121007' in codeSystem 'SNOMED CT') | |||||||
| ProductOmschrijving | bril | |||||||
| Toelichting | zonder bril bestaat verhoogd valrisico | |||||||
| Ziektebeleving | ||||||||
| Ziektebeleving | ||||||||
| ZiekteInzichtVanPatiënt | mevrouw kan niet overzien wat de ziekte betekent in het dagelijkse leven | |||||||
| OmgaanMetZiekteprocesDoorPatiënt | mevrouw wil niet praten over de toekomst. | |||||||
| OmgaanMetZiekteprocesDoorNaasten | echtgenoot maakt zich zorgen of hij de zorg voor mevrouw wel aan kan, omdat hij zelf ook slecht ter been is | |||||||
| Mentale status | ||||||||
| Probleem | ||||||||
| ProbleemType | Symptoom (code = '418799008' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | gedaald bewustzijn (code = '443371007' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProbleemBeginDatum | T - 22 dagen | |||||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||||
| Toelichting | sinds cva, verminderde alertheid | |||||||
| Probleem | ||||||||
| ProbleemType | Klacht (code = '409586006' in codeSystem 'SNOMED CT') | |||||||
| ProbleemNaam | toestand van verwardheid (code = '286933003' in codeSystem 'SNOMED Clinical Terms') | |||||||
| ProbleemBeginDatum | T - 22 dagen | |||||||
| ProbleemEindDatum | T - 5 dagen | |||||||
| ProbleemStatus | Niet actueel (code = '73425007' in codeSystem 'SNOMED CT') | |||||||
1.9 Validatie Overdracht 1.2
1.9.1 Administratieve gegevens
| Administratieve gegevens | ||||||
| Gegevenselement | Waarde | |||||
| Datum overplaatsing | T + 6 dagen | |||||
| Persoonsgegevens | ||||||
| Patient | ||||||
| Naamgegevens | ||||||
| Geslachtsnaam | ||||||
| Achternaam | XXX-Aansluittest-B | |||||
| Adresgegevens | ||||||
| Huisnummer | 1000 | |||||
| Postcode | 9999XA | |||||
| AdresSoort | Woon-/verblijfadres (code = 'PHYS' in codeSystem 'HL7 AddressUse') | |||||
| Identificatienummer | 999990019 (in identificerend systeem: BSN) | |||||
| Geboortedatum | 2 feb 1950 | |||||
| Geslacht | Vrouw (code = 'F' in codeSystem 'HL7 AdministrativeGender') | |||||
| Betaler | ||||||
| Verzekeraar | ||||||
| Verzekering | ||||||
| EindDatumTijd | T + 250 dagen | |||||
| Verzekeringssoort | Basis (code = 'B' in codeSystem 'ZIB Verzekeringssoort') | |||||
| IdentificatieNummer | 9664 (in identificerend systeem: UZOVI) | |||||
| OrganisatieNaam | Trias | |||||
| VerzekerdeNummer | 12345687 | |||||
| Sturende organisatie | ||||||
| Zorgaanbieder | ||||||
| OrganisatieNaam | HomeCare | |||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Geslachtsnaam | ||||||
| Achternaam | Moorman | |||||
| Ontvangende organisatie | ||||||
| Zorgaanbieder | ||||||
| OrganisatieNaam | St. Zonnehof | |||||
1.9.2 Medische context
| Medische context | ||||||
| Gegevenselement | Waarde | |||||
| Behandelaar | ||||||
| Zorgverlener | ||||||
| Naamgegevens | ||||||
| Geslachtsnaam | ||||||
| Achternaam | Curaçao | |||||
| Medische diagnose | ||||||
| Probleem | ||||||
| ProbleemNaam | toxisch delier (code = '231439009' in codeSystem 'SNOMED CT') | |||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | |||||
1.9.3 Verpleegkundige context: zorgplan
| Verpleegkundige context: zorgplan | |||||
| Gegevenselement | Waarde | ||||
| Actuele patiëntproblemen | |||||
| Patiëntprobleem | |||||
| Probleem eovd-val-1-2-probleem-01 | |||||
| ProbleemNaam | acute verwardheid (code = '130987000' in codeSystem 'Referentieset Nationale kernset patientproblemen') | ||||
| ProbleemStatus | Actueel (code = '55561003' in codeSystem 'SNOMED CT') | ||||
| VerpleegkundigeInterventie eovd-val-1-2-interventie-01 | |||||
| Interventie | omgevingsstimuli minimaliseren (code = '710978006' in codeSystem 'SNOMED Clinical Terms') | ||||
| Zorgresultaat | |||||
| UitkomstVanZorg | |||||
| Zorgresultaat | DOSS = 2 | ||||