臺灣長期照顧實作指引(TW LTC IG)
1.1.0 - STU 1.1.0
臺灣長期照顧實作指引(TW LTC IG) - Local Development build (v1.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="hah-transfer-document"/>
<meta>
<lastUpdated value="2026-09-11T10:01:00+08:00"/>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/HAHBundleSummary"/>
</meta>
<identifier>
<system value="https://example.org/hah/documents"/>
<value value="hah-transfer-document-v1"/>
</identifier>
<type value="document"/>
<timestamp value="2026-09-11T10:01:00+08:00"/>
<entry>
<fullUrl
value="https://example.org/fhir/Composition/hah-transfer-summary"/>
<resource>
<Composition>
<id value="hah-transfer-summary"/>
<meta>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/HAHCompositionSummary"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Composition_hah-transfer-summary"> </a><p class="res-header-id"><b>Generated Narrative: Composition hah-transfer-summary</b></p><a name="hah-transfer-summary"> </a><a name="hchah-transfer-summary"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-HAHCompositionSummary.html">在宅急症－結案與轉銜摘要</a></p></div><p><b>status</b>: Final</p><p><b>type</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/hah-document transfer-summary}, {http://loinc.org 18761-7}">Transfer summary note</span></p><p><b>encounter</b>: <a href="Encounter-hah-transfer-admission.html">Encounter: status = finished; class = inpatient encounter (ActCode#IMP); type = 在宅急症照護; period = 2026-09-10 08:00:00+0800 --> 2026-09-11 10:00:00+0800</a></p><p><b>date</b>: 2026-09-11 10:00:00+0800</p><p><b>author</b>: <a href="Practitioner-hah-practitioner.html">Practitioner 李示範</a></p><p><b>title</b>: 王測試在宅急症轉院摘要</p><p><b>custodian</b>: <a href="Organization-hah-organization.html">Organization 在宅急症示範醫療機構</a></p></div>
</text>
<status value="final"/>
<type>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-document"/>
<code value="transfer-summary"/>
</coding>
<coding>
<system value="http://loinc.org"/>
<code value="18761-7"/>
<display value="Transfer summary note"/>
</coding>
</type>
<subject>🔗
<reference value="Patient/hah-patient"/>
</subject>
<encounter>🔗
<reference value="Encounter/hah-transfer-admission"/>
</encounter>
<date value="2026-09-11T10:00:00+08:00"/>
<author>🔗
<reference value="Practitioner/hah-practitioner"/>
</author>
<title value="王測試在宅急症轉院摘要"/>
<custodian>🔗
<reference value="Organization/hah-organization"/>
</custodian>
<section>
<title value="療程經過"/>
<code>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-document"/>
<code value="course"/>
</coding>
</code>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>本次療程已轉出，接收醫院就醫結果尚未提供。</p></div>
</text>
<entry>🔗
<reference value="EpisodeOfCare/hah-transfer-episode"/>
</entry>
<entry>🔗
<reference value="Encounter/hah-transfer-admission"/>
</entry>
</section>
<section>
<title value="診斷與問題"/>
<code>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-document"/>
<code value="problems"/>
</coding>
</code>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>本次轉院摘要未提供此項資料，交班時須確認。</p></div>
</text>
</section>
<section>
<title value="過敏資訊"/>
<code>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-document"/>
<code value="allergies"/>
</coding>
</code>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>本次轉院摘要未提供此項資料，交班時須確認。</p></div>
</text>
</section>
<section>
<title value="藥物與給藥"/>
<code>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-document"/>
<code value="medications"/>
</coding>
</code>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>本次轉院摘要未提供此項資料，交班時須確認。</p></div>
</text>
</section>
<section>
<title value="檢查結果"/>
<code>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-document"/>
<code value="results"/>
</coding>
</code>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>本次轉院摘要未提供此項資料，交班時須確認。</p></div>
</text>
</section>
<section>
<title value="照護計畫與措施"/>
<code>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-document"/>
<code value="care"/>
</coding>
</code>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>本次轉院摘要未提供此項資料，交班時須確認。</p></div>
</text>
</section>
<section>
<title value="後續照護與交班"/>
<code>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-document"/>
<code value="follow-up"/>
</coding>
</code>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>轉院申請已建立；請接收機構續行評估。</p></div>
</text>
<entry>🔗
<reference value="ServiceRequest/hah-transfer-request"/>
</entry>
</section>
</Composition>
</resource>
</entry>
<entry>
<fullUrl value="https://example.org/fhir/Patient/hah-patient"/>
<resource>
<Patient>
<id value="hah-patient"/>
<meta>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/HAHPatient"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_hah-patient"> </a><p class="res-header-id"><b>Generated Narrative: Patient hah-patient</b></p><a name="hah-patient"> </a><a name="hchah-patient"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-HAHPatient.html">在宅急症－個案</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">王測試 Male, DoB: 1945-03-15 ( Provider number)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Other Id (see the one above)">Other Id:</td><td colspan="3">National Person Identifier where the xxx is the ISO table 3166 3-character (alphabetic) country code/A123456789</td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3"><ul><li>ph: 02-00000000</li><li>臺北市中正區測試路1號(home)</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Nominated Contact: Emergency Contact">Emergency Contact:</td><td colspan="3"><ul><li>王家屬</li><li>ph: 02-00000001</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Patient Links">Links:</td><td colspan="3"><ul><li>Managing Organization: <a href="Organization-hah-organization.html">Organization 在宅急症示範醫療機構</a></li></ul></td></tr></table></div>
</text>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PRN"/>
</coding>
</type>
<system value="https://example.org/hah/patients"/>
<value value="HAH0001"/>
</identifier>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="NNxxx"/>
</coding>
</type>
<system value="http://www.moi.gov.tw"/>
<value value="A123456789"/>
</identifier>
<name>
<use value="usual"/>
<text value="王測試"/>
</name>
<telecom>
<system value="phone"/>
<value value="02-00000000"/>
</telecom>
<gender value="male"/>
<birthDate value="1945-03-15"/>
<address>
<use value="home"/>
<text value="臺北市中正區測試路1號"/>
</address>
<contact>
<relationship>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0131"/>
<code value="C"/>
</coding>
</relationship>
<name>
<text value="王家屬"/>
</name>
<telecom>
<system value="phone"/>
<value value="02-00000001"/>
</telecom>
</contact>
<managingOrganization>🔗
<reference value="Organization/hah-organization"/>
</managingOrganization>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="https://example.org/fhir/EpisodeOfCare/hah-transfer-episode"/>
<resource>
<EpisodeOfCare>
<id value="hah-transfer-episode"/>
<meta>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/HAHEpisodeOfCare"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="EpisodeOfCare_hah-transfer-episode"> </a><p class="res-header-id"><b>Generated Narrative: EpisodeOfCare hah-transfer-episode</b></p><a name="hah-transfer-episode"> </a><a name="hchah-transfer-episode"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-HAHEpisodeOfCare.html">在宅急症－收案療程</a></p></div><p><b>在宅急症－療程結束原因</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/hah-outcome hospital-transfer}">轉急診或住院</span></p><p><b>identifier</b>: <code>https://example.org/hah/episodes</code>/HAH-20260910-002</p><p><b>status</b>: Finished</p><p><b>type</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/hah-activity acute-home}">在宅急症照護</span></p><p><b>patient</b>: <a href="Patient-hah-patient.html">王測試 Male, DoB: 1945-03-15 ( Provider number)</a></p><p><b>managingOrganization</b>: <a href="Organization-hah-organization.html">Organization 在宅急症示範醫療機構</a></p><p><b>period</b>: 2026-09-10 08:00:00+0800 --> 2026-09-11 10:00:00+0800</p></div>
</text>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/ExtHAHOutcome">
<valueCodeableConcept>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-outcome"/>
<code value="hospital-transfer"/>
</coding>
</valueCodeableConcept>
</extension>
<identifier>
<system value="https://example.org/hah/episodes"/>
<value value="HAH-20260910-002"/>
</identifier>
<status value="finished"/>
<type>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-activity"/>
<code value="acute-home"/>
</coding>
</type>
<patient>🔗
<reference value="Patient/hah-patient"/>
</patient>
<managingOrganization>🔗
<reference value="Organization/hah-organization"/>
</managingOrganization>
<period>
<start value="2026-09-10T08:00:00+08:00"/>
<end value="2026-09-11T10:00:00+08:00"/>
</period>
</EpisodeOfCare>
</resource>
</entry>
<entry>
<fullUrl
value="https://example.org/fhir/Encounter/hah-transfer-admission"/>
<resource>
<Encounter>
<id value="hah-transfer-admission"/>
<meta>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/HAHAdmissionEncounter"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Encounter_hah-transfer-admission"> </a><p class="res-header-id"><b>Generated Narrative: Encounter hah-transfer-admission</b></p><a name="hah-transfer-admission"> </a><a name="hchah-transfer-admission"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-HAHAdmissionEncounter.html">在宅急症－整段照護</a></p></div><p><b>status</b>: Finished</p><p><b>class</b>: <a href="http://terminology.hl7.org/7.4.0/CodeSystem-v3-ActCode.html#v3-ActCode-IMP">ActCode: IMP</a> (inpatient encounter)</p><p><b>type</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/hah-activity acute-home}">在宅急症照護</span></p><p><b>subject</b>: <a href="Patient-hah-patient.html">王測試 Male, DoB: 1945-03-15 ( Provider number)</a></p><p><b>episodeOfCare</b>: <a href="EpisodeOfCare-hah-transfer-episode.html">EpisodeOfCare: extension = 轉急診或住院; identifier = https://example.org/hah/episodes#HAH-20260910-002; status = finished; type = 在宅急症照護; period = 2026-09-10 08:00:00+0800 --> 2026-09-11 10:00:00+0800</a></p><h3>Participants</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Individual</b></td></tr><tr><td style="display: none">*</td><td><a href="Practitioner-hah-practitioner.html">Practitioner 李示範</a></td></tr></table><p><b>period</b>: 2026-09-10 08:00:00+0800 --> 2026-09-11 10:00:00+0800</p><h3>Hospitalizations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Destination</b></td><td><b>DischargeDisposition</b></td></tr><tr><td style="display: none">*</td><td><a href="Organization-hah-receiving-hospital.html">Organization 轉院接收示範醫院</a></td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/discharge-disposition other-hcf}">Other healthcare facility</span></td></tr></table><p><b>serviceProvider</b>: <a href="Organization-hah-organization.html">Organization 在宅急症示範醫療機構</a></p></div>
</text>
<status value="finished"/>
<class>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="IMP"/>
</class>
<type>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-activity"/>
<code value="acute-home"/>
</coding>
</type>
<subject>🔗
<reference value="Patient/hah-patient"/>
</subject>
<episodeOfCare>🔗
<reference value="EpisodeOfCare/hah-transfer-episode"/>
</episodeOfCare>
<participant>
<individual>🔗
<reference value="Practitioner/hah-practitioner"/>
</individual>
</participant>
<period>
<start value="2026-09-10T08:00:00+08:00"/>
<end value="2026-09-11T10:00:00+08:00"/>
</period>
<hospitalization>
<destination>🔗
<reference value="Organization/hah-receiving-hospital"/>
</destination>
<dischargeDisposition>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/discharge-disposition"/>
<code value="other-hcf"/>
</coding>
</dischargeDisposition>
</hospitalization>
<serviceProvider>🔗
<reference value="Organization/hah-organization"/>
</serviceProvider>
</Encounter>
</resource>
</entry>
<entry>
<fullUrl value="https://example.org/fhir/Practitioner/hah-practitioner"/>
<resource>
<Practitioner>
<id value="hah-practitioner"/>
<meta>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/LTCPractitioner"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_hah-practitioner"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner hah-practitioner</b></p><a name="hah-practitioner"> </a><a name="hchah-practitioner"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-LTCPractitioner.html">長期照顧－照顧服務提供者</a></p></div><p><b>identifier</b>: <code>https://example.org/practitioners</code>/HAH-STAFF-1</p><p><b>name</b>: 李示範</p></div>
</text>
<identifier>
<system value="https://example.org/practitioners"/>
<value value="HAH-STAFF-1"/>
</identifier>
<name>
<use value="usual"/>
<text value="李示範"/>
</name>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl value="https://example.org/fhir/Organization/hah-organization"/>
<resource>
<Organization>
<id value="hah-organization"/>
<meta>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/Organization-twltc"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_hah-organization"> </a><p class="res-header-id"><b>Generated Narrative: Organization hah-organization</b></p><a name="hah-organization"> </a><a name="hchah-organization"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-Organization-twltc.html">長期照顧－機構</a></p></div><p><b>identifier</b>: <code>https://example.org/organizations</code>/HAH-ORG-1</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}">Healthcare Provider</span></p><p><b>name</b>: 在宅急症示範醫療機構</p></div>
</text>
<identifier>
<system value="https://example.org/organizations"/>
<value value="HAH-ORG-1"/>
</identifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/organization-type"/>
<code value="prov"/>
</coding>
</type>
<name value="在宅急症示範醫療機構"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="https://example.org/fhir/Organization/hah-receiving-hospital"/>
<resource>
<Organization>
<id value="hah-receiving-hospital"/>
<meta>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/Organization-twltc"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_hah-receiving-hospital"> </a><p class="res-header-id"><b>Generated Narrative: Organization hah-receiving-hospital</b></p><a name="hah-receiving-hospital"> </a><a name="hchah-receiving-hospital"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-Organization-twltc.html">長期照顧－機構</a></p></div><p><b>identifier</b>: <code>https://example.org/organizations</code>/HAH-HOSPITAL-2</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}">Healthcare Provider</span></p><p><b>name</b>: 轉院接收示範醫院</p></div>
</text>
<identifier>
<system value="https://example.org/organizations"/>
<value value="HAH-HOSPITAL-2"/>
</identifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/organization-type"/>
<code value="prov"/>
</coding>
</type>
<name value="轉院接收示範醫院"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="https://example.org/fhir/ServiceRequest/hah-transfer-request"/>
<resource>
<ServiceRequest>
<id value="hah-transfer-request"/>
<meta>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/HAHServiceRequest"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="ServiceRequest_hah-transfer-request"> </a><p class="res-header-id"><b>Generated Narrative: ServiceRequest hah-transfer-request</b></p><a name="hah-transfer-request"> </a><a name="hchah-transfer-request"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-HAHServiceRequest.html">在宅急症－服務請求</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Order</p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/hah-activity referral}">轉介</span></p><p><b>code</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/hah-activity referral}">轉介</span></p><p><b>subject</b>: <a href="Patient-hah-patient.html">王測試 Male, DoB: 1945-03-15 ( Provider number)</a></p><p><b>encounter</b>: <a href="Encounter-hah-transfer-admission.html">Encounter: status = finished; class = inpatient encounter (ActCode#IMP); type = 在宅急症照護; period = 2026-09-10 08:00:00+0800 --> 2026-09-11 10:00:00+0800</a></p><p><b>authoredOn</b>: 2026-09-11 09:30:00+0800</p><p><b>requester</b>: <a href="Practitioner-hah-practitioner.html">Practitioner 李示範</a></p><p><b>performer</b>: <a href="Organization-hah-receiving-hospital.html">Organization 轉院接收示範醫院</a></p><p><b>reasonCode</b>: <span title="Codes:">本次照護需要超出居家服務能力，安排轉院評估。</span></p></div>
</text>
<status value="active"/>
<intent value="order"/>
<category>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-activity"/>
<code value="referral"/>
</coding>
</category>
<code>
<coding>
<system value="http://ltc-ig.fhir.tw/CodeSystem/hah-activity"/>
<code value="referral"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/hah-patient"/>
</subject>
<encounter>🔗
<reference value="Encounter/hah-transfer-admission"/>
</encounter>
<authoredOn value="2026-09-11T09:30:00+08:00"/>
<requester>🔗
<reference value="Practitioner/hah-practitioner"/>
</requester>
<performer>🔗
<reference value="Organization/hah-receiving-hospital"/>
</performer>
<reasonCode>
<text value="本次照護需要超出居家服務能力，安排轉院評估。"/>
</reasonCode>
</ServiceRequest>
</resource>
</entry>
</Bundle>