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

Example CarePlan: 轉介單居家服務計畫範例

status: Active

intent: Proposal

category: Assessment and Plan of Treatment

subject: 陳明慧 Female, DoB: 1945-03-15 ( National Person Identifier (TWN): A123456789 (use: official, ))

period: 2024-02-01 --> 2024-08-01

author: PractitionerRole Registered nurse

goal: Goal: lifecycleStatus = active; description = Advancing mobility; start[x] = 2024-01-15; note = 住民目前需要部分協助才能行走，期望透過復健訓練達到獨立行走的目標

activity

Details

-CodeStatusPerformerDescription
*居家護理Not StartedOrganization 新北市私立安康老人長期照顧中心（養護型）提供居家護理服務，如換藥、傷口照護、健康評估等

activity

Details

-CodeStatusPerformerDescription
*居家吞嚥Not StartedOrganization 新北市私立安康老人長期照顧中心（養護型）提供居家吞嚥訓練與相關照護服務

note: @2024-01-20

個案需要居家照顧及復健服務，由照管中心評估後安排服務提供單位