6.4. Scenario 3
6.4.1. Patient data
| NameInformation.FirstNames | Berend |
| NameInformation.Initials | |
| NameInformation.GivenName | |
| NameInformation.NameUsage | |
| NameInformation.LastName.Prefix | van de |
| NameInformation.LastName.LastName | Stok |
| NameInformation.LastNamePartner.PartnerPrefix | |
| NameInformation.LastNamePartner.PartnerLastName | |
| NameInformation.Titles | |
| AddressInformation.Street | Bloemstraat |
| AddressInformation.HouseNumber | 25 |
| AddressInformation.HouseNumberLetter | |
| AddressInformation.HouseNumberAddition | |
| AddressInformation.HouseNumberIndication | |
| AddressInformation.Postcode | 5678 BB |
| AddressInformation.PlaceOfResidence | Bergen op Zoom |
| AddressInformation.Municipality | |
| AddressInformation.Country | Netherlands (code 'NL' from code system 'ISO 3166-1 (alpha-2)') |
| AddressInformation.AdditionalInformation | |
| AddressInformation.AddressType | Officieel adres (code 'HP' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.TelephoneNumber | +31687654321 |
| ContactInformation.TelephoneNumbers.TelecomType | Mobiel telefoonnummer (code 'MC' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.NumberType | Telefoonnummer thuis (code 'HP' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.Comment | |
| ContactInformation.EmailAddresses.EmailAddress | berendvandestok@gmail.com |
| ContactInformation.EmailAddresses.EmailAddressType | Privé e-mailadres (code 'HP' from code system 'AddressUse') |
| PatientIdentificationNumber | 999998304 (in identifier system 'Burgerservicenummer') |
| DateOfBirth | 04-05-1980 |
| Gender | Man (code 'M' from code system 'AdministrativeGender') |
| MultipleBirthIndicator | |
| DeathIndicator | |
| DateOfDeath |
6.4.2. Health Professional data
| HealthProfessionalIdentificationNumber | 12000003 (in identifier system 'BIG register inschrijvingsnummer') |
| NameInformation.FirstNames | |
| NameInformation.Initials | B. |
| NameInformation.GivenName | |
| NameInformation.NameUsage | |
| NameInformation.LastName.Prefix | |
| NameInformation.LastName.LastName | Dijkstra |
| NameInformation.LastNamePartner.PartnerPrefix | |
| NameInformation.LastNamePartner.PartnerLastName | |
| NameInformation.Titles | |
| Speciality | Tandartsen, algemeen practicus (code '1200' from code system 'Vektis AGB-medische specialismen') |
| Gender | |
| AddressInformation.Street | Simon Smitweg |
| AddressInformation.HouseNumber | 1 |
| AddressInformation.HouseNumberLetter | |
| AddressInformation.HouseNumberAddition | |
| AddressInformation.HouseNumberIndication | |
| AddressInformation.Postcode | 2353 GA |
| AddressInformation.PlaceOfResidence | Leiderdorp |
| AddressInformation.Municipality | |
| AddressInformation.Country | Netherlands (code 'NL' from code system 'ISO 3166-1 (alpha-2)') |
| AddressInformation.AdditionalInformation | |
| AddressInformation.AddressType | |
| ContactInformation.TelephoneNumbers.TelephoneNumber | +31687654321 |
| ContactInformation.TelephoneNumbers.TelecomType | Mobiel telefoonnummer (code 'MC' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.NumberType | Zakelijk telefoonnummer (code 'WP' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.Comment | |
| ContactInformation.EmailAddresses.EmailAddress | dijkstra@tandarts.nl |
| ContactInformation.EmailAddresses.EmailAddressType | Zakelijk e-mailadres (code 'WP' from code system 'AddressUse') |
| HealthcareProvider | Defensie Tandheelkundige Dienst |
| HealthProfessionalRole |
6.4.3. Healthcare Provider data
6.4.3.1. Healthcare Provider - Defensie Tandheelkundige Dienst
| HealthProviderIdentificationNumber | 12095095 (in identifier system 'Vektis AGB-zorgverlener tabel') |
| OrganizationName | Defensie Tandheelkundige Dienst |
| DepartmentSpeciality | |
| ContactInformation.TelephoneNumbers.TelephoneNumber | +31653603740 |
| ContactInformation.TelephoneNumbers.TelecomType | Mobiel telefoonnummer (code 'MC' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.NumberType | Zakelijk telefoonnummer (code 'WP' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.Comment | |
| ContactInformation.EmailAddresses.EmailAddress | PJ.Jumpertz.01@mindef.nl |
| ContactInformation.EmailAddresses.EmailAddressType | Zakelijk e-mailadres (code 'WP' from code system 'AddressUse') |
| AddressInformation.Street | Herculeslaan |
| AddressInformation.HouseNumber | 1 |
| AddressInformation.HouseNumberLetter | |
| AddressInformation.HouseNumberAddition | |
| AddressInformation.HouseNumberIndication | |
| AddressInformation.Postcode | 3584 AB |
| AddressInformation.PlaceOfResidence | Utrecht |
| AddressInformation.Municipality | |
| AddressInformation.Country | Netherlands (code 'NL' from code system 'ISO 3166-1 (alpha-2)') |
| AddressInformation.AdditionalInformation | |
| AddressInformation.AddressType | Werkadres (code 'WP' from code system 'AddressUse') |
| OrganizationType | |
| OrganizationLocation.LocationName | |
| OrganizationLocation.LocationNumber |
6.4.3.2. Healthcare Provider - CWZ Nijmegen
| HealthProviderIdentificationNumber | |
| OrganizationName | CWZ Nijmegen |
| DepartmentSpeciality | |
| ContactInformation.TelephoneNumbers.TelephoneNumber | 0246412121 |
| ContactInformation.TelephoneNumbers.TelecomType | Vast telefoonnummer (code 'LL' from code system 'TelecomDeviceTypes') |
| ContactInformation.TelephoneNumbers.NumberType | Zakelijk telefoonnummer (code 'WP' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.Comment | |
| ContactInformation.EmailAddresses.EmailAddress | |
| ContactInformation.EmailAddresses.EmailAddressType | |
| AddressInformation.Street | Weg door Jonkerbos |
| AddressInformation.HouseNumber | 100 |
| AddressInformation.HouseNumberLetter | |
| AddressInformation.HouseNumberAddition | |
| AddressInformation.HouseNumberIndication | |
| AddressInformation.Postcode | 6532 SZ |
| AddressInformation.PlaceOfResidence | Nijmegen |
| AddressInformation.Municipality | |
| AddressInformation.Country | Netherlands (code 'NL' from code system 'ISO 3166-1 (alpha-2)') |
| AddressInformation.AdditionalInformation | |
| AddressInformation.AddressType | Werkadres (code 'WP' from code system 'AddressUse') |
| OrganizationType | |
| OrganizationLocation.LocationName | |
| OrganizationLocation.LocationNumber |
6.4.4. Contact Person data
| NameInformation.FirstNames | Piet |
| NameInformation.Initials | |
| NameInformation.GivenName | |
| NameInformation.NameUsage | |
| NameInformation.LastName.Prefix | |
| NameInformation.LastName.LastName | Klaas |
| NameInformation.LastNamePartner.PartnerPrefix | |
| NameInformation.LastNamePartner.PartnerLastName | |
| NameInformation.Titles | |
| ContactInformation.TelephoneNumbers.TelephoneNumber | |
| ContactInformation.TelephoneNumbers.TelecomType | |
| ContactInformation.TelephoneNumbers.NumberType | |
| ContactInformation.TelephoneNumbers.Comment | |
| ContactInformation.EmailAddresses.EmailAddress | |
| ContactInformation.EmailAddresses.EmailAddressType | |
| AddressInformation.Street | |
| AddressInformation.HouseNumber | |
| AddressInformation.HouseNumberLetter | |
| AddressInformation.HouseNumberAddition | |
| AddressInformation.HouseNumberIndication | |
| AddressInformation.Postcode | |
| AddressInformation.PlaceOfResidence | |
| AddressInformation.Municipality | |
| AddressInformation.Country | |
| AddressInformation.AdditionalInformation | |
| AddressInformation.AddressType | |
| Role | Eerste relatie/contactpersoon (code '01' from code system 'COD821-VEKT') |
| Relationship | Vader (code 'FTH' from code system 'RoleCode') |
6.4.5. ASA Score data
| ASAScoreDateTime | 01-01-2024 10:43 |
| ASAScoreValue | ASA-score 3 (code '413497009' from code system 'SNOMED CT') |
| Performer | B. Dijkstra, Tandarts |
| Comment | Allergisch voor gluten, heeft nierziekte en bloedarmoede |
6.4.6. Caries Risk data
| CariesRiskDateTime | 01-01-2024 08:43 |
| CariesRiskValue | Verhoogd (code '35105006' from code system 'SNOMED CT') |
| Performer | B. Dijkstra, Tandarts |
| Comment |
6.4.7. Dental Fitness data
| DentalFitnessDateTime | 03-03-2024 10:43 |
| DentalFitnessValue | Klasse 2 (code '258393007' from code system 'SNOMED CT') |
| Performer | B. Dijkstra, Tandarts |
| Comment |
6.4.8. Encounter data
| ContactType | Anders (code 'OTH' from code system 'NullFlavor'): Consult t.b.v. intake |
| ContactWith | B. Dijkstra, Tandarts |
| Location | CWZ Nijmegen |
| StartDateTime | 01-09-2025 09:00 |
| EndDateTime | 01-09-2025 09:30 |
| ContactReason.Problem | |
| ContactReason.Procedure | |
| ContactReason.DeviatingResult | |
| ContactReason.CommentContactReason | |
| Origin | |
| Destination |
6.4.9. Oral Hygiene data
| OralHygieneDateTime | 01-01-2024 08:43 |
| OralHygieneValue | Goed (code '20572008' from code system 'SNOMED CT') |
| Performer | B. Dijkstra, Tandarts |
| Comment |
6.4.10. Parafunctional Activity data
| ParafunctionalActivityDateTime | 01-01-2024 08:43 |
| ParafunctionalActivityValue | Tanden knarsen tijdens slaap |
| Performer | B. Dijkstra, Tandarts |
| Comment |
6.4.11. Payer data
6.4.11.1. Payer - Berend van de Stok
| PayerPerson.PayerName | Berend van de Stok |
| PayerPerson.BankInformation.BankName | ABNA |
| PayerPerson.BankInformation.BankCode | ABNA00NL |
| PayerPerson.BankInformation.AccountNumber | NL00ABNA0001234567 |
| InsuranceCompany.Insurance.StartDateTime | |
| InsuranceCompany.Insurance.EndDateTime | |
| InsuranceCompany.Insurance.InsuranceType | |
| InsuranceCompany.IdentificationNumber | |
| InsuranceCompany.OrganizationName | |
| InsuranceCompany.InsurantNumber | |
| AddressInformation.Street | Bloemstraat |
| AddressInformation.HouseNumber | 25 |
| AddressInformation.HouseNumberLetter | |
| AddressInformation.HouseNumberAddition | |
| AddressInformation.HouseNumberIndication | |
| AddressInformation.Postcode | 5678 BB |
| AddressInformation.PlaceOfResidence | Bergen op Zoom |
| AddressInformation.Municipality | |
| AddressInformation.Country | Netherlands (code 'NL' from code system 'ISO 3166-1 (alpha-2)') |
| AddressInformation.AdditionalInformation | |
| AddressInformation.AddressType | Officieel adres (code 'HP' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.TelephoneNumber | |
| ContactInformation.TelephoneNumbers.TelecomType | |
| ContactInformation.TelephoneNumbers.NumberType | |
| ContactInformation.TelephoneNumbers.Comment | |
| ContactInformation.EmailAddresses.EmailAddress | |
| ContactInformation.EmailAddresses.EmailAddressType |
6.4.11.2. Payer - A.S.R.
| PayerPerson.PayerName | |
| PayerPerson.BankInformation.BankName | |
| PayerPerson.BankInformation.BankCode | |
| PayerPerson.BankInformation.AccountNumber | |
| InsuranceCompany.Insurance.StartDateTime | 01-01-2025 |
| InsuranceCompany.Insurance.EndDateTime | 01-01-2026 |
| InsuranceCompany.Insurance.InsuranceType | Tandverzekering (los) (code 'T' from code system 'Verzekeringssoort') |
| InsuranceCompany.IdentificationNumber | |
| InsuranceCompany.OrganizationName | A.S.R. |
| InsuranceCompany.InsurantNumber | 12345679 |
| AddressInformation.Street | Archimedeslaan |
| AddressInformation.HouseNumber | 10 |
| AddressInformation.HouseNumberLetter | |
| AddressInformation.HouseNumberAddition | |
| AddressInformation.HouseNumberIndication | |
| AddressInformation.Postcode | 3584 BA |
| AddressInformation.PlaceOfResidence | Utrecht |
| AddressInformation.Municipality | |
| AddressInformation.Country | Netherlands (code 'NL' from code system 'ISO 3166-1 (alpha-2)') |
| AddressInformation.AdditionalInformation | |
| AddressInformation.AddressType | Werkadres (code 'WP' from code system 'AddressUse') |
| ContactInformation.TelephoneNumbers.TelephoneNumber | |
| ContactInformation.TelephoneNumbers.TelecomType | |
| ContactInformation.TelephoneNumbers.NumberType | |
| ContactInformation.TelephoneNumbers.Comment | |
| ContactInformation.EmailAddresses.EmailAddress | |
| ContactInformation.EmailAddresses.EmailAddressType |
6.4.12. Periodic Periodontal Screening Score data
| PeriodicPeriodontalScreeningScoreDateTime | 01-01-2024 08:43 |
| PeriodicPeriodontalScreeningScoreValue | Pockets groter dan of gelijk aan 6 millimeter = wellicht niet in orde (code 'ppsscore3' from code system 'PeriodicPeriodontalScreeningScore') |
| Performer | B. Dijkstra, Tandarts |
| Comment | Paro-traject |
6.4.13. Procedure data
| ProcedureStartDate | 01-01-2024 |
| ProcedureEndDate | |
| ProcedureType | Eerste consult (code 'F121A' from code system 'Vektis Prestatiecodelijst Mondzorg') |
| ProcedureMethod | |
| ProcedureAnatomicalLocation.Location | |
| ProcedureAnatomicalLocation.Laterality | |
| Indication | |
| Indication.ProblemType | |
| Indication.ProblemName | |
| Indication.FurtherSpecificationProblemName | |
| Indication.ProblemAnatomicalLocation | |
| Indication.ProblemAnatomicalLocation.Location | |
| Indication.ProblemAnatomicalLocation.Laterality | |
| Indication.ProblemStartDate | |
| Indication.ProblemEndDate | |
| Indication.ProblemStatus | |
| Indication.VerificationStatus | |
| Indication.Comment | |
| Location | CWZ Nijmegen |
| Performer | B. Dijkstra, Tandarts |
6.4.14. Treatment Objective data
6.4.14.1. Treatment Objective - Trekken snijtand linksboven
| DesiredHealthcareResult | Trekken snijtand linksboven |
| DesiredHealthCondition | |
| Problem |
6.4.14.2. Treatment Objective - Wortelpuntoperatie (apexresectie)
| DesiredHealthcareResult | Wortelpuntoperatie (apexresectie) |
| DesiredHealthCondition | |
| Problem |