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%1.2.276.763.1.5.5.4.2.910_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
U3 dokumentieren (Kindervorsorgeuntersuchungen)0.
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FHIR®-Mapping: %KBV_PR_MIO_CMR_Composition_U3|KBV_PR_MIO_CMR_Composition_U3.section:untersuchung%untersuchung

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Anker
U3 - Untersuchung - Haut
U3 - Untersuchung - Haut

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%1.2.276.763.1.1.5.5.4.2.919_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
U3 dokumentieren (Kindervorsorgeuntersuchungen)0.
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Terminologie-Assoziation:

CODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
364528001Skin observable (observable entity)SNOMED CT®, 2021-01-31

FHIR®-Mapping:
- %KBV KBV_PR_MIO_CMR_Diagnostic_Report_U3_U4_Physical_Exam_Skin|KBV_PR_MIO_CMR_Diagnostic_Report_U3_U4_Physical_Exam_Skin%
- %KBV
- KBV_PR_MIO_CMR_Observation_U3_U4_Physical_Exam_Skin|KBV_PR_MIO_CMR_Observation_U3_U4_Physical_Exam_Skin%

Wert: Code

Wert: Code

KONZEPT KONZEPT UND WIEDERGABENAMECODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
auffällige Blässe267029006Pale - symptom (finding)SNOMED CT®, 2021-01-31
Zyanose3415004Cyanosis (finding)SNOMED CT®, 2021-01-31
Ikterus18165001Jaundice (finding)SNOMED CT®, 2021-01-31
Hämangiome400210000Hemangioma (disorder)SNOMED CT®, 2021-01-31
Naevi und andere Pigmentanomalien370172004Skin pigmentation (finding)SNOMED CT®, 2021-01-31
Ödeme267038008Edema (finding)SNOMED CT®, 2021-01-31
Anhalt für Verletzungen (z. B. Hämatome, Petechien, Verbrennungen, Narben)781645001Injury to skin caused by trauma (finding)SNOMED CT®, 2021-01-31
entzündliche Hautveränderungen106076001 : 116676008 = 708039003Skin finding (finding) : Associated morphology (attribute) = Inflammatory lesion (morphologic abnormality)SNOMED CT®, 2021-01-31

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%1.2.276.763.1.1.5.5.4.2.918_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
U3 dokumentieren (Kindervorsorgeuntersuchungen)0.
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Terminologie-Assoziation:

CODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
364048003Respiratory observable (observable entity)SNOMED CT®, 2021-01-31

FHIR®-Mapping:
- %KBV KBV_PR_MIO_CMR_Diagnostic_Report_U2_U4_Physical_Exam_Chest_Lung_Respiratory_Tract|KBV_PR_MIO_CMR_Diagnostic_Report_U2_U4_Physical_Exam_Chest_Lung_Respiratory_Tract%
- %KBV
- KBV_PR_MIO_CMR_Observation_U2_U4_Physical_Exam_Chest_Lung_Respiratory_Tract|KBV_PR_MIO_CMR_Observation_U2_U4_Physical_Exam_Chest_Lung_Respiratory_Tract%

Wert: Code

KONZEPT UND WIEDERGABENAMECODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
Auskultation301272007Chest auscultation finding (finding)SNOMED CT®, 2021-01-31
Atemgeräusch301273002Abnormal breath sounds (finding)SNOMED CT®, 2021-01-31
Atemfrequenz17077006Abnormal respiratory rate (finding)SNOMED CT®, 2021-01-31
Einziehungen67909005Chest wall retraction (finding)SNOMED CT®, 2021-01-31
Thoraxkonfiguration298706004Finding of appearance of thorax (finding)SNOMED CT®, 2021-01-31
Schlüsselbeine298761006Finding of clavicle structure (finding)SNOMED CT®, 2021-01-31

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%1.2.276.0.76.3.1.1.5.5.4.2.917_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
U3 dokumentieren (Kindervorsorgeuntersuchungen)0...*R

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Terminologie-Assoziation:

CODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
364446009General characteristics of abdomen (observable entity)SNOMED CT®, 2021-01-31

FHIR®-Mapping:
- %KBV_PR_MIO_CMR_Diagnostic_Report_U2_U3_Physical_Exam_Abdomen_Genitals|KBV_PR_MIO_CMR_Diagnostic_Report_U2_U3_Physical_Exam_Abdomen_Genitals%
- %KBVFHIR®-Mapping:
- KBV_PR_MIO_CMR_ObservationDiagnostic_Report_U2_U3_Physical_Exam_Abdomen_Genitals|
- KBV_PR_MIO_CMR_Observation_U2_U3_Physical_Exam_Abdomen_Genitals%Genitals

Wert: Code

KONZEPT UND WIEDERGABENAMECODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
Anomalien822987005 : {116676008 = 49755003 , 363698007 = 818987002}Finding of abdominopelvic segment of trunk (finding) : {Associated morphology (attribute) = Morphologically abnormal structure (morphologic abnormality) , Finding site (attribute) = Structure of abdominopelvic cavity (body structure)SNOMED CT®, 2021-01-31
Nabelveränderungen249537008Umbilicus finding (finding)SNOMED CT®, 2021-01-31
Leber- und Milzgröße65476007 : {363698007 = 10200004 , 363698007 = 78961009}Abnormal size (finding) : {Finding site (attribute) = Liver structure (body structure) , Finding site (attribute) = Splenic structure (body structure)}SNOMED CT®, 2021-01-31
Hernien128545000Hernia of abdominal wall (disorder)SNOMED CT®, 2021-01-31

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%1.2.276.763.1.1.5.5.4.2.916_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
U3 dokumentieren (Kindervorsorgeuntersuchungen)0.
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.*R

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Terminologie-Assoziation:

CODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
364066008Cardiovascular observable (observable entity)SNOMED CT®, 2021-01-31

FHIR®-Mapping:
- %KBV KBV_PR_MIO_CMR_Diagnostic_Report_U2_U6_Physical_Exam_Heart_Blood_Circulation|KBV_PR_MIO_CMR_Diagnostic_Report_U2_U6_Physical_Exam_Heart_Blood_Circulation%
- %KBV
- KBV_PR_MIO_CMR_Observation_U2_U6_Physical_Exam_Heart_Blood_Circulation|KBV_PR_MIO_CMR_Observation_U2_U6_Physical_Exam_Heart_Blood_Circulation%

Wert: Code

KONZEPT UND WIEDERGABENAMECODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
Herzfrequenz361135004Abnormal cardiac rate (finding)SNOMED CT®, 2021-01-31
Herzrhythmus698247007Cardiac arrhythmia (disorder)SNOMED CT®, 2021-01-31
Herztöne123824001Heart sounds abnormal (finding)SNOMED CT®, 2021-01-31
Herznebengeräusche88610006Heart murmur (finding)SNOMED CT®, 2021-01-31
Femoralispulse50178004Abnormal femoral pulse (finding)SNOMED CT®, 2021-01-31

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%1.2.276.763.1.1.5.5.4.2.915_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
U3 dokumentieren (Kindervorsorgeuntersuchungen)0.
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Terminologie-Assoziation:

CODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
363991003Ear observable (observable entity)SNOMED CT®, 2021-01-31

FHIR®-Mapping:
- %KBV_PR_MIO_CMR_Diagnostic_Report_U2_U3_Physical_Exam_Ears|
- KBV_PR_MIO_CMR_Diagnostic_Report_U2_U3_Physical_Exam_Ears%Ears
- %KBV KBV_PR_MIO_CMR_Observation_U2_U3_Physical_Exam_Ears|KBV_PR_MIO_CMR_Observation_U2_U3_Physical_Exam_Ears%

Wert: Code

KONZEPT UND WIEDERGABENAMECODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
Fehlbildungen (z. B. Ohrfisteln, Anhängsel, Atresie)282038006Congenital abnormality of external ear (disorder)SNOMED CT®, 2021-01-31

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%1.2.276.0.76.3.1.1.5.5.4.2.914_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
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Terminologie-Assoziation:

CODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
106029005Musculoskeletal function (observable entity)SNOMED CT®, 2021-01-31

FHIR®-Mapping:
- %KBV KBV_PR_MIO_CMR_Diagnostic_Report_U3_Physical_Exam_Musculoskeletal_System|KBV_PR_MIO_CMR_Diagnostic_Report_U3_Physical_Exam_Musculoskeletal_System%
- %KBV_PR_MIO_CMR_Observation_U3_Physical_Exam_Musculoskeletal_System|
- KBV_PR_MIO_CMR_Observation_U3_Physical_Exam_Musculoskeletal_System%System

Wert: Code

KONZEPT UND WIEDERGABENAMECODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
Asymmetrien422949007Musculoskeletal asymmetry (finding)SNOMED CT®, 2021-01-31
Schiefhaltung43029002Abnormal posture (finding)SNOMED CT®, 2021-01-31
Spontanmotorik225606002Abnormal movement (finding)SNOMED CT®, 2021-01-31
Muskeltonus366725004Finding of muscle tone (finding)SNOMED CT®, 2021-01-31
Opisthotonus8652009Opisthotonus (finding)SNOMED CT®, 2021-01-31
passive Beweglichkeit der großen Gelenke298180004Finding of range of joint movement (finding)SNOMED CT®, 2021-01-31
Muskeleigenreflexe366420008Peripheral reflex finding (finding)SNOMED CT®, 2021-01-31
Handgreifreflex299745004 + 299746003Palmar reflex absent (finding) + Palmar reflex equivocal (finding)SNOMED CT®, 2021-01-31
Moro-Reaktion299742001 + 299743006Moro reflex absent (finding) + Moro reflex equivocal (finding)SNOMED CT®, 2021-01-31
Saugreflex299757008 + 299758003Sucking reflex absent (finding) + Sucking reflex equivocal (finding)SNOMED CT®, 2021-01-31
klinische Frakturzeichen404684003 : 116676008 = 72704001Clinical finding (finding) : Associated morphology (attribute) = Fracture (morphologic abnormality)SNOMED CT®, 2021-01-31

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%1.2.276.763.1.1.5.5.4.2.913_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
U3 dokumentieren (Kindervorsorgeuntersuchungen)0.
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Terminologie-Assoziation:

CODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
364404000Head region observable (observable entity)SNOMED CT®, 2021-01-31

FHIR®-Mapping:
- %KBV_PR_MIO_CMR_Diagnostic_Report_U3_Physical_Exam_Head|
- KBV_PR_MIO_CMR_Diagnostic_Report_U3_Physical_Exam_Head%Head
- %KBV KBV_PR_MIO_CMR_Observation_U3_Physical_Exam_Head|KBV_PR_MIO_CMR_Observation_U3_Physical_Exam_Head%

Wert: Code

KONZEPT UND WIEDERGABENAMECODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
Fehlhaltung111235007Musculoskeletal disorder of the neck (disorder)SNOMED CT®, 2021-01-31
Dysmorphiezeichen253978002Dysmorphic features (finding)SNOMED CT®, 2021-01-31
Schädelnähte248387005Cranial suture finding (finding)SNOMED CT®, 2021-01-31
Kephalhämatom206200000Cephalhematoma due to birth trauma (disorder)SNOMED CT®, 2021-01-31
Fontanellentonus366372002Finding of level of fontanelle (finding)SNOMED CT®, 2021-01-31
Crepitatio capitis23149001 : 363698007 = 783207002Bone crepitus (finding) : Finding site (attribute) = Bone and/or joint structure of cranium (body structure)SNOMED CT®, 2021-01-31
lagebedingte Schädelasymmetrie293291000119108Acquired postural plagiocephaly (disorder)SNOMED CT®, 2021-01-31

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%1.2.276.0.76.3.1.1.5.5.4.2.912_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
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Terminologie-Assoziation:

CODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
271914002 + 364111005Ear, nose and throat examination finding (observable entity) + Oral cavity observable (observable entity)SNOMED CT®, 2021-01-31

FHIR®-Mapping:
- KBVFHIR®-Mapping:
- %KBV_PR_MIO_CMR_Diagnostic_Report_U3_U4_Physical_Exam_Mouth_Nose|KBV_PR_MIO_CMR_Diagnostic_Report_U3_U4_Physical_Exam_Mouth_Nose%
- %KBV_PR_MIO_CMR_Diagnostic_ObservationReport_U3_U4_Physical_Exam_Mouth_Nose|
- KBV_PR_MIO_CMR_Observation_U3_U4_Physical_Exam_Mouth_Nose%Nose

Wert: Code

KONZEPT UND WIEDERGABENAMECODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
Auffälligkeiten der Schleimhaut und des Kieferkamms300255008Oral cavity problem (finding)SNOMED CT®, 2021-01-31
Kiefer- Gaumenanomalie449790007Orofacial cleft (disorder)SNOMED CT®, 2021-01-31
Verletzungszeichen125593007Injury of face (disorder)SNOMED CT®, 2021-01-31
abnorme Größe der Zunge65476007 : 363698007 = 21974007Abnormal size (finding) : Finding site (attribute) = Tongue structure (body structure)SNOMED CT®, 2021-01-31
behinderte Nasenatmung232209000Nasal obstruction (finding)SNOMED CT®, 2021-01-31
orofacialer Hypotonus367381002Weak mouth closure (finding)SNOMED CT®, 2021-01-31

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%1.2.276.763.1.1.5.5.4.2.911_scenarioCardinalityConformity%
SZENARIOKARDINALITÄTKONFORMITÄT
U3 dokumentieren (Kindervorsorgeuntersuchungen)0.
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Terminologie-Assoziation:

CODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
414174009Eye observable (observable entity)SNOMED CT®, 2021-01-31

FHIR®-Mapping:
- %KBV KBV_PR_MIO_CMR_Diagnostic_Report_U2_U3_Physical_Exam_Eyes|KBV_PR_MIO_CMR_Diagnostic_Report_U2_U3_Physical_Exam_Eyes%
- %KBV
- KBV_PR_MIO_CMR_Observation_U2_U3_Physical_Exam_Eyes|KBV_PR_MIO_CMR_Observation_U2_U3_Physical_Exam_Eyes%

Wert: Code

KONZEPT UND WIEDERGABENAMECODEBEZEICHNUNG IM CODE-SYSTEMCODE-SYSTEM
Inspektion: morphologische Auffälligkeiten (z. B. Ptosis, Leukokorie, Bulbusgrößenauffälligkeiten, Kolobom)737269000Eye appearance abnormal (finding)SNOMED CT®, 2021-01-31
Inspektion: Nystagmus307699005Nystagmus present (finding)SNOMED CT®, 2021-01-31
Prüfung im durchfallenden Licht: Transilluminationsauffälligkeit bei Trübung der brechenden Medien400964006Iris transillumination (finding)SNOMED CT®, 2021-01-31

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