Příloha č. 1
Datové rozhraní pro vyúčtování nákladných pojištěnců
1. Zdravotní pojišťovny provedou roční vyúčtování nákladné zdravotní péče podle § 21a odst. 10 zákona, za kterou má zdravotní pojišťovna nárok na úhradu 80 % částky o kterou nákladná péče překročí částku podle § 21a odst. 2 zákona v tomto datovém rozhraní:
kód zdravotní pojišťovny:
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rok:
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Oddíl I: Oddíl II (v Kč): Oddíl III (v Kč):
pořadí nákladného roční úhrada za nákladného nárokovaná částka na pojištěnce
pojištěnce pojištěnce podle § 21a odst. 2 podle § 21a odst. 3 zákona
zákona
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| 0 | 0 | 0 | 0 | 3 | | | | | | | | | | | | | | | | | | | | | | | | | | |
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| x | x | x | x | x | | | | | | | | | | | | | | | | | | | | | | | | | | |
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Celková částka za
zdravotní pojišťovnu
v Kč: +---+---+---+---+---+---+---+---+---+---+---+---+ +---+---+---+---+---+---+---+---+---+---+---+---+
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2. Součástí datového rozhraní je i datum pořízení a podpis oprávněné osoby a razítko příslušné zdravotní pojišťovny.
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