DA050 - Send erklæring eller meddelelse om erhvervssygdom
Artikel 38 i forordning (EF) nr. 883/2004 og artikel 36, stk. 1 og 2, i forordning (EF) nr. 987/2009
SED API version: 0.16.2 build 2
Model version: 4.2.0
Person
*
[ SC ]
Identifikation af personen
*
[ CC ]
Efternavn(e)
*
[ BDT ]
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
Fornavn(e)
*
[ BDT ]
{{metaSection.forename.$$error}}
{{metaSection.forename.$$warning}}
Fødselsdato
*
[ BDT ]
{{metaSection.dateBirth.$$error}}
{{metaSection.dateBirth.$$warning}}
Køn
*
{{option.name}}
[ ENUM ]
{{metaSection.sex.$$error}}
{{metaSection.sex.$$warning}}
Efternavn(e) ved fødslen
[ BDT ]
{{metaSection.familyNameAtBirth.$$error}}
{{metaSection.familyNameAtBirth.$$warning}}
Fornavn(e) ved fødslen
[ BDT ]
{{metaSection.forenameAtBirth.$$error}}
{{metaSection.forenameAtBirth.$$warning}}
PIN for personen i hver institution
[ CC ]
Personlige identifikationsnumre
*
[ CC ]
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Personligt identifikationsnummer (PIN)
*
[ BDT ]
{{metaSection.personalIdentificationNumber.$$error}}
{{metaSection.personalIdentificationNumber.$$warning}}
Sektor
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.sector.$$error}}
{{metaSection.sector.$$warning}}
Institution
[ CC ]
Institutions-ID
*
[ BDT ]
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Institutionens navn
*
[ CDT ]
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
Hvis der ikke er oplyst PIN fra hver institution, fremsend den venligst
[ CC ]
Fødested
[ CC ]
By
*
[ CDT ]
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Region
[ CDT ]
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Faderens efternavn ved fødslen
[ BDT ]
{{metaSection.fatherFamilyNameAtBirth.$$error}}
{{metaSection.fatherFamilyNameAtBirth.$$warning}}
Faderens fornavn
[ BDT ]
{{metaSection.forenameFather.$$error}}
{{metaSection.forenameFather.$$warning}}
Moderens efternavn ved fødslen
[ BDT ]
{{metaSection.motherFamilyNameAtBirth.$$error}}
{{metaSection.motherFamilyNameAtBirth.$$warning}}
Moderens fornavn
[ BDT ]
{{metaSection.forenameMother.$$error}}
{{metaSection.forenameMother.$$warning}}
Yderligere oplysninger om personen
[ SC ]
Statsborgerskab
[ ENUM ]
{{metaSection.nationality.$$error}}
{{metaSection.nationality.$$warning}}
Tidligere efternavn(e)
[ BDT ]
{{metaSection.previousFamilyName.$$error}}
{{metaSection.previousFamilyName.$$warning}}
Tidligere fornavn(e)
[ BDT ]
{{metaSection.previousForename.$$error}}
{{metaSection.previousForename.$$warning}}
Personens adresser
[ SC ]
Personens adresse
[ SC ]
Adresse
[ CC ]
Gade
[ CDT ]
{{metaSection.street.$$error}}
{{metaSection.street.$$warning}}
Navn på bygning
[ CDT ]
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
By
*
[ CDT ]
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Postnummer
[ CDT ]
{{metaSection.postalCode.$$error}}
{{metaSection.postalCode.$$warning}}
Region
[ CDT ]
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Adressetype
{{option.name}}
[ ENUM ]
{{metaSection.typeAddress.$$error}}
{{metaSection.typeAddress.$$warning}}
Dette SED vedrører en erhvervssygdom
*
[ SC ]
Dato
*
[ BDT ]
{{metaSection.date.$$error}}
{{metaSection.date.$$warning}}
Kode
[ CDT ]
{{metaSection.code.$$error}}
{{metaSection.code.$$warning}}
Kodningssystem
[ CDT ]
{{metaSection.codingSystem.$$error}}
{{metaSection.codingSystem.$$warning}}
Beskrivelse
*
[ CDT ]
{{metaSection.description.$$error}}
{{metaSection.description.$$warning}}
Personens status
{{option.name}}
[ ENUM ]
{{metaSection.statusPerson.$$error}}
{{metaSection.statusPerson.$$warning}}
Hvis "Personens status" = "Andet", udfyldes følgende:
[ SC ]
Personens status (hvis "Andet")
[ CDT ]
{{metaSection.statusPersonIfOther.$$error}}
{{metaSection.statusPersonIfOther.$$warning}}
Arbejdsgiver(e)
[ SC ]
Arbejdsgiver
[ CC ]
Navn
*
[ CDT ]
{{metaSection.name.$$error}}
{{metaSection.name.$$warning}}
Identifikationsnumre
[ CC ]
Identifikationsnummer
[ CC ]
Nummer
*
[ CDT ]
{{metaSection.number.$$error}}
{{metaSection.number.$$warning}}
Type
*
{{option.name}}
[ ENUM ]
{{metaSection.type.$$error}}
{{metaSection.type.$$warning}}
Adresse
[ CC ]
Gade
[ CDT ]
{{metaSection.street.$$error}}
{{metaSection.street.$$warning}}
Navn på bygning
[ CDT ]
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
By
*
[ CDT ]
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Postnummer
[ CDT ]
{{metaSection.postalCode.$$error}}
{{metaSection.postalCode.$$warning}}
Region
[ CDT ]
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Oplysning om eksponeringsperioder
*
[ SED ]
Oplysning om eksponeringsperioder
*
[ SED ]
Arbejdsgiver
*
[ CC ]
Navn
*
[ CDT ]
{{metaSection.name.$$error}}
{{metaSection.name.$$warning}}
Identifikationsnumre
[ CC ]
Identifikationsnummer
[ CC ]
Nummer
*
[ CDT ]
{{metaSection.number.$$error}}
{{metaSection.number.$$warning}}
Type
*
{{option.name}}
[ ENUM ]
{{metaSection.type.$$error}}
{{metaSection.type.$$warning}}
Adresse
[ CC ]
Gade
[ CDT ]
{{metaSection.street.$$error}}
{{metaSection.street.$$warning}}
Navn på bygning
[ CDT ]
{{metaSection.buildingName.$$error}}
{{metaSection.buildingName.$$warning}}
By
*
[ CDT ]
{{metaSection.town.$$error}}
{{metaSection.town.$$warning}}
Postnummer
[ CDT ]
{{metaSection.postalCode.$$error}}
{{metaSection.postalCode.$$warning}}
Region
[ CDT ]
{{metaSection.region.$$error}}
{{metaSection.region.$$warning}}
Land
*
{{$select.selected[ 'name']}}
[ ENUM ]
{{metaSection.country.$$error}}
{{metaSection.country.$$warning}}
Årsagssammenhæng
{{option.name}}
[ ENUM ]
{{metaSection.causalLinkIndicator.$$error}}
{{metaSection.causalLinkIndicator.$$warning}}
Beskæftigelsesperiode
[ CC ]
Fast periode
*
[ CC ]
Åben periode
*
[ CC ]
Startdato
*
[ BDT ]
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
Slutdato
*
[ BDT ]
{{metaSection.endDate.$$error}}
{{metaSection.endDate.$$warning}}
Type af åben periode
*
{{option.name}}
[ ENUM ]
{{metaSection.typeOpenPeriod.$$error}}
{{metaSection.typeOpenPeriod.$$warning}}
Startdato
*
[ BDT ]
{{metaSection.startDate.$$error}}
{{metaSection.startDate.$$warning}}
Beskrivelse af det udførte job
*
[ CDT ]
{{metaSection.descriptionJobPerformed.$$error}}
{{metaSection.descriptionJobPerformed.$$warning}}
Yderligere oplysninger
[ SC ]
Yderligere oplysninger
[ CDT ]
{{metaSection.additionalInformation.$$error}}
{{metaSection.additionalInformation.$$warning}}