PrescribeIT™ Specification and Guide Version 2.0 Revision F

 

3.49 StructureDefinition: PrescribeIT Dispense

The official URL for this profile is: 

http://prescribeit.ca/fhir/StructureDefinition/profile-medicationdispense

3.49.1 Scope and Usage

An Excel spreadsheet providing guidance on how to populate dosage instructions can be found here.

3.49.2 Formal Views of Profile Content

Download Excel representation

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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This structure is derived from MedicationDispense

NameCard.TypeConstraints and Usage
.  MedicationDispense 0..*mdd-1: whenHandedOver cannot be before whenPrepared
Definition:
Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

..  id 1..1idDefinition:
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.


Comments:
Usage Note: This will usually be a GUID and is assigned by the sending application. Ideally it should be consistent for all messages referencing this same set of coverage information.

..  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

..  extension
     (renderedDosageInstruction) 		1..1Medication Rendered Dosage InstructionDefinition:
Provides a complete text rendering of the dosage instruction lines for an order or dispense (separate from the rendering of the overall resource instance)


Comments:
Conformance Rule: In the context of a dispense notification, this will be populated by the PMS and will reflect the directions as presented to the patient on the label. The rendered dosage instruction must contain all dosage instructions and must be able to stand on its own.

Conformance Rule: This field is made up of structured dosage information as well as patient instructions, assembled into one field and formatted as human-readable, meaning that codes should not be used (e.g. 'days' should be used instead of 'd').

Conformance Rule: Dosage quantity, dosage unit, dosage frequency, form, strength, max quantity per period,minimal interval between dispense, route of administration and where applicable, the administration site.

Note: Any additional patient instructions that are specified at the dosage line level (e.g. take with food, starting one day before dental appointment) should be included.

Conformance Rule: If a PMS sends discrete data elements they must also populate this with a textual view of the SIG. E.g. PO value for RouteofAdministration will be conveyed as 'oral' in this field.

..  extension
     (quantityRemaining) 		1..1Medication Dispense Quantity RemainingDefinition:
The total authorized quantity outstanding after the fill issued as part of this dispense record


Comments:
Should be specified even if 0.

..  identifier 1..1Shared Health IdentifierDefinition:
A technical identifier - identifies some entity uniquely and unambiguously.


Comments:
This is the identifier assigned by the pharmacy to a specific dispense. The system element will generally be an OID of the form [Vendor root].[Application instance node].4 expressed as a urn (e.g. urn:oid:1.2.3.4). The value will be the pharmacy-assigned dispense identifier.

..  status 1..1codeBinding: MedicationDispenseStatus (required)
Fixed Value: completed
Definition:
A code specifying the state of the set of dispense events.


Comments:
Fixed value: completed

..  medicationCodeableConcept 1..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionMedicinalProduct (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Conformance Rule: This element is used to represent the medication dispensed A 'code' (Canadian Clinical Drug Data Set, or DIN or NPN) must be accompanied by 'text' when dispensing. For compounds, a code is not used and the description will be sent as 'text'. A DIN or an NPN may also be used if an appropriate CCDD code is not yet available. This has an extensible binding meaning that the CCDD code system should be used but if a code is not available, vendors may also submit a code from the DIN or NPN code system. (Eventually CCDD will encompass all DINs and NPNs.)

     Code systems that are acceptable in the message are:
     CCDD - https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset
     DIN - http://hl7.org/fhir/NamingSystem/ca-hc-din
     NPN - http://hl7.org/fhir/NamingSystem/ca-hc-npn

      When sending CCDD codes, only the Manufactured Product (MP) or Device NTP codes should be used. In cases where a Canadian Clinical Drug Data Set value is not available within the PMS, the PMS can send a DIN or Natural Product Number (NPN).

     If no drug code (TM, NTP, MP, or DIN) is available in the EMR, only then should the EMR send the drug name as text without a code.

     The pharmacy system may use the drug coding (TM, NTP, MP, DIN, NPN or representative DIN) to display to the user the list of products that can be dispensed.
..  patient 1..1Reference(Shared Health Patient) {b}Definition:
A link to a resource representing the person to whom the medication will be given.


Comments:
SubstanceAdministration->subject->Patient.

...  reference 1..1stringDefinition:
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.


Comments:
This must point to the patient associated with the message

..  dispenser 1..1Reference(Practitioner) {b}Definition:
The individual responsible for dispensing the medication.


Comments:
Only organization (conveyed by the extension) is needed. No need to send the actual dispensing practitioner

...  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

...  extension
       (organization) 		1..1Reference Practitioner OrganizationDefinition:
Allows capturing the organization responsible for an action instead of or in addition to identifying the responsible practitioner


Comments:
For Shared Health purposes, only the pharmacy is relevant, not the dispensing pharmacist or technician. In the future, this should be supported directly by the resource.

..  authorizingPrescription 1..1Reference(PrescribeIT Prescription) {br}Definition:
Indicates the medication order that is being dispensed against.


Comments:
Conformance note: This must refer to the MedicationOrder being dispensed. Conformance Rule: If the MedicationOrder is included in the bundle (e.g. for a renewal request when sending the most recent dispense), use the 'reference' element and refer to the MedicationOrder.id. If the MedicationOrder is not included in the bundle (e.g. a Dispense Notification), use the extension to convey the business identifier of the prescription.

...  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

...  extension
       (identifier) 		1..1Referenced Requisition identifierDefinition:
Allows a reference to identify the target prescription, dispense or task by business identifier rather than URL


Comments:
Usage Note: This is used when the dispense is sent stand-alone.

....  url 1..1uri"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
....  valueIdentifier 1..1PrescribeIT™ Prescriber Prescription IdentifierDefinition:
A technical identifier - identifies some entity uniquely and unambiguously.


Comments:
When this is present, the reference is typically omitted

..  type 0..1Shared Health CodeableConcept CodeBinding: ActPharmacySupplyType (required)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Usage note: For future use

..  quantity 1..1PrescribeIT Drug Quantityqty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
Conformance Rule: Quantity is used throughout the messages. It may be a drug form (e.g. TAB) an administrable drug (e.g. PUFF) form or a unit of measure (e.g. mg). You must send the coding system and code.

..  daysSupply 1..1SimpleQuantityDefinition:
The number of days that the dispensed quantity is expected to last. Cannot be mandatory as there are some situations where 'as needed' cannot be used to determine days supply.


Comments:
Usage Note: There are some situations where this cannot be calculated, an estimated value will be used as drug plans will require this.(e.g. warfarin 1mg with take as directed dosing instructions)

...  value 1..1decimalDefinition:
The value of the measured amount. The value includes an implicit precision in the presentation of the value.


Comments:
The implicit precision in the value should always be honored.

...  system 1..1uriDefinition:
The identification of the system that provides the coded form of the unit.

...  code 1..1codeFixed Value: d
Definition:
A computer processable form of the unit in some unit representation system.


Comments:
Fixed value: d

..  whenPrepared 1..1dateTimeDefinition:
The time when the dispensed product was packaged and reviewed.


Comments:
This represents the date the medication was dispensed.

..  dosageInstruction 0..*BackboneElementDefinition:
Indicates how the medication is to be used by the patient. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.


Comments:
When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates.  Conformance Rule:  If PMS is able to support the structured dosage, they may do so but this is not mandatory

...  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

...  extension
       (sequence) 		1..1Medication Dosage Line SequenceDefinition:
Indicates the sequence of a particular dosage line within all dosage lines - equivalent to the repetition number of the dosage instruction element this extension is on.


Comments:
Conformance Rule: This must match the positional sequence of the dosageInstruction repetition. I.e. The first dosageInstruction repetition must have a 'sequence' value of 1, the second a 'sequence' value of 2, etc.

...  extension
       (instructionRelationship) 		0..1Medication Order Dosage Instruction RelationshipDefinition:
Indicates how the timing of this dosage instruction relates to the preceding dosage instruction. Specifically, is it concurrent (AND) or sequential (THEN).


Comments:
Conformance Rule: As this will establish the relationship to the previous dosage lines (example: first and second dosage line, the second and thrid dosage line, etc.) this must be present for all dosage lines except for the FIRST dosage line.

Usage Note: If THEN; is specified, there is typically a COMPLEX_ADMINISTRATION_PERIOD specified as well. These will be consecutive periods.

Conformance Rule: ANDs and THENs should not be mixed due to ambiguity of meaning

...  text 0..1stringDefinition:
A free form description of how the dispensed medication is to be administered to the patient.


Comments:
Conformance Rule: If supported by the PMS, multiple dosage lines can be expressed individually. However, they must be concatenated into the RENDERED_DOSAGE_INSTRUCTION as PMS will not be forced to support the receipt of individual lines.

Usage Note: This is a string that is typically composed of the route, duration, dose, frequency, per line.

Examples are: Prednisone, variable dosage instruction, or concurrent instructions (1 pill morning and 1 pill before bed) or sequential dosages (1 pill for 2 days, then 2 pills).

...  additionalInstructions 0..1Shared Health CodeableConcept TextBinding: (unbound) (example)
inv-1: Must have coding or text but not both
Definition:
A free form textual description of extended instruction regarding the administration of the drug.


Comments:
Conformance Rule: When providing an additional instruction at the dosage line level (complex), this should be populated when appropriate.

Usage Note: It may be necessary for the EMR to parse instructions such as QHS (take at bedtime), into two data elements DOSAGE_TIMING_FREQUENCY = once a day and 'at bedtime' would be placed into this field.

Usage Note: 'Coding' is not available, so 'Text' is expected to be used

HL7 MAPPING - ADDITIONAL_DOSAGE_INSTRUCTION (Business Name Change).

Conformance Rule: When text is present, this should contain the additional instructions.

Usage Note: At this time there is no known coding system. Therefore ‘text’ will be used.

Conformance Rule: Maximum character length set to ‘5000’.

....  coding 0..*CodingDefinition:
A reference to a code defined by a terminology system.


Comments:
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

.....  system 1..1uriDefinition:
The identification of the code system that defines the meaning of the symbol in the code.


Comments:
.....  code 1..1codeDefinition:
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

....  text 1..1stringMax Length: 5000
Definition:
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.


Comments:
Very often the text is the same as a displayName of one of the codings.

...  timing 0..1TimingDefinition:
A structure describing the frequency (how often the drug is to be administered), offset (elapse time between administrations) represented by one line of dosage administration instruction. Includes the overall time-period the dosage instruction applies.


Comments:
Conformance Rule: For EMRs that can support it, this should be specified. Must also be part of the COMPLEX_DOSAGE_INSTRUCTION

Conformance Rule: A start date may optionally be included. Refer to the Timing data type page for guidance on its use.

....  repeat 0..1Elementtim-3: Either frequency or when can exist, not both
tim-1: if there's a duration, there needs to be duration units
tim-2: if there's a period, there needs to be period units
tim-9: If there's an offset, there must be a when
tim-6: If there's a periodMax, there must be a period
tim-8: If there's a countMax, there must be a count
tim-7: If there's a durationMax, there must be a duration
tim-4: duration SHALL be a non-negative value
Definition:
A set of rules that describe when the event should occur.

.....  boundsPeriod 0..1PeriodDefinition:
Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.


Comments:
Conformance Rule: If MULTI_LINE_DOSAGE, this will be populated with the total duration of the ADMINISTRATIVE_PERIOD for each dosage line.

Conformance Rule: When providing a structured SIG, this should be populated when appropriate. This maps to Duration Must also be part of the COMPLEX_DOSAGE_INSTRUCTION

.....  count 0..1integerDefinition:
A total count of the desired number of repetitions.


Comments:
If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

.....  countMax 0..1integerDefinition:
A maximum value for the count of the desired repetitions (e.g. do something 6-8 times).

.....  duration 0..1decimalDefinition:
How long this thing happens for when it happens.


Comments:
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

.....  durationMax 0..1decimalDefinition:
The upper limit of how long this thing happens for when it happens.


Comments:
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

.....  durationUnit 0..1codeBinding: UnitsOfTime (required)
Definition:
The units of time for the duration, in UCUM units.

.....  frequency 0..1integerDefinition:
The number of times to repeat the action within the specified period / period range (i.e. both period and periodMax provided).

.....  frequencyMax 0..1integerDefinition:
If present, indicates that the frequency is a range - so repeat between [frequency] and [frequencyMax] times within the period or period range.

.....  period 0..1decimalDefinition:
Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period.

.....  periodMax 0..1decimalDefinition:
If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.

.....  periodUnit 0..1codeBinding: UnitsOfTime (required)
Definition:
The units of time for the period in UCUM units.

...  asNeeded[x] 0..1boolean, CodeableConceptBinding: (unbound) (example)
Definition:
Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept). Specifically if 'boolean' datatype is selected, then the following logic applies: If set to True, this indicates that the medication is only taken when needed, within the specified schedule.


Comments:
Conformance Rule: Set value = true.

Conformance Rule: When this is specified, it is not acceptable to express the quantity exclusively as a duration/DAYSSUPPLY. The DOSAGEQUANTITY must be set.

...  siteCodeableConcept 0..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionAdministrationSite (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Conformance Rule: When providing a structured SIG, this should be populated when appropriate. If not structured, this should be part of the SIG (RENDERED_DOSAGE_INSTRUCTION).

Also can be specified for COMPLEX

...  route 0..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionRouteOfAdministration (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Conformance Rule: Coding should be populated if a code is available. However, text is always required.

...  doseQuantity 0..1PrescribeIT Drug Quantity for Administrationqty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
Conformance Rule: Could be sent as part of the dosage instruction. OR for those PMSs that can support it, this should be specified.

This is quite pointless without the frequency.

Conformance Rule: This is NOT specified for COMPLEX.

...  rateRatio 0..1RatioDefinition:
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

...  maxDosePerPeriod 0..1RatioDefinition:
The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time, e.g. 1000mg in 24 hours.


Comments:
Conformance Rule: When providing a structured SIG, this should be populated when appropriate.

Also can be specified for COMPLEX

....  numerator 1..1PrescribeIT Drug Quantity for Administrationqty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
Usage Note: Quantity is used throughout the messages. It may be a drug form (e.g. TAB) an administrable drug (e.g. PUFF) form or a unit of measure (e.g. mg).

....  denominator 1..1Shared Health Quantityqty-3: If a code for the unit is present, the system SHALL also be present
Definition:
A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.


Comments:
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

This structure is derived from MedicationDispense

Summary

Mandatory: 18 elements (4 nested mandatory elements)
Must-Support: 51 elements
Fixed Value: 2 elements
Prohibited: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

This structure is derived from MedicationDispense

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense S0..*
... id S1..1id
... extension S0..*ExtensionSlice: Unordered, Open by value:url
... ext-medication-rendered-dosage S1..1stringRendered dosage
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
... ext-dispense-quantity-remaining S1..1PrescribeIT Drug QuantityTotal quantity remaining
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
... identifier S1..1Shared Health Identifier
... status S1..1codeFixed Value: completed
... medicationCodeableConcept S1..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionMedicinalProduct (extensible)
... patient S1..1Reference(Shared Health Patient) {b}
.... reference S1..1string
... dispenser S1..1Reference(Practitioner) {b}
.... extension S0..*ExtensionSlice: Unordered, Open by value:url
.... ext-reference-practitioner-org S1..1Reference(Shared Health - eRx Service Location) {b}Responsible organization
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
... authorizingPrescription S1..1Reference(PrescribeIT Prescription) {br}
.... extension S0..*ExtensionSlice: Unordered, Open by value:url
.... ext-reference-identifier S1..1Shared Health IdentifierReferenced identifier
URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
..... valueIdentifier S1..1PrescribeIT™ Prescriber Prescription IdentifierPrescriber's order number
... type S0..1Shared Health CodeableConcept CodeBinding: ActPharmacySupplyType (required)
... quantity S1..1PrescribeIT Drug Quantity
... daysSupply S1..1SimpleQuantity
.... value S1..1decimal
.... system S1..1uri
.... code S1..1codeFixed Value: d
... whenPrepared S1..1dateTime
... dosageInstruction S0..*BackboneElement
.... extension S0..*ExtensionSlice: Unordered, Open by value:url
.... ext-medication-dosageinstruction-sequence S1..1positiveIntDosage instruction sequence
URL: http://hl7.org/fhir/StructureDefinition/extension-Dosage.sequence profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence
.... ext-medicationorder-dosageinstruction-relationship S0..1code​AND | THEN
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
Binding: PrescriptionDosageInstructionLineRelationship (required)
.... text S0..1string
.... additionalInstructions S0..1Shared Health CodeableConcept Text
..... text S1..1stringMax Length: 5000
.... timing S0..1Timing
..... repeat S0..1Element
...... boundsPeriod S0..1Period
...... count S0..1integer
...... countMax S0..1integer
...... duration S0..1decimal
...... durationMax S0..1decimal
...... durationUnit S0..1code
...... frequency S0..1integer
...... frequencyMax S0..1integer
...... period S0..1decimal
...... periodMax S0..1decimal
...... periodUnit S0..1code
...... when 0..0
...... offset 0..0
.... asNeeded[x] S0..1boolean, CodeableConcept
.... siteCodeableConcept S0..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionAdministrationSite (extensible)
.... route S0..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionRouteOfAdministration (extensible)
.... doseQuantity S0..1PrescribeIT Drug Quantity for Administration
.... rateRatio S0..1Ratio
.... maxDosePerPeriod S0..1Ratio
..... numerator S1..1PrescribeIT Drug Quantity for Administration
..... denominator S1..1Shared Health Quantity

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense SΣI0..*Dispensing a medication to a named patient
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: http://tools.ietf.org/html/bcp47 (required)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... ext-medication-rendered-dosage S1..1stringRendered dosage
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
... ext-dispense-quantity-remaining S1..1PrescribeIT Drug QuantityTotal quantity remaining
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S1..1Shared Health IdentifierAn identifier intended for computation
... status ?!SΣ1..1codein-progress | on-hold | completed | entered-in-error | stopped
Binding: MedicationDispenseStatus (required)
Fixed Value: completed
... medicationCodeableConcept S1..1Shared Health CodeableConcept Required Text with optional code​Concept - reference to a terminology or just text
Binding: PrescriptionMedicinalProduct (extensible)
... patient SΣ1..1Reference(Shared Health Patient) {b}Who the dispense is for
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... reference SΣI1..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... dispenser SΣ1..1Reference(Practitioner) {b}Practitioner responsible for dispensing medication
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-practitioner-org S1..1Reference(Shared Health - eRx Service Location) {b}Responsible organization
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
.... reference ΣI0..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... authorizingPrescription SΣ1..1Reference(PrescribeIT Prescription) {br}Medication order that authorizes the dispense
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-identifier S1..1Shared Health IdentifierReferenced identifier
URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
..... id 0..1idxml:id (or equivalent in JSON)
..... url S1..1uri"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
..... valueIdentifier S1..1PrescribeIT™ Prescriber Prescription IdentifierPrescriber's order number
.... reference ΣI0..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... type S0..1Shared Health CodeableConcept CodeConcept - reference to a terminology or just text
Binding: ActPharmacySupplyType (required)
... quantity SI1..1PrescribeIT Drug QuantityQuantity of a medication
... daysSupply SΣ1..1SimpleQuantityAmount of medication expressed as a timing amount
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... value SΣ1..1decimalNumerical value (with implicit precision)
.... unit Σ0..1stringUnit representation
.... system SΣI1..1uriSystem that defines coded unit form
.... code SΣ1..1codeCoded form of the unit
Fixed Value: d
... whenPrepared SΣ1..1dateTimeDispense processing time
... whenHandedOver Σ0..1dateTimeWhen product was given out
... destination Σ0..1Reference(Location)Where the medication was sent
... receiver Σ0..*Reference(Patient | Practitioner)Who collected the medication
... note Σ0..*AnnotationInformation about the dispense
... dosageInstruction SΣ0..*BackboneElementMedicine administration instructions to the patient/caregiver
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-medication-dosageinstruction-sequence S1..1positiveIntDosage instruction sequence
URL: http://hl7.org/fhir/StructureDefinition/extension-Dosage.sequence profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence
.... ext-medicationorder-dosageinstruction-relationship S0..1code​AND | THEN
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
Binding: PrescriptionDosageInstructionLineRelationship (required)
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions SI0..1Shared Health CodeableConcept TextConcept - reference to a terminology or just text
Binding: (unbound) (example)
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... coding SΣ0..*CodingCode defined by a terminology system
...... id 0..1idxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... system SΣ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeSymbol in syntax defined by the system
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text SΣ1..1stringPlain text representation of the concept
Max Length: 5000
.... timing SΣ0..1TimingWhen medication should be administered
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... event Σ0..*dateTimeWhen the event occurs
..... repeat SΣI0..1ElementWhen the event is to occur
...... id 0..1idxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... boundsPeriod SΣ0..1PeriodLength/Range of lengths, or (Start and/or end) limits
...... count SΣ0..1integerNumber of times to repeat
...... countMax SΣ0..1integerMaximum number of times to repeat
...... duration SΣ0..1decimalHow long when it happens
...... durationMax SΣ0..1decimalHow long when it happens (Max)
...... durationUnit SΣ0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: UnitsOfTime (required)
...... frequency SΣ0..1integerEvent occurs frequency times per period
...... frequencyMax SΣ0..1integerEvent occurs up to frequencyMax times per period
...... period SΣ0..1decimalEvent occurs frequency times per period
...... periodMax SΣ0..1decimalUpper limit of period (3-4 hours)
...... periodUnit SΣ0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: UnitsOfTime (required)
..... code Σ0..1CodeableConceptQD | QOD | Q4H | Q6H | BID | TID | QID | AM | PM +
Binding: TimingAbbreviation (preferred)
.... asNeeded[x] SΣ0..1boolean, CodeableConceptTake "as needed" f(or x)
Binding: (unbound) (example)
.... siteCodeableConcept S0..1Shared Health CodeableConcept Required Text with optional code​Concept - reference to a terminology or just text
Binding: PrescriptionAdministrationSite (extensible)
.... route S0..1Shared Health CodeableConcept Required Text with optional code​Concept - reference to a terminology or just text
Binding: PrescriptionRouteOfAdministration (extensible)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: (unbound) (example)
.... doseQuantity SI0..1PrescribeIT Drug Quantity for AdministrationQuantity of a medication
.... rateRatio SΣ0..1RatioAmount of medication per unit of time
.... maxDosePerPeriod SΣ0..1RatioUpper limit on medication per unit of time
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... numerator SI1..1PrescribeIT Drug Quantity for AdministrationQuantity of a medication
..... denominator SI1..1Shared Health QuantityA measured or measurable amount
... substitution Σ0..1BackboneElementDeals with substitution of one medicine for another
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type Σ1..1CodeableConceptCode signifying whether a different drug was dispensed from what was prescribed
Binding: ActSubstanceAdminSubstitutionCode (example)
.... reason Σ0..*CodeableConceptWhy was substitution made
Binding: SubstanceAdminSubstitutionReason (example)
.... responsibleParty Σ0..*Reference(Practitioner)Who is responsible for the substitution

doco Documentation for this format

Grid View

This structure is derived from MedicationDispense

NameCard.TypeConstraints and Usage
.  MedicationDispense 0..*mdd-1: whenHandedOver cannot be before whenPrepared
Definition:
Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

..  id 1..1idDefinition:
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.


Comments:
Usage Note: This will usually be a GUID and is assigned by the sending application. Ideally it should be consistent for all messages referencing this same set of coverage information.

..  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

..  extension
     (renderedDosageInstruction) 		1..1Medication Rendered Dosage InstructionDefinition:
Provides a complete text rendering of the dosage instruction lines for an order or dispense (separate from the rendering of the overall resource instance)


Comments:
Conformance Rule: In the context of a dispense notification, this will be populated by the PMS and will reflect the directions as presented to the patient on the label. The rendered dosage instruction must contain all dosage instructions and must be able to stand on its own.

Conformance Rule: This field is made up of structured dosage information as well as patient instructions, assembled into one field and formatted as human-readable, meaning that codes should not be used (e.g. 'days' should be used instead of 'd').

Conformance Rule: Dosage quantity, dosage unit, dosage frequency, form, strength, max quantity per period,minimal interval between dispense, route of administration and where applicable, the administration site.

Note: Any additional patient instructions that are specified at the dosage line level (e.g. take with food, starting one day before dental appointment) should be included.

Conformance Rule: If a PMS sends discrete data elements they must also populate this with a textual view of the SIG. E.g. PO value for RouteofAdministration will be conveyed as 'oral' in this field.

..  extension
     (quantityRemaining) 		1..1Medication Dispense Quantity RemainingDefinition:
The total authorized quantity outstanding after the fill issued as part of this dispense record


Comments:
Should be specified even if 0.

..  identifier 1..1Shared Health IdentifierDefinition:
A technical identifier - identifies some entity uniquely and unambiguously.


Comments:
This is the identifier assigned by the pharmacy to a specific dispense. The system element will generally be an OID of the form [Vendor root].[Application instance node].4 expressed as a urn (e.g. urn:oid:1.2.3.4). The value will be the pharmacy-assigned dispense identifier.

..  status 1..1codeBinding: MedicationDispenseStatus (required)
Fixed Value: completed
Definition:
A code specifying the state of the set of dispense events.


Comments:
Fixed value: completed

..  medicationCodeableConcept 1..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionMedicinalProduct (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Conformance Rule: This element is used to represent the medication dispensed A 'code' (Canadian Clinical Drug Data Set, or DIN or NPN) must be accompanied by 'text' when dispensing. For compounds, a code is not used and the description will be sent as 'text'. A DIN or an NPN may also be used if an appropriate CCDD code is not yet available. This has an extensible binding meaning that the CCDD code system should be used but if a code is not available, vendors may also submit a code from the DIN or NPN code system. (Eventually CCDD will encompass all DINs and NPNs.)

     Code systems that are acceptable in the message are:
     CCDD - https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset
     DIN - http://hl7.org/fhir/NamingSystem/ca-hc-din
     NPN - http://hl7.org/fhir/NamingSystem/ca-hc-npn

      When sending CCDD codes, only the Manufactured Product (MP) or Device NTP codes should be used. In cases where a Canadian Clinical Drug Data Set value is not available within the PMS, the PMS can send a DIN or Natural Product Number (NPN).

     If no drug code (TM, NTP, MP, or DIN) is available in the EMR, only then should the EMR send the drug name as text without a code.

     The pharmacy system may use the drug coding (TM, NTP, MP, DIN, NPN or representative DIN) to display to the user the list of products that can be dispensed.
..  patient 1..1Reference(Shared Health Patient) {b}Definition:
A link to a resource representing the person to whom the medication will be given.


Comments:
SubstanceAdministration->subject->Patient.

...  reference 1..1stringDefinition:
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.


Comments:
This must point to the patient associated with the message

..  dispenser 1..1Reference(Practitioner) {b}Definition:
The individual responsible for dispensing the medication.


Comments:
Only organization (conveyed by the extension) is needed. No need to send the actual dispensing practitioner

...  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

...  extension
       (organization) 		1..1Reference Practitioner OrganizationDefinition:
Allows capturing the organization responsible for an action instead of or in addition to identifying the responsible practitioner


Comments:
For Shared Health purposes, only the pharmacy is relevant, not the dispensing pharmacist or technician. In the future, this should be supported directly by the resource.

..  authorizingPrescription 1..1Reference(PrescribeIT Prescription) {br}Definition:
Indicates the medication order that is being dispensed against.


Comments:
Conformance note: This must refer to the MedicationOrder being dispensed. Conformance Rule: If the MedicationOrder is included in the bundle (e.g. for a renewal request when sending the most recent dispense), use the 'reference' element and refer to the MedicationOrder.id. If the MedicationOrder is not included in the bundle (e.g. a Dispense Notification), use the extension to convey the business identifier of the prescription.

...  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

...  extension
       (identifier) 		1..1Referenced Requisition identifierDefinition:
Allows a reference to identify the target prescription, dispense or task by business identifier rather than URL


Comments:
Usage Note: This is used when the dispense is sent stand-alone.

....  url 1..1uri"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
....  valueIdentifier 1..1PrescribeIT™ Prescriber Prescription IdentifierDefinition:
A technical identifier - identifies some entity uniquely and unambiguously.


Comments:
When this is present, the reference is typically omitted

..  type 0..1Shared Health CodeableConcept CodeBinding: ActPharmacySupplyType (required)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Usage note: For future use

..  quantity 1..1PrescribeIT Drug Quantityqty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
Conformance Rule: Quantity is used throughout the messages. It may be a drug form (e.g. TAB) an administrable drug (e.g. PUFF) form or a unit of measure (e.g. mg). You must send the coding system and code.

..  daysSupply 1..1SimpleQuantityDefinition:
The number of days that the dispensed quantity is expected to last. Cannot be mandatory as there are some situations where 'as needed' cannot be used to determine days supply.


Comments:
Usage Note: There are some situations where this cannot be calculated, an estimated value will be used as drug plans will require this.(e.g. warfarin 1mg with take as directed dosing instructions)

...  value 1..1decimalDefinition:
The value of the measured amount. The value includes an implicit precision in the presentation of the value.


Comments:
The implicit precision in the value should always be honored.

...  system 1..1uriDefinition:
The identification of the system that provides the coded form of the unit.

...  code 1..1codeFixed Value: d
Definition:
A computer processable form of the unit in some unit representation system.


Comments:
Fixed value: d

..  whenPrepared 1..1dateTimeDefinition:
The time when the dispensed product was packaged and reviewed.


Comments:
This represents the date the medication was dispensed.

..  dosageInstruction 0..*BackboneElementDefinition:
Indicates how the medication is to be used by the patient. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.


Comments:
When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates.  Conformance Rule:  If PMS is able to support the structured dosage, they may do so but this is not mandatory

...  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

...  extension
       (sequence) 		1..1Medication Dosage Line SequenceDefinition:
Indicates the sequence of a particular dosage line within all dosage lines - equivalent to the repetition number of the dosage instruction element this extension is on.


Comments:
Conformance Rule: This must match the positional sequence of the dosageInstruction repetition. I.e. The first dosageInstruction repetition must have a 'sequence' value of 1, the second a 'sequence' value of 2, etc.

...  extension
       (instructionRelationship) 		0..1Medication Order Dosage Instruction RelationshipDefinition:
Indicates how the timing of this dosage instruction relates to the preceding dosage instruction. Specifically, is it concurrent (AND) or sequential (THEN).


Comments:
Conformance Rule: As this will establish the relationship to the previous dosage lines (example: first and second dosage line, the second and thrid dosage line, etc.) this must be present for all dosage lines except for the FIRST dosage line.

Usage Note: If THEN; is specified, there is typically a COMPLEX_ADMINISTRATION_PERIOD specified as well. These will be consecutive periods.

Conformance Rule: ANDs and THENs should not be mixed due to ambiguity of meaning

...  text 0..1stringDefinition:
A free form description of how the dispensed medication is to be administered to the patient.


Comments:
Conformance Rule: If supported by the PMS, multiple dosage lines can be expressed individually. However, they must be concatenated into the RENDERED_DOSAGE_INSTRUCTION as PMS will not be forced to support the receipt of individual lines.

Usage Note: This is a string that is typically composed of the route, duration, dose, frequency, per line.

Examples are: Prednisone, variable dosage instruction, or concurrent instructions (1 pill morning and 1 pill before bed) or sequential dosages (1 pill for 2 days, then 2 pills).

...  additionalInstructions 0..1Shared Health CodeableConcept TextBinding: (unbound) (example)
inv-1: Must have coding or text but not both
Definition:
A free form textual description of extended instruction regarding the administration of the drug.


Comments:
Conformance Rule: When providing an additional instruction at the dosage line level (complex), this should be populated when appropriate.

Usage Note: It may be necessary for the EMR to parse instructions such as QHS (take at bedtime), into two data elements DOSAGE_TIMING_FREQUENCY = once a day and 'at bedtime' would be placed into this field.

Usage Note: 'Coding' is not available, so 'Text' is expected to be used

HL7 MAPPING - ADDITIONAL_DOSAGE_INSTRUCTION (Business Name Change).

Conformance Rule: When text is present, this should contain the additional instructions.

Usage Note: At this time there is no known coding system. Therefore ‘text’ will be used.

Conformance Rule: Maximum character length set to ‘5000’.

....  coding 0..*CodingDefinition:
A reference to a code defined by a terminology system.


Comments:
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

.....  system 1..1uriDefinition:
The identification of the code system that defines the meaning of the symbol in the code.


Comments:
.....  code 1..1codeDefinition:
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

....  text 1..1stringMax Length: 5000
Definition:
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.


Comments:
Very often the text is the same as a displayName of one of the codings.

...  timing 0..1TimingDefinition:
A structure describing the frequency (how often the drug is to be administered), offset (elapse time between administrations) represented by one line of dosage administration instruction. Includes the overall time-period the dosage instruction applies.


Comments:
Conformance Rule: For EMRs that can support it, this should be specified. Must also be part of the COMPLEX_DOSAGE_INSTRUCTION

Conformance Rule: A start date may optionally be included. Refer to the Timing data type page for guidance on its use.

....  repeat 0..1Elementtim-3: Either frequency or when can exist, not both
tim-1: if there's a duration, there needs to be duration units
tim-2: if there's a period, there needs to be period units
tim-9: If there's an offset, there must be a when
tim-6: If there's a periodMax, there must be a period
tim-8: If there's a countMax, there must be a count
tim-7: If there's a durationMax, there must be a duration
tim-4: duration SHALL be a non-negative value
Definition:
A set of rules that describe when the event should occur.

.....  boundsPeriod 0..1PeriodDefinition:
Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.


Comments:
Conformance Rule: If MULTI_LINE_DOSAGE, this will be populated with the total duration of the ADMINISTRATIVE_PERIOD for each dosage line.

Conformance Rule: When providing a structured SIG, this should be populated when appropriate. This maps to Duration Must also be part of the COMPLEX_DOSAGE_INSTRUCTION

.....  count 0..1integerDefinition:
A total count of the desired number of repetitions.


Comments:
If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

.....  countMax 0..1integerDefinition:
A maximum value for the count of the desired repetitions (e.g. do something 6-8 times).

.....  duration 0..1decimalDefinition:
How long this thing happens for when it happens.


Comments:
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

.....  durationMax 0..1decimalDefinition:
The upper limit of how long this thing happens for when it happens.


Comments:
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

.....  durationUnit 0..1codeBinding: UnitsOfTime (required)
Definition:
The units of time for the duration, in UCUM units.

.....  frequency 0..1integerDefinition:
The number of times to repeat the action within the specified period / period range (i.e. both period and periodMax provided).

.....  frequencyMax 0..1integerDefinition:
If present, indicates that the frequency is a range - so repeat between [frequency] and [frequencyMax] times within the period or period range.

.....  period 0..1decimalDefinition:
Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period.

.....  periodMax 0..1decimalDefinition:
If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.

.....  periodUnit 0..1codeBinding: UnitsOfTime (required)
Definition:
The units of time for the period in UCUM units.

...  asNeeded[x] 0..1boolean, CodeableConceptBinding: (unbound) (example)
Definition:
Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept). Specifically if 'boolean' datatype is selected, then the following logic applies: If set to True, this indicates that the medication is only taken when needed, within the specified schedule.


Comments:
Conformance Rule: Set value = true.

Conformance Rule: When this is specified, it is not acceptable to express the quantity exclusively as a duration/DAYSSUPPLY. The DOSAGEQUANTITY must be set.

...  siteCodeableConcept 0..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionAdministrationSite (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Conformance Rule: When providing a structured SIG, this should be populated when appropriate. If not structured, this should be part of the SIG (RENDERED_DOSAGE_INSTRUCTION).

Also can be specified for COMPLEX

...  route 0..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionRouteOfAdministration (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Conformance Rule: Coding should be populated if a code is available. However, text is always required.

...  doseQuantity 0..1PrescribeIT Drug Quantity for Administrationqty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
Conformance Rule: Could be sent as part of the dosage instruction. OR for those PMSs that can support it, this should be specified.

This is quite pointless without the frequency.

Conformance Rule: This is NOT specified for COMPLEX.

...  rateRatio 0..1RatioDefinition:
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

...  maxDosePerPeriod 0..1RatioDefinition:
The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time, e.g. 1000mg in 24 hours.


Comments:
Conformance Rule: When providing a structured SIG, this should be populated when appropriate.

Also can be specified for COMPLEX

....  numerator 1..1PrescribeIT Drug Quantity for Administrationqty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
Usage Note: Quantity is used throughout the messages. It may be a drug form (e.g. TAB) an administrable drug (e.g. PUFF) form or a unit of measure (e.g. mg).

....  denominator 1..1Shared Health Quantityqty-3: If a code for the unit is present, the system SHALL also be present
Definition:
A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.


Comments:
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

This structure is derived from MedicationDispense

Summary

Mandatory: 18 elements (4 nested mandatory elements)
Must-Support: 51 elements
Fixed Value: 2 elements
Prohibited: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Differential View

This structure is derived from MedicationDispense

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense S0..*
... id S1..1id
... extension S0..*ExtensionSlice: Unordered, Open by value:url
... ext-medication-rendered-dosage S1..1stringRendered dosage
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
... ext-dispense-quantity-remaining S1..1PrescribeIT Drug QuantityTotal quantity remaining
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
... identifier S1..1Shared Health Identifier
... status S1..1codeFixed Value: completed
... medicationCodeableConcept S1..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionMedicinalProduct (extensible)
... patient S1..1Reference(Shared Health Patient) {b}
.... reference S1..1string
... dispenser S1..1Reference(Practitioner) {b}
.... extension S0..*ExtensionSlice: Unordered, Open by value:url
.... ext-reference-practitioner-org S1..1Reference(Shared Health - eRx Service Location) {b}Responsible organization
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
... authorizingPrescription S1..1Reference(PrescribeIT Prescription) {br}
.... extension S0..*ExtensionSlice: Unordered, Open by value:url
.... ext-reference-identifier S1..1Shared Health IdentifierReferenced identifier
URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
..... valueIdentifier S1..1PrescribeIT™ Prescriber Prescription IdentifierPrescriber's order number
... type S0..1Shared Health CodeableConcept CodeBinding: ActPharmacySupplyType (required)
... quantity S1..1PrescribeIT Drug Quantity
... daysSupply S1..1SimpleQuantity
.... value S1..1decimal
.... system S1..1uri
.... code S1..1codeFixed Value: d
... whenPrepared S1..1dateTime
... dosageInstruction S0..*BackboneElement
.... extension S0..*ExtensionSlice: Unordered, Open by value:url
.... ext-medication-dosageinstruction-sequence S1..1positiveIntDosage instruction sequence
URL: http://hl7.org/fhir/StructureDefinition/extension-Dosage.sequence profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence
.... ext-medicationorder-dosageinstruction-relationship S0..1code​AND | THEN
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
Binding: PrescriptionDosageInstructionLineRelationship (required)
.... text S0..1string
.... additionalInstructions S0..1Shared Health CodeableConcept Text
..... text S1..1stringMax Length: 5000
.... timing S0..1Timing
..... repeat S0..1Element
...... boundsPeriod S0..1Period
...... count S0..1integer
...... countMax S0..1integer
...... duration S0..1decimal
...... durationMax S0..1decimal
...... durationUnit S0..1code
...... frequency S0..1integer
...... frequencyMax S0..1integer
...... period S0..1decimal
...... periodMax S0..1decimal
...... periodUnit S0..1code
...... when 0..0
...... offset 0..0
.... asNeeded[x] S0..1boolean, CodeableConcept
.... siteCodeableConcept S0..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionAdministrationSite (extensible)
.... route S0..1Shared Health CodeableConcept Required Text with optional code​Binding: PrescriptionRouteOfAdministration (extensible)
.... doseQuantity S0..1PrescribeIT Drug Quantity for Administration
.... rateRatio S0..1Ratio
.... maxDosePerPeriod S0..1Ratio
..... numerator S1..1PrescribeIT Drug Quantity for Administration
..... denominator S1..1Shared Health Quantity

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense SΣI0..*Dispensing a medication to a named patient
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: http://tools.ietf.org/html/bcp47 (required)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... ext-medication-rendered-dosage S1..1stringRendered dosage
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
... ext-dispense-quantity-remaining S1..1PrescribeIT Drug QuantityTotal quantity remaining
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S1..1Shared Health IdentifierAn identifier intended for computation
... status ?!SΣ1..1codein-progress | on-hold | completed | entered-in-error | stopped
Binding: MedicationDispenseStatus (required)
Fixed Value: completed
... medicationCodeableConcept S1..1Shared Health CodeableConcept Required Text with optional code​Concept - reference to a terminology or just text
Binding: PrescriptionMedicinalProduct (extensible)
... patient SΣ1..1Reference(Shared Health Patient) {b}Who the dispense is for
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... reference SΣI1..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... dispenser SΣ1..1Reference(Practitioner) {b}Practitioner responsible for dispensing medication
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-practitioner-org S1..1Reference(Shared Health - eRx Service Location) {b}Responsible organization
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
.... reference ΣI0..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... authorizingPrescription SΣ1..1Reference(PrescribeIT Prescription) {br}Medication order that authorizes the dispense
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-identifier S1..1Shared Health IdentifierReferenced identifier
URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
..... id 0..1idxml:id (or equivalent in JSON)
..... url S1..1uri"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
..... valueIdentifier S1..1PrescribeIT™ Prescriber Prescription IdentifierPrescriber's order number
.... reference ΣI0..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... type S0..1Shared Health CodeableConcept CodeConcept - reference to a terminology or just text
Binding: ActPharmacySupplyType (required)
... quantity SI1..1PrescribeIT Drug QuantityQuantity of a medication
... daysSupply SΣ1..1SimpleQuantityAmount of medication expressed as a timing amount
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... value SΣ1..1decimalNumerical value (with implicit precision)
.... unit Σ0..1stringUnit representation
.... system SΣI1..1uriSystem that defines coded unit form
.... code SΣ1..1codeCoded form of the unit
Fixed Value: d
... whenPrepared SΣ1..1dateTimeDispense processing time
... whenHandedOver Σ0..1dateTimeWhen product was given out
... destination Σ0..1Reference(Location)Where the medication was sent
... receiver Σ0..*Reference(Patient | Practitioner)Who collected the medication
... note Σ0..*AnnotationInformation about the dispense
... dosageInstruction SΣ0..*BackboneElementMedicine administration instructions to the patient/caregiver
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-medication-dosageinstruction-sequence S1..1positiveIntDosage instruction sequence
URL: http://hl7.org/fhir/StructureDefinition/extension-Dosage.sequence profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence
.... ext-medicationorder-dosageinstruction-relationship S0..1code​AND | THEN
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
Binding: PrescriptionDosageInstructionLineRelationship (required)
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions SI0..1Shared Health CodeableConcept TextConcept - reference to a terminology or just text
Binding: (unbound) (example)
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... coding SΣ0..*CodingCode defined by a terminology system
...... id 0..1idxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... system SΣ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeSymbol in syntax defined by the system
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text SΣ1..1stringPlain text representation of the concept
Max Length: 5000
.... timing SΣ0..1TimingWhen medication should be administered
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... event Σ0..*dateTimeWhen the event occurs
..... repeat SΣI0..1ElementWhen the event is to occur
...... id 0..1idxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... boundsPeriod SΣ0..1PeriodLength/Range of lengths, or (Start and/or end) limits
...... count SΣ0..1integerNumber of times to repeat
...... countMax SΣ0..1integerMaximum number of times to repeat
...... duration SΣ0..1decimalHow long when it happens
...... durationMax SΣ0..1decimalHow long when it happens (Max)
...... durationUnit SΣ0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: UnitsOfTime (required)
...... frequency SΣ0..1integerEvent occurs frequency times per period
...... frequencyMax SΣ0..1integerEvent occurs up to frequencyMax times per period
...... period SΣ0..1decimalEvent occurs frequency times per period
...... periodMax SΣ0..1decimalUpper limit of period (3-4 hours)
...... periodUnit SΣ0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: UnitsOfTime (required)
..... code Σ0..1CodeableConceptQD | QOD | Q4H | Q6H | BID | TID | QID | AM | PM +
Binding: TimingAbbreviation (preferred)
.... asNeeded[x] SΣ0..1boolean, CodeableConceptTake "as needed" f(or x)
Binding: (unbound) (example)
.... siteCodeableConcept S0..1Shared Health CodeableConcept Required Text with optional code​Concept - reference to a terminology or just text
Binding: PrescriptionAdministrationSite (extensible)
.... route S0..1Shared Health CodeableConcept Required Text with optional code​Concept - reference to a terminology or just text
Binding: PrescriptionRouteOfAdministration (extensible)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: (unbound) (example)
.... doseQuantity SI0..1PrescribeIT Drug Quantity for AdministrationQuantity of a medication
.... rateRatio SΣ0..1RatioAmount of medication per unit of time
.... maxDosePerPeriod SΣ0..1RatioUpper limit on medication per unit of time
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... numerator SI1..1PrescribeIT Drug Quantity for AdministrationQuantity of a medication
..... denominator SI1..1Shared Health QuantityA measured or measurable amount
... substitution Σ0..1BackboneElementDeals with substitution of one medicine for another
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type Σ1..1CodeableConceptCode signifying whether a different drug was dispensed from what was prescribed
Binding: ActSubstanceAdminSubstitutionCode (example)
.... reason Σ0..*CodeableConceptWhy was substitution made
Binding: SubstanceAdminSubstitutionReason (example)
.... responsibleParty Σ0..*Reference(Practitioner)Who is responsible for the substitution

doco Documentation for this format

 

Other representations of profile: Schematron

3.49.3 Terminology Bindings

Terminology Bindings

PathNameConformanceValueSet
MedicationDispense.language?extrequiredhttp://tools.ietf.org/html/bcp47
MedicationDispense.statusMedicationDispenseStatusrequiredMedicationDispenseStatus
MedicationDispense.medicationCodeableConceptPrescriptionMedicinalProductextensible​PrescriptionMedicinalProduct
MedicationDispense.typeActPharmacySupplyTyperequiredActPharmacySupplyType
MedicationDispense.dosageInstruction.additionalInstructions?extexample
MedicationDispense.dosageInstruction.timing.repeat.durationUnitUnitsOfTimerequiredUnitsOfTime
MedicationDispense.dosageInstruction.timing.repeat.periodUnitUnitsOfTimerequiredUnitsOfTime
MedicationDispense.dosageInstruction.timing.codeTimingAbbreviationpreferredTimingAbbreviation
MedicationDispense.dosageInstruction.asNeeded[x]?extexample
MedicationDispense.dosageInstruction.siteCodeableConceptPrescriptionAdministrationSiteextensible​PrescriptionAdministrationSite
MedicationDispense.dosageInstruction.routePrescriptionRouteOfAdministrationextensible​PrescriptionRouteOfAdministration
MedicationDispense.dosageInstruction.method?extexample
MedicationDispense.substitution.typeActSubstanceAdminSubstitutionCodeexampleActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonSubstanceAdminSubstitutionReasonexampleSubstanceAdminSubstitutionReason

3.49.4 Constraints

Constraints

IdPathDetailsRequirements
mdd-1MedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
qty-3MedicationDispense.quantityIf a code for the unit is present, the system SHALL also be present
: code.empty() or system.exists()
sqty-1MedicationDispense.quantityThe comparator is not used on a SimpleQuantity
: comparator.empty()
inv-1MedicationDispense.dosageInstruction.additionalInstructionsMust have coding or text but not both
: coding.exists() xor text.exists()
tim-3MedicationDispense.dosageInstruction.timing.repeatEither frequency or when can exist, not both
: ((period or frequency) and when).not()
tim-1MedicationDispense.dosageInstruction.timing.repeatif there's a duration, there needs to be duration units
: duration.empty() or durationUnit.exists()
tim-2MedicationDispense.dosageInstruction.timing.repeatif there's a period, there needs to be period units
: period.empty() or periodUnit.exists()
tim-9MedicationDispense.dosageInstruction.timing.repeatIf there's an offset, there must be a when
: offset.empty() or when.exists()
tim-6MedicationDispense.dosageInstruction.timing.repeatIf there's a periodMax, there must be a period
: periodMax.empty() or period.exists()
tim-8MedicationDispense.dosageInstruction.timing.repeatIf there's a countMax, there must be a count
: countMax.empty() or count.exists()
tim-7MedicationDispense.dosageInstruction.timing.repeatIf there's a durationMax, there must be a duration
: durationMax.empty() or duration.exists()
tim-4MedicationDispense.dosageInstruction.timing.repeatduration SHALL be a non-negative value
: duration.exists() implies duration >= 0
qty-3MedicationDispense.dosageInstruction.doseQuantityIf a code for the unit is present, the system SHALL also be present
: code.empty() or system.exists()
sqty-1MedicationDispense.dosageInstruction.doseQuantityThe comparator is not used on a SimpleQuantity
: comparator.empty()
qty-3MedicationDispense.dosageInstruction.maxDosePerPeriod.numeratorIf a code for the unit is present, the system SHALL also be present
: code.empty() or system.exists()
sqty-1MedicationDispense.dosageInstruction.maxDosePerPeriod.numeratorThe comparator is not used on a SimpleQuantity
: comparator.empty()
qty-3MedicationDispense.dosageInstruction.maxDosePerPeriod.denominatorIf a code for the unit is present, the system SHALL also be present
: code.empty() or system.exists()