PrescribeIT® Specification and Guide Version 5.0

Provides specific instructions as to how the first fill of a prescription should be dispensed.

Usage Note: This is typically provided when the prescriber wants the patient to try a medication for short period of time in order to determine if the patient can tolerate the medication without issues or to determine whether the medication is effective prior to the patient receiving a larger supply that would be wasted if not tolerated or not effective. The first fill information should only be specified in the case of additional refills, where the quantity or expected supply duration of the refills differs from the first fill. If the first fill information is not provided, it means that the general dispenseRequest instructions related to the quantity or expected supply duration apply to all fills.

Conformance Rule: If entry of the first fill information is supported within the EMR as discrete information, this must be populated. For the first fill instructions to be meaningful, the first fill quantity or the first fill expected supply duration must be provided. Both can be provided if available but at minimum one of these must be provided.

unique id for the element within a resource (for internal references).

An Extension

• value @ url

Indicates the date by which the initial fill of the prescription must be made. If not dispensed on or before this date, no subsequent fills are permitted.

Conformance Rules: If the first fill expiry date concept is supported within the EMR as a discrete data element, this must be populated.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

Fixed value: expiry

First fill expiry date value.

Conformance Rule: Must be a full date value, time is not required unless it can be specified in EMR by the user.

Indicates the quantity that should be provided as part of the first dispense that is done against the prescription.

Allows a more limited quantity to be dispensed on the initial dispense to confirm the medication is tolerated and providing the desired effect before incurring the costs of a full fill.

Conformance Rule: The first fill quantity or the first fill expected supply duration must be provided. Both can be provided if available but at minimum one of these needs to be provided.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

Fixed value: quantity

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

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).

Indicates the number of days supply of the medication that should be provided as part of the first dispense that is done against the prescription.

Allows a more limited quantity to be dispensed on the initial dispense to confirm the medication is tolerated and providing the desired effect before incurring the costs of a full fill.

Conformance Rules: The first fill quantity or the first fill expected supply duration must be provided. Both can be provided if available but at minimum one of these needs to be provided.

Conformance Rule: When providing the first fill expected supply duration it must be expressed as a duration of time in days'.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

Fixed value: expectedSupplyDuration

There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.

Conformance Rule: The duration must be expressed as a ‘day(s)’ value and must be coded in the following way; code must be 'd' and system must be 'http://unitsofmeasure.org'.

Source of the definition for the extension code - a logical name or a URL.

Fixed value: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-first-fill

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).