PrescribeIT® Specification and Guide Version 5.0


v5.0 of this specification has been superseded by v5.3. v5.3 is compatible but adds additional features for Quebec.

The version (Bundle.meta.tag:version) that is sent in the message will remain PrescribeIT5.0

 

Definitions for the profile-medicationorder-pms-rx-dispense Profile.

1. MedicationOrder
Definition

This represents the pharmacy prescription information that is being requested for renewal or is being included for informational purposes.

Control0..*
Must Supporttrue
Alternate NamesPrescription
Comments

If the prescription is for a medication that has been dispensed, the information will be populated using the details of the last dispense that is associated to the prescription and if the prescription has never been dispensed, the data must be populated using the details related to pharmacy prescription.

Max Length0
2. MedicationOrder.id
Definition

The technical id of the resource.

Control1..1
Typeid
Must Supporttrue
Comments

Usage Note: This is usually a GUID but can be any ID string value that is assigned by the sending application.

Max Length0
3. MedicationOrder.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Max Length0
4. MedicationOrder.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.

Max Length0
5. MedicationOrder.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHALL be taken from http://tools.ietf.org/html/bcp47 A human language.

Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Max Length0
6. MedicationOrder.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

Max Length0
7. MedicationOrder.contained
Definition

This will contain the medication details that is associated to the prescription or the last dispense of the prescription.

Usage: Provides context to the prescriber what medication the pharmacy is requesting.

Control1..1
TypeResource
Must Supporttrue
Alternate Namesinline resources, anonymous resources, contained resources
Comments

Conformance Rules: This will be used to contain the Medication resource. No other resources should be 'contained'.

The medication should be provided using a coded value that is either a DIN or NPN. CCDD can be used but it is not expected to be sent given the PMS processes prescriptions and dispenses using manufactured products that have DINs/NPNs. Representative DIN must never be used to describe the medication when providing this information as part of this profile.

For products that have no coding or a coding system that is not DIN, NPN or CCDD send only the medication name (medication.code.text).

The medication strength and product form should be sent as discreet data if known and its not already included as part of the medication name.

The product ingredient data does not need to be populated as it is for future use.

Max Length0
8. MedicationOrder.extension
Definition

An Extension

Control0..*
TypeExtension
Must Supporttrue
Max Length0
SlicingThis element introduces a set of slices on MedicationOrder.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
9. MedicationOrder.extension:category
SliceNamecategory
Definition

Sub-categorizes medication prescriptions into drugs, devices, compounds, etc. May be used to apply sub-type-specific constraints

Control0..1
TypeExtension(Medication Order Category) (Extension Type: CodeableConcept(Shared Health CodeableConcept Text))
Must Supporttrue
Comments

Usage Note: Can be omitted if not known or not captured properly in the PMS.

Max Length0
10. MedicationOrder.extension:dateLastDispense
SliceNamedateLastDispense
Definition

Identifies the date of the last dispense

Control0..1
TypeExtension(Medication Order Date of Last Dispense) (Extension Type: date)
Must Supporttrue
Comments

Usage Note: If the prescription has not been dispensed this will be omitted.

Max Length0
11. MedicationOrder.extension:daysSinceLastDispense
SliceNamedaysSinceLastDispense
Definition

The number of days since that has elapsed between the date of the last dispense and the date the renewal request is being sent.

Control0..1
TypeExtension(Medication Order Days Since Last Dispense) (Extension Type: Quantity(Duration))
Must Supporttrue
Comments

Usage Note: If the prescription has not been dispensed this will be omitted.

Max Length0
12. MedicationOrder.extension:renderedDosageInstruction
SliceNamerenderedDosageInstruction
Definition

This provides the full textual description of the directions for use as entered by the pharmacy on the dispense or prescription. This 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.

Control1..1
TypeExtension(Medication Rendered Dosage Instruction) (Extension Type: string)
Must Supporttrue
Requirements

Allows the provider to verify the codified structured dosage information entered and ensure that the exploded instruction is consistent with the intended instructions. Also useful in bringing back administration instructions on query responses. This is mandatory as dosage instructions must always be available in rendered form.

Comments

Usage Note: Allows the provider to verify and compare the directions for use with the original directions of use that was provided on the original prescription. This is particularly helpful when the pharmacy split the original order into multiple dispensed products.

Max Length0
13. MedicationOrder.extension:pharmacyInstructions
SliceNamepharmacyInstructions
Definition

Provides additional instructions from the prescriber to the pharmacy or other dispenser

Control0..1
TypeExtension(Request Dispenser Instructions) (Extension Type: string)
Must Supporttrue
Comments

Usage Note: Can provide additional information for example special authorization codes, no substitution indication, etc.

Max Length0
14. MedicationOrder.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

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.

Max Length0
15. MedicationOrder.identifier
Definition

A technical identifier - identifies some entity uniquely and unambiguously.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1
TypeIdentifier(Shared Health Identifier)
Must Supporttrue
Comments

These are the identifiers assigned by the EMR and, in some cases, by the DIS.

Max Length0
SlicingThis element introduces a set of slices on MedicationOrder.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
16. MedicationOrder.identifier:PMS-id
SliceNamePMS-id
Definition

A technical identifier - identifies some entity uniquely and unambiguously.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1
TypeIdentifier(PrescribeIT® Prescriber Prescription Identifier)
Must Supporttrue
Comments

This is the prescription identifier assigned by the PMS to the local prescription.

Max Length0
17. MedicationOrder.identifier:PMS-id.id
Definition

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

Control0..1
Typeid
Max Length0
18. MedicationOrder.identifier:PMS-id.extension
Definition

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
19. MedicationOrder.identifier:PMS-id.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Max Length0
20. MedicationOrder.identifier:PMS-id.type
Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Control1..1
BindingThe codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

TypeCodeableConcept(Shared Health CodeableConcept Code)
Must Supporttrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

-

Max Length0
Pattern Value<valueCodeableConcept xmlns="http://hl7.org/fhir">
  <coding>
    <system value="http://hl7.org/fhir/identifier-type"/>
    <code value="PLAC"/>
  </coding>
</valueCodeableConcept>
21. MedicationOrder.identifier:PMS-id.type.id
Definition

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

Control0..1
Typeid
Max Length0
22. MedicationOrder.identifier:PMS-id.type.extension
Definition

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
23. MedicationOrder.identifier:PMS-id.type.coding
Definition

A reference to a code defined by a terminology system.

Control1..*
TypeCoding
Must Supporttrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

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.

Max Length0
SlicingThis element introduces a set of slices on MedicationOrder.identifier.type.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
  • ,
  • value @ code
24. MedicationOrder.identifier:PMS-id.type.coding.id
Definition

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

Control0..1
Typeid
Max Length0
25. MedicationOrder.identifier:PMS-id.type.coding.extension
Definition

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
26. MedicationOrder.identifier:PMS-id.type.coding.system
Definition

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

Control1..1
Typeuri
Must Supporttrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

This is the URI that represents the coding system as defined within the binding.

Max Length0
27. MedicationOrder.identifier:PMS-id.type.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Max Length0
28. MedicationOrder.identifier:PMS-id.type.coding.code
Definition

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).

Control1..1
Typecode
Must Supporttrue
Requirements

Need to refer to a particular code in the system.

Comments

This is the code as defined within the binding.

Max Length0
29. MedicationOrder.identifier:PMS-id.type.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Max Length0
30. MedicationOrder.identifier:PMS-id.type.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Max Length0
31. MedicationOrder.identifier:PMS-id.type.coding:placer
SliceNameplacer
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Must Supporttrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

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.

Max Length0
32. MedicationOrder.identifier:PMS-id.type.coding:placer.id
Definition

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

Control0..1
Typeid
Max Length0
33. MedicationOrder.identifier:PMS-id.type.coding:placer.extension
Definition

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
34. MedicationOrder.identifier:PMS-id.type.coding:placer.system
Definition

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

Control1..1
Typeuri
Must Supporttrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

Fixed value: http://hl7.org/fhir/identifier-type

Max Length0
Fixed Valuehttp://hl7.org/fhir/identifier-type
35. MedicationOrder.identifier:PMS-id.type.coding:placer.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Max Length0
36. MedicationOrder.identifier:PMS-id.type.coding:placer.code
Definition

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).

Control1..1
Typecode
Must Supporttrue
Requirements

Need to refer to a particular code in the system.

Comments

Fixed value: PLAC

Max Length0
Fixed ValuePLAC
37. MedicationOrder.identifier:PMS-id.type.coding:placer.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Max Length0
38. MedicationOrder.identifier:PMS-id.type.coding:placer.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Max Length0
39. MedicationOrder.identifier:PMS-id.type.text
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.

Control0..1
Typestring
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

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

Max Length0
40. MedicationOrder.identifier:PMS-id.system
Definition

Establishes the namespace in which set of possible id values is unique.

Control1..1
Typeuri
Must Supporttrue
Requirements

There are many sequences of identifiers. To perform matching, we need to know what sequence we're dealing with. The system identifies a particular sequence or set of unique identifiers.

Comments

Conformance Rule: This must be an OID of the URI form [Vendor root].[Application instance node].2 (e.g. urn:oid:1.2.3.4). The branch, “.2” is appended to create a unique namespace for the Prescription Identifer

Max Length0
Example
General:http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
InvariantsDefined on this element
EMR-id-branch-2: This must be an OID ending in .2 (: $this.matches('^urn\\:oid\\:(\\d+\\.)+2$'))
41. MedicationOrder.identifier:PMS-id.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control1..1
Typestring
Must Supporttrue
Comments

Usage Rule: The business identifier that uniquely identifies a prescription.

Max Length0
Example
General:123456
42. MedicationOrder.identifier:PMS-id.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
Max Length0
43. MedicationOrder.identifier:PMS-id.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Max Length0
44. MedicationOrder.status
Definition

A code specifying the state of the order. Generally this will be active or completed state.

Control1..1
BindingThe codes SHALL be taken from MedicationOrderStatus A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

Typecode
Is Modifiertrue
Must Supporttrue
Comments

Fixed value: active

Max Length0
Fixed Valueactive
45. MedicationOrder.medication[x]
Definition

Identifies the medication being administered. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.

Control1..1
TypeReference
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. Note: do not use Medication.name to describe the prescribed medication. When the only available information is a text description of the medication, Medication.code.text should be used.

Max Length0
SlicingThis element introduces a set of slices on MedicationOrder.medication[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
46. MedicationOrder.medication[x]:medicationReference
SliceNamemedicationReference
Definition

A reference from one resource to another.

Control1..1
TypeReference(Shared Health Reference)(PrescribeIT® Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Comments

Usage Note: this is populated with the reference to the Medication resource pertaining to this Medication Order. It will point to the 'contained' Medication resource. E.g. <reference value='#med'/>

Max Length0
47. MedicationOrder.patient
Definition

A reference from one resource to another.

Control1..1
TypeReference(Shared Health Reference)(Shared Health Patient)
Must Supporttrue
Comments

Usage Note: This must reference the Patient.id.

Max Length0
48. MedicationOrder.encounter
Definition

A link to a resource that identifies the particular occurrence of contact between patient and health care provider.

Control0..1
TypeReference(Encounter)
Comments

SubstanceAdministration->component->EncounterEvent.

Max Length0
49. MedicationOrder.dateWritten
Definition

The date (and perhaps time) when the prescription was written.

Control1..1
TypedateTime
Must Supporttrue
Comments

Conformance Rule: Must be either equal to or earlier then the MedicationOrder.dispenseRequest.validityPeriod.start element. Must be either a full date (i.e. yyyy-mm-dd) or a full date and time with timezone (i.e. yyyy-mm-dd-HH:mm:ss.SSS-ZZZZZ).

Conformance Rule: Prescriptions sent within Alberta must support the full date time.

Max Length0
50. MedicationOrder.prescriber
Definition

The healthcare professional responsible for authorizing the prescription.

Control0..1
TypeReference(Practitioner)
Max Length0
51. MedicationOrder.reasonCode
Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Control0..5
BindingThe codes SHALL be taken from PrescriptionIndicationForUse (20190430); other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Required Text with optional code)
Must Supporttrue
Comments

Conformance Rule: In the case where the prescriber wants to send an Indication for Use that is not included in the value set the prescriber must be able to send a text value without a code.

Max Length0
52. MedicationOrder.reasonCode.id
Definition

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

Control0..1
Typeid
Max Length0
53. MedicationOrder.reasonCode.extension
Definition

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
54. MedicationOrder.reasonCode.coding
Definition

A reference to a code defined by a terminology system.

Control0..1
TypeCoding
Must Supporttrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

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.

Max Length0
55. MedicationOrder.reasonCode.coding.id
Definition

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

Control0..1
Typeid
Max Length0
56. MedicationOrder.reasonCode.coding.extension
Definition

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
57. MedicationOrder.reasonCode.coding.system
Definition

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

Control1..1
Typeuri
Must Supporttrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

This is the URI that represents the coding system as defined within the binding.

Max Length0
58. MedicationOrder.reasonCode.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Max Length0
59. MedicationOrder.reasonCode.coding.code
Definition

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).

Control1..1
Typecode
Must Supporttrue
Requirements

Need to refer to a particular code in the system.

Comments

This is the code as defined within the binding.

Max Length0
60. MedicationOrder.reasonCode.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Max Length0
61. MedicationOrder.reasonCode.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Max Length0
62. MedicationOrder.reasonCode.text
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.

Control1..1
Typestring
Must Supporttrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Usage Note: When conveying the reason, this must be populated

Max Length2500
63. MedicationOrder.reasonReference
Definition

Condition that supports why the prescription is being written.

Control0..*
TypeReference(Condition)
Max Length0
64. MedicationOrder.dateEnded
Definition

The date (and perhaps time) when the prescription was stopped.

Control0..1
TypedateTime
Max Length0
65. MedicationOrder.reasonEnded
Definition

The reason why the prescription was stopped, if it was.

Control0..1
Binding

Codes indicating why the medication was terminated; e.g. Adverse reaction, medication change, issue resolved, etc.

TypeCodeableConcept
Max Length0
66. MedicationOrder.note
Definition

Extra information about the prescription that could not be conveyed by the other attributes.

Control0..*
TypeAnnotation
Max Length0
67. MedicationOrder.dosageInstruction
Definition

Indicates how the medication is to be used by the patient.

Control0..*
TypeBackboneElement
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. Another common example in institutional settings is 'titration' of an IV medication dose to maintain a specific stated hemodynamic value or range e.g. drug x to be administered to maintain AM (arterial mean) greater than 65.

Max Length0
68. MedicationOrder.dosageInstruction.id
Definition

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

Control0..1
Typeid
Max Length0
69. MedicationOrder.dosageInstruction.extension
Definition

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
70. MedicationOrder.dosageInstruction.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Max Length0
71. MedicationOrder.dosageInstruction.text
Definition

Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.

Control0..1
Typestring
Max Length0
72. MedicationOrder.dosageInstruction.additionalInstructions
Definition

Additional instructions such as "Swallow with plenty of water" which may or may not be coded.

Control0..1
Binding

Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

TypeCodeableConcept
Max Length0
73. MedicationOrder.dosageInstruction.timing
Definition

The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013".

Control0..1
TypeTiming
Comments

This attribute may not always be populated while the DosageInstruction.text is expected to be populated. If both are populated, then the DosageInstruction.text should reflect the content of the Dosage.timing.

Max Length0
74. MedicationOrder.dosageInstruction.asNeeded[x]
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).

Control0..1
Binding

A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

TypeChoice of: boolean, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

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.

Max Length0
75. MedicationOrder.dosageInstruction.site[x]
Definition

A coded specification of the anatomic site where the medication first enters the body.

Control0..1
BindingFor example codes, see SNOMED CT Anatomical Structure for Administration Site Codes A coded concept describing the site location the medicine enters into or onto the body.

TypeChoice of: CodeableConcept, Reference(BodySite)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Max Length0
76. MedicationOrder.dosageInstruction.route
Definition

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

Control0..1
BindingFor example codes, see SNOMED CT Route Codes A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

TypeCodeableConcept
Max Length0
77. MedicationOrder.dosageInstruction.method
Definition

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

Control0..1
Binding

A coded concept describing the technique by which the medicine is administered.

TypeCodeableConcept
Comments

Terminologies used often pre-coordinate this term with the route and or form of administration.

Max Length0
78. MedicationOrder.dosageInstruction.dose[x]
Definition

The amount of therapeutic or other substance given at one administration event.

Control0..1
TypeChoice of: Range, Quantity(SimpleQuantity)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

Max Length0
79. MedicationOrder.dosageInstruction.rate[x]
Definition

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.

Control0..1
TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationOrder with an updated rate, or captured with a new MedicationOrder with the new rate.

Max Length0
80. MedicationOrder.dosageInstruction.maxDosePerPeriod
Definition

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

Control0..1
TypeRatio
Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

Max Length0
81. MedicationOrder.dispenseRequest
Definition

Indicates the specific details around the quantity and duration that is associated to the dispense or the prescription.

Control1..1
TypeBackboneElement
Must Supporttrue
Max Length0
82. MedicationOrder.dispenseRequest.id
Definition

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

Control0..1
Typeid
Max Length0
83. MedicationOrder.dispenseRequest.extension
Definition

An Extension

Control0..*
TypeExtension
Must Supporttrue
Max Length0
SlicingThis element introduces a set of slices on MedicationOrder.dispenseRequest.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
84. MedicationOrder.dispenseRequest.extension:dispenseInterval
SliceNamedispenseInterval
Definition

Indicates the minimum period of time that must pass between dispensing events as recorded against the dispense or prescription.

Control0..1
TypeExtension(Medication Order Dispense Interval) (Extension Type: Quantity(Duration))
Must Supporttrue
Comments

Indicates the minimum period of time that must pass between dispensing events.

Conformance Rule: Only days are currently support as a measurement of dispenseInterval.

Max Length0
85. MedicationOrder.dispenseRequest.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Max Length0
86. MedicationOrder.dispenseRequest.medication[x]
Definition

Identifies the medication being administered. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.

Control0..1
TypeChoice of: CodeableConcept, Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.

Max Length0
87. MedicationOrder.dispenseRequest.validityPeriod
Definition

This indicates the validity period of a prescription (stale dating the Prescription).

Control0..1
TypePeriod
Requirements

Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Comments

It reflects the prescriber perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.

Max Length0
88. MedicationOrder.dispenseRequest.numberOfRepeatsAllowed
Definition

An integer indicating the number of additional times (aka refills or repeats) the patient can receive the prescribed medication. Usage Notes: This integer does NOT include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.

Control0..1
TypepositiveInt
Comments

If displaying "number of authorized refills", subtract 1 from this number.

Max Length0
89. MedicationOrder.dispenseRequest.quantity
Definition

This will provide the details of how much quantity was dispensed or is suppose to be dispense as part of one fill.

Control1..1
BindingThe codes SHALL be taken from PrescribedQuantityUnit (20210308); other codes may be used where these codes are not suitable
TypeQuantity(PrescribeIT® Drug Quantity)
Must Supporttrue
Comments

Conformance Rule: Must always to be populated with either the quantity associated to the dispense or the quantity of one fill that is recorded against the prescription.

Max Length0
InvariantsDefined on this element
qty-3: If a code for the unit is present, the system SHALL also be present (: code.empty() or system.exists())
sqty-1: The comparator is not used on a SimpleQuantity (: comparator.empty())
90. MedicationOrder.dispenseRequest.expectedSupplyDuration
Definition

The number of days that the dispensed quantity is expected to last.

Control1..1
TypeQuantity(Duration)
Must Supporttrue
Comments

Conformance Rule: Must always to be populated with either the days supply value associated to the dispense or the days supply value of one fill that is recorded against the prescription.

Max Length0
91. MedicationOrder.dispenseRequest.expectedSupplyDuration.id
Definition

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

Control0..1
Typeid
Max Length0
92. MedicationOrder.dispenseRequest.expectedSupplyDuration.extension
Definition

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
93. MedicationOrder.dispenseRequest.expectedSupplyDuration.value
Definition

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

Control1..1
Typedecimal
Must Supporttrue
Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

A decimal duration value is allowed (i.e. 1.5 days).

Max Length0
94. MedicationOrder.dispenseRequest.expectedSupplyDuration.comparator
Definition

How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

Control0..0
BindingThe codes SHALL be taken from QuantityComparator How the Quantity should be understood and represented.

Typecode
Is Modifiertrue
Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Comments

This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

Max Length0
Meaning if MissingIf there is no comparator, then there is no modification of the value
95. MedicationOrder.dispenseRequest.expectedSupplyDuration.unit
Definition

A human-readable form of the unit.

Control0..1
Typestring
Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Max Length0
96. MedicationOrder.dispenseRequest.expectedSupplyDuration.system
Definition

The identification of the system that provides the coded form of the unit.

Control1..1 This element is affected by the following invariants: qty-3
Typeuri
Must Supporttrue
Requirements

Need to know the system that defines the coded form of the unit.

Comments

Fixed value: http://unitsofmeasure.org

Max Length0
Fixed Valuehttp://unitsofmeasure.org
97. MedicationOrder.dispenseRequest.expectedSupplyDuration.code
Definition

A computer processable form of the unit in some unit representation system.

Control1..1
Typecode
Must Supporttrue
Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

Fixed value: d

Max Length0
Fixed Valued
98. MedicationOrder.substitution
Definition

Indicates whether or not substitution can or should be part of the dispense. In some cases substitution must happen, in other cases substitution must not happen, and in others it does not matter. This block explains the prescriber's intent. If nothing is specified substitution may be done.

Control0..1
TypeBackboneElement
Max Length0
99. MedicationOrder.substitution.id
Definition

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

Control0..1
Typeid
Max Length0
100. MedicationOrder.substitution.extension
Definition

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
101. MedicationOrder.substitution.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Max Length0
102. MedicationOrder.substitution.type
Definition

A code signifying whether a different drug should be dispensed from what was prescribed.

Control1..1
BindingFor example codes, see ActSubstanceAdminSubstitutionCode A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

TypeCodeableConcept
Max Length0
103. MedicationOrder.substitution.reason
Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Control0..1
BindingFor example codes, see SubstanceAdminSubstitutionReason A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

TypeCodeableConcept
Max Length0
104. MedicationOrder.priorPrescription
Definition

A link to a resource representing an earlier order or prescription that this order supersedes.

Control0..1
TypeReference(MedicationOrder)
Max Length0