PrescribeIT® Specification and Guide Version 5.0

 

The official URL for this extension is:

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

Status: draft
Extension maintained by:

Provides instructions specific to how the first fill of a prescription should be processed (if different from other fills)

Context of Use

This extension may be used on the following element(s):

  • {"type"=>"MedicationOrder.dispenseRequest"}

Usage info

Usage:

Download Excel representation

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

This structure is derived from Extension

NameCard.TypeConstraints and Usage
.  Extension 0..1ExtensionDefinition:
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.


Comments:
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.

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

..  extension
     (date)
0..1ExtensionDefinition:
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.


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

...  url 1..1uri"expiry"
...  value[x] 1..1dateexpiry-full: Must be at least a full date. i.e. yyyy-mm-dd
Definition:
First fill expiry date value.


Comments:
Conformance Rule: Must be a full date value.

..  extension
     (quantity)
0..1ExtensionDefinition:
Indicates the quantity that should be provided as part of the first dispense that is done against the prescription.


Comments:
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.

...  url 1..1uri"quantity"
...  value[x] 1..1PrescribeIT® Drug QuantityBinding: PrescribedQuantityUnit (20210308) (extensible)
qty-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).

..  extension
     (expectedSupplyDuration)
0..1ExtensionDefinition:
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.


Comments:
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'.

...  url 1..1uri"expectedSupplyDuration"
...  value[x] 1..1Durationqty-3: If a code for the unit is present, the system SHALL also be present
drt-1: 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.
Definition:
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.


Comments:
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'.

..  url 1..1uri"http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-first-fill"

This structure is derived from Extension

Summary

Mandatory: 1 element (6 nested mandatory elements)
Must-Support: 11 elements
Fixed Value: 4 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..1ExtensionFirst fill instructions
... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:date S0..1ExtensionDate to make first fill by
.... url S1..1uri"expiry"
.... value[x] SI1..1dateValue of extension
expiry-full: Must be at least a full date. i.e. yyyy-mm-dd
... extension:quantity S0..1ExtensionAmount of initial fill
.... url S1..1uri"quantity"
.... value[x] S1..1PrescribeIT® Drug QuantityQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
... extension:expectedSupplyDuration S0..1ExtensionDays supply for initial fill
.... url S1..1uri"expectedSupplyDuration"
.... value[x] S1..1DurationA length of time
... url S1..1uri"http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-first-fill"
... value[x] 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..1ExtensionFirst fill instructions
... id 0..1idxml:id (or equivalent in JSON)
... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:date S0..1ExtensionDate to make first fill by
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... url S1..1uri"expiry"
.... value[x] SI1..1dateValue of extension
expiry-full: Must be at least a full date. i.e. yyyy-mm-dd
... extension:quantity S0..1ExtensionAmount of initial fill
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... url S1..1uri"quantity"
.... value[x] SI1..1PrescribeIT® Drug QuantityQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
... extension:expectedSupplyDuration S0..1ExtensionDays supply for initial fill
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... url S1..1uri"expectedSupplyDuration"
.... value[x] SI1..1DurationA length of time
... url S1..1uri"http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-first-fill"

doco Documentation for this format

Grid View

This structure is derived from Extension

NameCard.TypeConstraints and Usage
.  Extension 0..1ExtensionDefinition:
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.


Comments:
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.

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

..  extension
     (date)
0..1ExtensionDefinition:
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.


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

...  url 1..1uri"expiry"
...  value[x] 1..1dateexpiry-full: Must be at least a full date. i.e. yyyy-mm-dd
Definition:
First fill expiry date value.


Comments:
Conformance Rule: Must be a full date value.

..  extension
     (quantity)
0..1ExtensionDefinition:
Indicates the quantity that should be provided as part of the first dispense that is done against the prescription.


Comments:
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.

...  url 1..1uri"quantity"
...  value[x] 1..1PrescribeIT® Drug QuantityBinding: PrescribedQuantityUnit (20210308) (extensible)
qty-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).

..  extension
     (expectedSupplyDuration)
0..1ExtensionDefinition:
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.


Comments:
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'.

...  url 1..1uri"expectedSupplyDuration"
...  value[x] 1..1Durationqty-3: If a code for the unit is present, the system SHALL also be present
drt-1: 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.
Definition:
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.


Comments:
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'.

..  url 1..1uri"http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-first-fill"

This structure is derived from Extension

Summary

Mandatory: 1 element (6 nested mandatory elements)
Must-Support: 11 elements
Fixed Value: 4 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..1ExtensionFirst fill instructions
... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:date S0..1ExtensionDate to make first fill by
.... url S1..1uri"expiry"
.... value[x] SI1..1dateValue of extension
expiry-full: Must be at least a full date. i.e. yyyy-mm-dd
... extension:quantity S0..1ExtensionAmount of initial fill
.... url S1..1uri"quantity"
.... value[x] S1..1PrescribeIT® Drug QuantityQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
... extension:expectedSupplyDuration S0..1ExtensionDays supply for initial fill
.... url S1..1uri"expectedSupplyDuration"
.... value[x] S1..1DurationA length of time
... url S1..1uri"http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-first-fill"
... value[x] 0..0

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..1ExtensionFirst fill instructions
... id 0..1idxml:id (or equivalent in JSON)
... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:date S0..1ExtensionDate to make first fill by
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... url S1..1uri"expiry"
.... value[x] SI1..1dateValue of extension
expiry-full: Must be at least a full date. i.e. yyyy-mm-dd
... extension:quantity S0..1ExtensionAmount of initial fill
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... url S1..1uri"quantity"
.... value[x] SI1..1PrescribeIT® Drug QuantityQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
... extension:expectedSupplyDuration S0..1ExtensionDays supply for initial fill
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... url S1..1uri"expectedSupplyDuration"
.... value[x] SI1..1DurationA length of time
... url S1..1uri"http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-first-fill"

doco Documentation for this format

 

Other representations of extension: Schematron

3.37.3 Terminology Bindings

Terminology Bindings

PathConformanceValueSet
Extension.extension:quantity.value[x]extensiblePrescribedQuantityUnit

Constraints

IdPathDetailsRequirements
expiry-fullExtension.extension:date.value[x]Must be at least a full date. i.e. yyyy-mm-dd
: length()>=10
qty-3Extension.extension:quantity.value[x]If a code for the unit is present, the system SHALL also be present
: code.empty() or system.exists()
sqty-1Extension.extension:quantity.value[x]The comparator is not used on a SimpleQuantity
: comparator.empty()
qty-3Extension.extension:expectedSupplyDuration.value[x]If a code for the unit is present, the system SHALL also be present
: code.empty() or system.exists()
drt-1Extension.extension:expectedSupplyDuration.value[x]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.
: (code.exists() or value.empty()) and (system.empty() or system = %ucum)