PrescribeIT® Specification and Guide Version 5.0

 

The official URL for this profile is:

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

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

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..*MedicationDispensemdd-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.

..  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 be an OID of the form [Vendor root].[Application instance node].4 expressed as a uri (e.g. urn:oid:1.2.3.4). The value element will be the pharmacy-assigned dispense identifier.

...  system 1..1uridispenseIdentifier-branch-4: This must be an OID ending in .4
Example' General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
Definition:
Establishes the namespace in which set of possible id values is unique.


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, “.4” is appended to create a unique namespace for the Pharmacy-assigned dispense identifier.

...  value 1..1stringExample' General': 123456
Definition:
The portion of the identifier typically relevant to the user and which is unique within the context of the system.


Comments:
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

..  status 1..1codeBinding: MedicationDispenseStatus (required): A code specifying the state of the dispense event.


Fixed Value: completed
Definition:
A code specifying the state of the set of dispense events.


Comments:
Fixed value: completed

..  medication[x]
     (medicationCodeableConcept)
1..1Shared Health CodeableConcept Required Text with optional codeBinding: 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:
Usage Note: This segment provides the medication order that the dispense is associated with.

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

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


Comments:
This provides the medication order identifier that the dispense is associated with.



Usage Note: In the context of p160 and p200, PMS's will populate this identifier value with the appropriate value.



Usage Note: In the context of p200, EMR's need to use this value to find the corresponding medication order in their local system in order to associate the incoming dispense it to.



Usage in the context of p160, EMR's can use either this value or the medicationOrder.identifier (emr-id) to find the corresponding medication order in their local system which is related to the medication order which is asking to be renewed.

....  url 1..1uri"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
....  value[x] 1..1PrescribeIT® Prescriber Prescription IdentifierSlice: Unordered, Closed by type:$this
Definition:
A technical identifier - identifies some entity uniquely and unambiguously.


Comments:
In the context of a p200 this will represent the mediation order identifier of the original electronic prescription (e110, e120, e162, e163, e180) which the dispense is associated with.



In the context of a p160 this will represent either the mediation order identifier of the original electronic prescription (e110, e120, e162, e163, e180) which is the dispense is associated with or it will be the pharmacies own medication order identifier when the dispense is associated with a previous non-electronic order (i.e. paper or fax).



Usage Note: EMR's should use the identifier.system and identifier.value to determine whether medication order relates to an order within the local application. The identifier.system value represents the application (application instance id) that assigned the identifier and identifier.value represents the actual medication order value. When the system value does NOT match the local application then this identifier was assigned by another application and should be treated like a non-electronic (i.e. paper or fax) order. When the system value matches the local application then this identifier was assigned by this application and the system should then proceed to find the value. If the value cannot be found it should be treated like a non-electronic (i.e. paper or fax) order. Only when both the system and value match a local medication order can the application treat it as a electronic medication order.

...  reference 0..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:
If the MedicationOrder is included in the bundle (e.g. p160 Renewal Request when sending the most recent dispense), this reference can be provide which points to the medication order resource found in the same bundle. This reference is optional and can be omitted.



Conformance Rule: When providing this reference it must be the same as the Task.subject reference value.

..  type 0..1Shared Health CodeableConcept CodeBinding: ActPharmacySupplyType (20210501) (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 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:
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 Text RequiredBinding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery"


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.



HL7 MAPPING - ADDITIONAL_DOSAGE_INSTRUCTION (Business Name Change).

....  text 1..1stringMax Length: 2500
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:
Conformance Rule: This is the text used to convey the exact word that was displayed to the practitioner

...  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.

....  event 0..1dateTimeDefinition:
Identifies specific times when the event occurs.

....  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.

.....  bounds[x] 0..1Period, Shared Health Duration, RangeDefinition:
boundsPeriod defines the start and/or end date of the period over which the specified instruction should take place for a given dosage line. For example, if the prescriber wants a patient to start taking the medication starting the day before surgery, and the surgery is scheduled for Feb 16th 2019, the start date within bounds period would be Feb 15 2019. The end date can be included if the prescriber wants the patient to stop medication after a certain number of days. In the example above lets say the prescriber wants to the patient to stop the medication after 10 days the end date would Feb 26 2019.



boundsQuantity defines the amount a time that the patient should be taking the specified instruction for a given dosage line. As an example, a prescription may call for taking 1-2 pills per day for 10 days. The boundsQuantity would be 10 days.



boundsRange defines a minimum and maximum amount of time that the patient should be taking the specified instruction for a given dosage line. As an example, a prescriber may indicate that a patient should apply a cream 2 times per day for a minimum of 10 days but if the rash persists, continue applying for up to 14 days. In this case the minimum for boundsRange would be 10 days and the maximum for boundsRange would be 14 days.

.....  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: x_TimeUnitsOfMeasure (20210501) (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: x_TimeUnitsOfMeasure (20210501) (required)
Definition:
The units of time for the period in UCUM units.

...  asNeeded[x] 0..1boolean, CodeableConceptBinding: (unbound) (example): 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.


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.

...  site[x]
       (siteCodeableConcept)
0..1Shared Health CodeableConcept Required Text with optional codeBinding: PrescriptionAdministrationSite (20190430) (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 codeBinding: PrescriptionRouteOfAdministration (20190415) (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.

...  dose[x] 0..1PrescribeIT® Drug Quantity for Administration, PrescribeIT® Drug RangeBinding: PrescriptionDoseQuantityUnit (20210308) (extensible)
Definition:
The amount of therapeutic or other substance given at one administration event.


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

...  rate[x]
       (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 AdministrationBinding: 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).

....  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: 19 elements (4 nested mandatory elements)
Must-Support: 54 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..*MedicationDispenseDispensing a medication to a named patient
... id S1..1idLogical id of this artifact
... 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
Binding: PrescribedQuantityUnit (20210308) (extensible)
... identifier S1..1Shared Health IdentifierAn identifier intended for computation
.... system SI1..1uriThe namespace for the identifier
dispenseIdentifier-branch-4: This must be an OID ending in .4
... status S1..1codein-progress | on-hold | completed | entered-in-error | stopped
Fixed Value: completed
... medicationCodeableConcept S1..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionMedicinalProduct (extensible)
... patient S1..1Reference(Shared Health Patient) {b}Who the dispense is for
.... reference S1..1stringRelative, internal or absolute URL reference
... dispenser S1..1Reference(Practitioner) {b}Practitioner responsible for dispensing medication
.... 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
... authorizingPrescription S1..1Reference(PrescribeIT® Prescription) {br}Medication order that authorizes the dispense
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-identifier S1..1IdentifierReferenced identifier
URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
..... value[x] S1..1PrescribeIT® Prescriber Prescription IdentifierPrescriber's order number
.... reference S0..1stringRelative, internal or absolute URL reference
... type S0..1Shared Health CodeableConcept CodeConcept - reference to a terminology or just text
Binding: ActPharmacySupplyType (20210501) (required)
... quantity S1..1PrescribeIT® Drug QuantityQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
... daysSupply S1..1SimpleQuantityAmount of medication expressed as a timing amount
.... value S1..1decimalNumerical value (with implicit precision)
.... system S1..1uriSystem that defines coded unit form
.... code S1..1codeCoded form of the unit
Fixed Value: d
... whenPrepared S1..1dateTimeDispense processing time
... dosageInstruction S0..*BackboneElementMedicine administration instructions to the patient/caregiver
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-medication-dosageinstruction-sequence S1..1integerDosage 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..1codeAND | THEN
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
Binding: PrescriptionDosageInstructionLineRelationship (20170626) (required)
.... text S0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions S0..1Shared Health CodeableConcept Text RequiredConcept - reference to a terminology or just text
..... text S1..1stringPlain text representation of the concept
.... timing S0..1TimingWhen medication should be administered
..... event S0..1dateTimeWhen the event occurs
..... repeat S0..1ElementWhen the event is to occur
...... bounds[x] S0..1Length/Range of lengths, or (Start and/or end) limits
....... boundsPeriodPeriod
....... boundsQuantityQuantity(Shared Health Duration)
....... boundsRangeRange
...... count S0..1integerNumber of times to repeat
...... countMax S0..1integerMaximum number of times to repeat
...... duration S0..1decimalHow long when it happens
...... durationMax S0..1decimalHow long when it happens (Max)
...... durationUnit S0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: x_TimeUnitsOfMeasure (20210501) (required)
...... frequency S0..1integerEvent occurs frequency times per period
...... frequencyMax S0..1integerEvent occurs up to frequencyMax times per period
...... period S0..1decimalEvent occurs frequency times per period
...... periodMax S0..1decimalUpper limit of period (3-4 hours)
...... periodUnit S0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: x_TimeUnitsOfMeasure (20210501) (required)
...... when 0..0
...... offset 0..0
.... asNeeded[x] S0..1boolean, CodeableConceptTake "as needed" f(or x)
.... siteCodeableConcept S0..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionAdministrationSite (20190430) (extensible)
.... route S0..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionRouteOfAdministration (20190415) (extensible)
.... dose[x] S0..1Amount of medication per dose
Binding: PrescriptionDoseQuantityUnit (20210308) (extensible)
..... doseQuantityQuantity(PrescribeIT® Drug Quantity for Administration)
..... doseRangeRange(PrescribeIT® Drug Range)
.... rateRatio S0..1RatioAmount of medication per unit of time
.... maxDosePerPeriod S0..1RatioUpper limit on medication per unit of time
..... numerator S1..1PrescribeIT® Drug Quantity for AdministrationQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
..... denominator S1..1Shared Health QuantityA measured or measurable amount

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense SΣI0..*MedicationDispenseDispensing 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): A human language.


... text 0..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
Binding: PrescribedQuantityUnit (20210308) (extensible)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S1..1Shared Health IdentifierAn identifier intended for computation
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣI1..1uriThe namespace for the identifier
dispenseIdentifier-branch-4: This must be an OID ending in .4
Example General: http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
.... value SΣ1..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codein-progress | on-hold | completed | entered-in-error | stopped
Binding: MedicationDispenseStatus (required): A code specifying the state of the dispense event.


Fixed Value: completed
... medication[x] Σ1..1(Slice Definition)What medication was supplied
Slice: Unordered, Closed by type:$this
.... medication[x]:medicationCodeableConcept S1..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionMedicinalProduct (extensible)
... patient SΣ1..1Reference(Shared Health Patient) {b}Who the dispense is for
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... reference SΣI1..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... dispenser SΣ1..1Reference(Practitioner) {b}Practitioner responsible for dispensing medication
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-practitioner-org S1..1Reference(Shared Health - eRx Service Location) {b}Responsible organization
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
.... reference ΣI0..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... authorizingPrescription SΣ1..1Reference(PrescribeIT® Prescription) {br}Medication order that authorizes the dispense
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-identifier S1..1IdentifierReferenced identifier
URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
..... id 0..1idxml:id (or equivalent in JSON)
..... url S1..1uri"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
..... value[x] S1..1(Slice Definition)Prescriber's order number
Slice: Unordered, Closed by type:$this
...... value[x]:valueIdentifier 1..1IdentifierValue of extension
.... reference SΣI0..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 (20210501) (required)
... quantity SI1..1PrescribeIT® Drug QuantityQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
... 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..1integerDosage 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..1codeAND | THEN
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
Binding: PrescriptionDosageInstructionLineRelationship (20170626) (required)
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions S0..1Shared Health CodeableConcept Text RequiredConcept - reference to a terminology or just text
Binding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery"

..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... coding Σ0..*CodingCode defined by a terminology system
..... text SΣ1..1stringPlain text representation of the concept
Max Length: 2500
.... timing SΣ0..1TimingWhen medication should be administered
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... event SΣ0..1dateTimeWhen 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
...... bounds[x] SΣ0..1Length/Range of lengths, or (Start and/or end) limits
....... boundsPeriodPeriod
....... boundsQuantityQuantity(Shared Health Duration)
....... boundsRangeRange
...... 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: x_TimeUnitsOfMeasure (20210501) (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: x_TimeUnitsOfMeasure (20210501) (required)
..... code Σ0..1CodeableConceptQD | QOD | Q4H | Q6H | BID | TID | QID | AM | PM +
Binding: TimingAbbreviation (preferred): Code for a known / defined timing pattern.

.... asNeeded[x] SΣ0..1Take "as needed" f(or x)
Binding: (unbound) (example): 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.

..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site[x] Σ0..1(Slice Definition)Body site to administer to
Slice: Unordered, Closed by type:$this
Binding: SNOMED CT Anatomical Structure for Administration Site Codes (example): A coded concept describing the site location the medicine enters into or onto the body

..... site[x]:siteCodeableConcept S0..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionAdministrationSite (20190430) (extensible)
.... route S0..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionRouteOfAdministration (20190415) (extensible)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: (unbound) (example): A coded concept describing the technique by which the medicine is administered

.... dose[x] SΣ0..1Amount of medication per dose
Binding: PrescriptionDoseQuantityUnit (20210308) (extensible)
..... doseQuantityQuantity(PrescribeIT® Drug Quantity for Administration)
..... doseRangeRange(PrescribeIT® Drug Range)
.... rate[x] Σ0..1(Slice Definition)Amount of medication per unit of time
Slice: Unordered, Closed by type:$this
..... rate[x]: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
Binding: PrescribedQuantityUnit (20210308) (extensible)
..... 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): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription

.... reason Σ0..*CodeableConceptWhy was substitution made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed


.... 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..*MedicationDispensemdd-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.

..  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 be an OID of the form [Vendor root].[Application instance node].4 expressed as a uri (e.g. urn:oid:1.2.3.4). The value element will be the pharmacy-assigned dispense identifier.

...  system 1..1uridispenseIdentifier-branch-4: This must be an OID ending in .4
Example' General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
Definition:
Establishes the namespace in which set of possible id values is unique.


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, “.4” is appended to create a unique namespace for the Pharmacy-assigned dispense identifier.

...  value 1..1stringExample' General': 123456
Definition:
The portion of the identifier typically relevant to the user and which is unique within the context of the system.


Comments:
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

..  status 1..1codeBinding: MedicationDispenseStatus (required): A code specifying the state of the dispense event.


Fixed Value: completed
Definition:
A code specifying the state of the set of dispense events.


Comments:
Fixed value: completed

..  medication[x]
     (medicationCodeableConcept)
1..1Shared Health CodeableConcept Required Text with optional codeBinding: 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:
Usage Note: This segment provides the medication order that the dispense is associated with.

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

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


Comments:
This provides the medication order identifier that the dispense is associated with.



Usage Note: In the context of p160 and p200, PMS's will populate this identifier value with the appropriate value.



Usage Note: In the context of p200, EMR's need to use this value to find the corresponding medication order in their local system in order to associate the incoming dispense it to.



Usage in the context of p160, EMR's can use either this value or the medicationOrder.identifier (emr-id) to find the corresponding medication order in their local system which is related to the medication order which is asking to be renewed.

....  url 1..1uri"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
....  value[x] 1..1PrescribeIT® Prescriber Prescription IdentifierSlice: Unordered, Closed by type:$this
Definition:
A technical identifier - identifies some entity uniquely and unambiguously.


Comments:
In the context of a p200 this will represent the mediation order identifier of the original electronic prescription (e110, e120, e162, e163, e180) which the dispense is associated with.



In the context of a p160 this will represent either the mediation order identifier of the original electronic prescription (e110, e120, e162, e163, e180) which is the dispense is associated with or it will be the pharmacies own medication order identifier when the dispense is associated with a previous non-electronic order (i.e. paper or fax).



Usage Note: EMR's should use the identifier.system and identifier.value to determine whether medication order relates to an order within the local application. The identifier.system value represents the application (application instance id) that assigned the identifier and identifier.value represents the actual medication order value. When the system value does NOT match the local application then this identifier was assigned by another application and should be treated like a non-electronic (i.e. paper or fax) order. When the system value matches the local application then this identifier was assigned by this application and the system should then proceed to find the value. If the value cannot be found it should be treated like a non-electronic (i.e. paper or fax) order. Only when both the system and value match a local medication order can the application treat it as a electronic medication order.

...  reference 0..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:
If the MedicationOrder is included in the bundle (e.g. p160 Renewal Request when sending the most recent dispense), this reference can be provide which points to the medication order resource found in the same bundle. This reference is optional and can be omitted.



Conformance Rule: When providing this reference it must be the same as the Task.subject reference value.

..  type 0..1Shared Health CodeableConcept CodeBinding: ActPharmacySupplyType (20210501) (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 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:
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 Text RequiredBinding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery"


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.



HL7 MAPPING - ADDITIONAL_DOSAGE_INSTRUCTION (Business Name Change).

....  text 1..1stringMax Length: 2500
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:
Conformance Rule: This is the text used to convey the exact word that was displayed to the practitioner

...  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.

....  event 0..1dateTimeDefinition:
Identifies specific times when the event occurs.

....  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.

.....  bounds[x] 0..1Period, Shared Health Duration, RangeDefinition:
boundsPeriod defines the start and/or end date of the period over which the specified instruction should take place for a given dosage line. For example, if the prescriber wants a patient to start taking the medication starting the day before surgery, and the surgery is scheduled for Feb 16th 2019, the start date within bounds period would be Feb 15 2019. The end date can be included if the prescriber wants the patient to stop medication after a certain number of days. In the example above lets say the prescriber wants to the patient to stop the medication after 10 days the end date would Feb 26 2019.



boundsQuantity defines the amount a time that the patient should be taking the specified instruction for a given dosage line. As an example, a prescription may call for taking 1-2 pills per day for 10 days. The boundsQuantity would be 10 days.



boundsRange defines a minimum and maximum amount of time that the patient should be taking the specified instruction for a given dosage line. As an example, a prescriber may indicate that a patient should apply a cream 2 times per day for a minimum of 10 days but if the rash persists, continue applying for up to 14 days. In this case the minimum for boundsRange would be 10 days and the maximum for boundsRange would be 14 days.

.....  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: x_TimeUnitsOfMeasure (20210501) (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: x_TimeUnitsOfMeasure (20210501) (required)
Definition:
The units of time for the period in UCUM units.

...  asNeeded[x] 0..1boolean, CodeableConceptBinding: (unbound) (example): 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.


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.

...  site[x]
       (siteCodeableConcept)
0..1Shared Health CodeableConcept Required Text with optional codeBinding: PrescriptionAdministrationSite (20190430) (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 codeBinding: PrescriptionRouteOfAdministration (20190415) (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.

...  dose[x] 0..1PrescribeIT® Drug Quantity for Administration, PrescribeIT® Drug RangeBinding: PrescriptionDoseQuantityUnit (20210308) (extensible)
Definition:
The amount of therapeutic or other substance given at one administration event.


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

...  rate[x]
       (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 AdministrationBinding: 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).

....  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: 19 elements (4 nested mandatory elements)
Must-Support: 54 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..*MedicationDispenseDispensing a medication to a named patient
... id S1..1idLogical id of this artifact
... 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
Binding: PrescribedQuantityUnit (20210308) (extensible)
... identifier S1..1Shared Health IdentifierAn identifier intended for computation
.... system SI1..1uriThe namespace for the identifier
dispenseIdentifier-branch-4: This must be an OID ending in .4
... status S1..1codein-progress | on-hold | completed | entered-in-error | stopped
Fixed Value: completed
... medicationCodeableConcept S1..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionMedicinalProduct (extensible)
... patient S1..1Reference(Shared Health Patient) {b}Who the dispense is for
.... reference S1..1stringRelative, internal or absolute URL reference
... dispenser S1..1Reference(Practitioner) {b}Practitioner responsible for dispensing medication
.... 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
... authorizingPrescription S1..1Reference(PrescribeIT® Prescription) {br}Medication order that authorizes the dispense
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-identifier S1..1IdentifierReferenced identifier
URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
..... value[x] S1..1PrescribeIT® Prescriber Prescription IdentifierPrescriber's order number
.... reference S0..1stringRelative, internal or absolute URL reference
... type S0..1Shared Health CodeableConcept CodeConcept - reference to a terminology or just text
Binding: ActPharmacySupplyType (20210501) (required)
... quantity S1..1PrescribeIT® Drug QuantityQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
... daysSupply S1..1SimpleQuantityAmount of medication expressed as a timing amount
.... value S1..1decimalNumerical value (with implicit precision)
.... system S1..1uriSystem that defines coded unit form
.... code S1..1codeCoded form of the unit
Fixed Value: d
... whenPrepared S1..1dateTimeDispense processing time
... dosageInstruction S0..*BackboneElementMedicine administration instructions to the patient/caregiver
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-medication-dosageinstruction-sequence S1..1integerDosage 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..1codeAND | THEN
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
Binding: PrescriptionDosageInstructionLineRelationship (20170626) (required)
.... text S0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions S0..1Shared Health CodeableConcept Text RequiredConcept - reference to a terminology or just text
..... text S1..1stringPlain text representation of the concept
.... timing S0..1TimingWhen medication should be administered
..... event S0..1dateTimeWhen the event occurs
..... repeat S0..1ElementWhen the event is to occur
...... bounds[x] S0..1Length/Range of lengths, or (Start and/or end) limits
....... boundsPeriodPeriod
....... boundsQuantityQuantity(Shared Health Duration)
....... boundsRangeRange
...... count S0..1integerNumber of times to repeat
...... countMax S0..1integerMaximum number of times to repeat
...... duration S0..1decimalHow long when it happens
...... durationMax S0..1decimalHow long when it happens (Max)
...... durationUnit S0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: x_TimeUnitsOfMeasure (20210501) (required)
...... frequency S0..1integerEvent occurs frequency times per period
...... frequencyMax S0..1integerEvent occurs up to frequencyMax times per period
...... period S0..1decimalEvent occurs frequency times per period
...... periodMax S0..1decimalUpper limit of period (3-4 hours)
...... periodUnit S0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: x_TimeUnitsOfMeasure (20210501) (required)
...... when 0..0
...... offset 0..0
.... asNeeded[x] S0..1boolean, CodeableConceptTake "as needed" f(or x)
.... siteCodeableConcept S0..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionAdministrationSite (20190430) (extensible)
.... route S0..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionRouteOfAdministration (20190415) (extensible)
.... dose[x] S0..1Amount of medication per dose
Binding: PrescriptionDoseQuantityUnit (20210308) (extensible)
..... doseQuantityQuantity(PrescribeIT® Drug Quantity for Administration)
..... doseRangeRange(PrescribeIT® Drug Range)
.... rateRatio S0..1RatioAmount of medication per unit of time
.... maxDosePerPeriod S0..1RatioUpper limit on medication per unit of time
..... numerator S1..1PrescribeIT® Drug Quantity for AdministrationQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
..... denominator S1..1Shared Health QuantityA measured or measurable amount

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense SΣI0..*MedicationDispenseDispensing 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): A human language.


... text 0..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
Binding: PrescribedQuantityUnit (20210308) (extensible)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S1..1Shared Health IdentifierAn identifier intended for computation
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣI1..1uriThe namespace for the identifier
dispenseIdentifier-branch-4: This must be an OID ending in .4
Example General: http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
.... value SΣ1..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codein-progress | on-hold | completed | entered-in-error | stopped
Binding: MedicationDispenseStatus (required): A code specifying the state of the dispense event.


Fixed Value: completed
... medication[x] Σ1..1(Slice Definition)What medication was supplied
Slice: Unordered, Closed by type:$this
.... medication[x]:medicationCodeableConcept S1..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionMedicinalProduct (extensible)
... patient SΣ1..1Reference(Shared Health Patient) {b}Who the dispense is for
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... reference SΣI1..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... dispenser SΣ1..1Reference(Practitioner) {b}Practitioner responsible for dispensing medication
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-practitioner-org S1..1Reference(Shared Health - eRx Service Location) {b}Responsible organization
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
.... reference ΣI0..1stringRelative, internal or absolute URL reference
.... display Σ0..1stringText alternative for the resource
... authorizingPrescription SΣ1..1Reference(PrescribeIT® Prescription) {br}Medication order that authorizes the dispense
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-identifier S1..1IdentifierReferenced identifier
URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
..... id 0..1idxml:id (or equivalent in JSON)
..... url S1..1uri"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
..... value[x] S1..1(Slice Definition)Prescriber's order number
Slice: Unordered, Closed by type:$this
...... value[x]:valueIdentifier 1..1IdentifierValue of extension
.... reference SΣI0..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 (20210501) (required)
... quantity SI1..1PrescribeIT® Drug QuantityQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
... 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..1integerDosage 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..1codeAND | THEN
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
Binding: PrescriptionDosageInstructionLineRelationship (20170626) (required)
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions S0..1Shared Health CodeableConcept Text RequiredConcept - reference to a terminology or just text
Binding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery"

..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... coding Σ0..*CodingCode defined by a terminology system
..... text SΣ1..1stringPlain text representation of the concept
Max Length: 2500
.... timing SΣ0..1TimingWhen medication should be administered
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... event SΣ0..1dateTimeWhen 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
...... bounds[x] SΣ0..1Length/Range of lengths, or (Start and/or end) limits
....... boundsPeriodPeriod
....... boundsQuantityQuantity(Shared Health Duration)
....... boundsRangeRange
...... 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: x_TimeUnitsOfMeasure (20210501) (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: x_TimeUnitsOfMeasure (20210501) (required)
..... code Σ0..1CodeableConceptQD | QOD | Q4H | Q6H | BID | TID | QID | AM | PM +
Binding: TimingAbbreviation (preferred): Code for a known / defined timing pattern.

.... asNeeded[x] SΣ0..1Take "as needed" f(or x)
Binding: (unbound) (example): 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.

..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site[x] Σ0..1(Slice Definition)Body site to administer to
Slice: Unordered, Closed by type:$this
Binding: SNOMED CT Anatomical Structure for Administration Site Codes (example): A coded concept describing the site location the medicine enters into or onto the body

..... site[x]:siteCodeableConcept S0..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionAdministrationSite (20190430) (extensible)
.... route S0..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionRouteOfAdministration (20190415) (extensible)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: (unbound) (example): A coded concept describing the technique by which the medicine is administered

.... dose[x] SΣ0..1Amount of medication per dose
Binding: PrescriptionDoseQuantityUnit (20210308) (extensible)
..... doseQuantityQuantity(PrescribeIT® Drug Quantity for Administration)
..... doseRangeRange(PrescribeIT® Drug Range)
.... rate[x] Σ0..1(Slice Definition)Amount of medication per unit of time
Slice: Unordered, Closed by type:$this
..... rate[x]: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
Binding: PrescribedQuantityUnit (20210308) (extensible)
..... 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): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription

.... reason Σ0..*CodeableConceptWhy was substitution made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed


.... responsibleParty Σ0..*Reference(Practitioner)Who is responsible for the substitution

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet / Code
MedicationDispense.languagerequiredhttp://tools.ietf.org/html/bcp47
MedicationDispense.identifier.userequiredIdentifierUse
MedicationDispense.identifier.typeextensibleIdentifier Type Codes
MedicationDispense.statusrequiredFixed Value: completed
MedicationDispense.medication[x]:medicationCodeableConceptextensiblePrescriptionMedicinalProduct
MedicationDispense.typerequiredActPharmacySupplyType
MedicationDispense.quantityextensiblePrescribedQuantityUnit
MedicationDispense.dosageInstruction.additionalInstructionsexample
MedicationDispense.dosageInstruction.timing.repeat.durationUnitrequiredx_TimeUnitsOfMeasure
MedicationDispense.dosageInstruction.timing.repeat.periodUnitrequiredx_TimeUnitsOfMeasure
MedicationDispense.dosageInstruction.timing.codepreferredTimingAbbreviation
MedicationDispense.dosageInstruction.asNeeded[x]example
MedicationDispense.dosageInstruction.site[x]exampleSNOMED CT Anatomical Structure for Administration Site Codes
MedicationDispense.dosageInstruction.site[x]:siteCodeableConceptextensiblePrescriptionAdministrationSite
MedicationDispense.dosageInstruction.routeextensiblePrescriptionRouteOfAdministration
MedicationDispense.dosageInstruction.methodexample
MedicationDispense.dosageInstruction.dose[x]extensiblePrescriptionDoseQuantityUnit
MedicationDispense.dosageInstruction.maxDosePerPeriod.numeratorextensiblePrescribedQuantityUnit
MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason

Constraints

IdPathDetailsRequirements
mdd-1MedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
dispenseIdentifier-branch-4MedicationDispense.identifier.systemThis must be an OID ending in .4
: $this.matches('^urn\\:oid\\:(\\d+\\.)+4$')
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()
tim-3MedicationDispense.dosageInstruction.timing.repeatEither frequency or when can exist, not both
: ((period.exists() or frequency.exists()) and when.exists()).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.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()