PrescribeIT® Specification and Guide Version 5.0

 

3.102 StructureDefinition: PrescribeIT® Prescription 903

The official URL for this profile is: 

http://prescribeit.ca/fhir/StructureDefinition/profile-medicationorder-903

3.102.2 Formal Views of Profile Content

Download Excel representation

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

>

This structure is derived from MedicationOrder

NameCard.TypeConstraints and Usage
.  MedicationOrder 0..*MedicationOrderDefinition:
An order for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationOrder" rather than "MedicationPrescription" to generalize the use across inpatient and outpatient settings as well as for care plans, etc.

..  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.

..  contained 1..1ResourceDefinition:
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.


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

..  medication[x]
     (medicationReference) 		1..1Reference()Definition:
Identifies the medication being administered. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.


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

...  display 1..1stringFixed Value: medication
Definition:
Plain text narrative that identifies the resource in addition to the resource reference.


Comments:
Fixed value: medication

..  patient 1..1Reference(Shared Health Patient - 903) {b}Definition:
A link to a resource representing the person to whom the medication will be given.


Comments:
Identifies the patient tied to the task. (FHIR prohibits inheritance of context, so this must be explicitly declared rather than inferred from the presence of the Patient resource in the message)

...  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:
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

This structure is derived from MedicationOrder

Summary

Mandatory: 5 elements
Must-Support: 6 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

This structure is derived from MedicationOrder

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder S0..*MedicationOrderPrescription of medication to for patient
... id S1..1idLogical id of this artifact
... contained S1..1ResourceContained, inline Resources
... medicationReference S1..1Reference()Medication to be taken
.... display S1..1stringText alternative for the resource
Fixed Value: medication
... patient S1..1Reference(Shared Health Patient - 903) {b}Who prescription is for
.... reference S1..1stringRelative, internal or absolute URL reference

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder SΣ0..*MedicationOrderPrescription of medication to for 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 S1..1ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal identifier
... status ?!Σ0..1codeactive | on-hold | completed | entered-in-error | stopped | draft
Binding: MedicationOrderStatus (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

... medication[x] Σ1..1(Slice Definition)Medication to be taken
Slice: Unordered, Closed by type:$this
.... medication[x]:medicationReference SΣ1..1Reference()Medication to be taken
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... reference ΣI0..1stringRelative, internal or absolute URL reference
..... display SΣ1..1stringText alternative for the resource
Fixed Value: medication
... patient SΣ1..1Reference(Shared Health Patient - 903) {b}Who prescription 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
... encounter Σ0..1Reference(Encounter)Created during encounter/admission/stay
... dateWritten Σ0..1dateTimeWhen prescription was authorized
... prescriber Σ0..1Reference(Practitioner)Who ordered the medication(s)
... reasonCode Σ0..*CodeableConceptReason or indication for writing the prescription
Binding: Condition/Problem/Diagnosis Codes (example): Codes indicating why the medication was ordered.


... reasonReference Σ0..*Reference(Condition)Condition that supports why the prescription is being written
... dateEnded Σ0..1dateTimeWhen prescription was stopped
... reasonEnded Σ0..1CodeableConceptWhy prescription was stopped
Binding: (unbound) (example): Codes indicating why the medication was terminated; e.g. Adverse reaction, medication change, issue resolved, etc.

... note Σ0..*AnnotationInformation about the prescription
... dosageInstruction Σ0..*BackboneElementHow medication should be taken
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... text Σ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions Σ0..1CodeableConceptSupplemental instructions - e.g. "with meals"
Binding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

.... timing Σ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for 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..1Body site to administer to
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.

..... siteCodeableConceptCodeableConcept
..... siteReferenceReference(BodySite)
.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMED CT Route Codes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: (unbound) (example): A coded concept describing the technique by which the medicine is administered.

.... dose[x] Σ0..1Amount of medication per dose
..... doseRangeRange
..... doseQuantityQuantity(SimpleQuantity)
.... rate[x] Σ0..1Amount of medication per unit of time
..... rateRatioRatio
..... rateRangeRange
..... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
... dispenseRequest Σ0..1BackboneElementMedication supply authorization
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... medication[x] Σ0..1Product to be supplied
..... medicationCodeableConceptCodeableConcept
..... medicationReferenceReference(Medication)
.... validityPeriod Σ0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed Σ0..1positiveIntNumber of refills authorized
.... quantity Σ0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration Σ0..1DurationNumber of days supply per dispense
... substitution Σ0..1BackboneElementAny restrictions on medication substitution
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type Σ1..1CodeableConceptgeneric | formulary +
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..1CodeableConceptWhy should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

... priorPrescription Σ0..1Reference(MedicationOrder)An order/prescription that this supersedes

doco Documentation for this format

Grid View

This structure is derived from MedicationOrder

NameCard.TypeConstraints and Usage
.  MedicationOrder 0..*MedicationOrderDefinition:
An order for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationOrder" rather than "MedicationPrescription" to generalize the use across inpatient and outpatient settings as well as for care plans, etc.

..  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.

..  contained 1..1ResourceDefinition:
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.


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

..  medication[x]
     (medicationReference) 		1..1Reference()Definition:
Identifies the medication being administered. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.


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

...  display 1..1stringFixed Value: medication
Definition:
Plain text narrative that identifies the resource in addition to the resource reference.


Comments:
Fixed value: medication

..  patient 1..1Reference(Shared Health Patient - 903) {b}Definition:
A link to a resource representing the person to whom the medication will be given.


Comments:
Identifies the patient tied to the task. (FHIR prohibits inheritance of context, so this must be explicitly declared rather than inferred from the presence of the Patient resource in the message)

...  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:
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

This structure is derived from MedicationOrder

Summary

Mandatory: 5 elements
Must-Support: 6 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

Differential View

This structure is derived from MedicationOrder

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder S0..*MedicationOrderPrescription of medication to for patient
... id S1..1idLogical id of this artifact
... contained S1..1ResourceContained, inline Resources
... medicationReference S1..1Reference()Medication to be taken
.... display S1..1stringText alternative for the resource
Fixed Value: medication
... patient S1..1Reference(Shared Health Patient - 903) {b}Who prescription is for
.... reference S1..1stringRelative, internal or absolute URL reference

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder SΣ0..*MedicationOrderPrescription of medication to for 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 S1..1ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal identifier
... status ?!Σ0..1codeactive | on-hold | completed | entered-in-error | stopped | draft
Binding: MedicationOrderStatus (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

... medication[x] Σ1..1(Slice Definition)Medication to be taken
Slice: Unordered, Closed by type:$this
.... medication[x]:medicationReference SΣ1..1Reference()Medication to be taken
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... reference ΣI0..1stringRelative, internal or absolute URL reference
..... display SΣ1..1stringText alternative for the resource
Fixed Value: medication
... patient SΣ1..1Reference(Shared Health Patient - 903) {b}Who prescription 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
... encounter Σ0..1Reference(Encounter)Created during encounter/admission/stay
... dateWritten Σ0..1dateTimeWhen prescription was authorized
... prescriber Σ0..1Reference(Practitioner)Who ordered the medication(s)
... reasonCode Σ0..*CodeableConceptReason or indication for writing the prescription
Binding: Condition/Problem/Diagnosis Codes (example): Codes indicating why the medication was ordered.


... reasonReference Σ0..*Reference(Condition)Condition that supports why the prescription is being written
... dateEnded Σ0..1dateTimeWhen prescription was stopped
... reasonEnded Σ0..1CodeableConceptWhy prescription was stopped
Binding: (unbound) (example): Codes indicating why the medication was terminated; e.g. Adverse reaction, medication change, issue resolved, etc.

... note Σ0..*AnnotationInformation about the prescription
... dosageInstruction Σ0..*BackboneElementHow medication should be taken
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... text Σ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions Σ0..1CodeableConceptSupplemental instructions - e.g. "with meals"
Binding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

.... timing Σ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for 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..1Body site to administer to
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.

..... siteCodeableConceptCodeableConcept
..... siteReferenceReference(BodySite)
.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMED CT Route Codes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: (unbound) (example): A coded concept describing the technique by which the medicine is administered.

.... dose[x] Σ0..1Amount of medication per dose
..... doseRangeRange
..... doseQuantityQuantity(SimpleQuantity)
.... rate[x] Σ0..1Amount of medication per unit of time
..... rateRatioRatio
..... rateRangeRange
..... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
... dispenseRequest Σ0..1BackboneElementMedication supply authorization
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... medication[x] Σ0..1Product to be supplied
..... medicationCodeableConceptCodeableConcept
..... medicationReferenceReference(Medication)
.... validityPeriod Σ0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed Σ0..1positiveIntNumber of refills authorized
.... quantity Σ0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration Σ0..1DurationNumber of days supply per dispense
... substitution Σ0..1BackboneElementAny restrictions on medication substitution
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type Σ1..1CodeableConceptgeneric | formulary +
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..1CodeableConceptWhy should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

... priorPrescription Σ0..1Reference(MedicationOrder)An order/prescription that this supersedes

doco Documentation for this format

 

Other representations of profile: Schematron

3.102.3 Terminology Bindings

Terminology Bindings

PathConformanceValueSet
MedicationOrder.languagerequiredhttp://tools.ietf.org/html/bcp47
MedicationOrder.statusrequiredMedicationOrderStatus
MedicationOrder.reasonCodeexampleCondition/Problem/Diagnosis Codes
MedicationOrder.reasonEndedexample
MedicationOrder.dosageInstruction.additionalInstructionsexample
MedicationOrder.dosageInstruction.asNeeded[x]example
MedicationOrder.dosageInstruction.site[x]exampleSNOMED CT Anatomical Structure for Administration Site Codes
MedicationOrder.dosageInstruction.routeexampleSNOMED CT Route Codes
MedicationOrder.dosageInstruction.methodexample
MedicationOrder.substitution.typeexampleActSubstanceAdminSubstitutionCode
MedicationOrder.substitution.reasonexampleSubstanceAdminSubstitutionReason

3.102.4 Constraints

Constraints

IdPathDetailsRequirements