PrescribeIT® Specification and Guide Version 5.0

 

Definitions for the profile-medicationorder-new Profile.

1. MedicationOrder
Definition

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.

Control0..*
Must Supporttrue
Alternate NamesPrescription
Comments

For Task e110-m - New RX Fill Request, this conveys the details of a single medication order.

For Task e120-m - Renewal RX Fill Request, this conveys the medication order for which a fill is being requested.

For Task p160-m - RX Renewal Create Request, this conveys the details of a single medication order for which the renewal is being requested.

Max Length0
InvariantsDefined on this element
over25dur-true: IF over25dur = TRUE, total number of detectedissue must be 25 (: (extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-over-25-dur').exists() and extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-over-25-dur').value=true) implies extension('http://prescribeit.ca/fhir/StructureDefinition/ext-request-detectedissue').count() = 25)
2. MedicationOrder.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control1..1
Typeid
Must Supporttrue
Comments

Usage Note: This will usually be a GUID and is assigned by the sending application.

Max Length0
3. MedicationOrder.meta
Definition

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

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

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

Control0..1
Typeuri
Is Modifiertrue
Comments

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

Max Length0
5. MedicationOrder.language
Definition

The base language in which the resource is written.

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

Typecode
Comments

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

Max Length0
6. MedicationOrder.text
Definition

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

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

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

Max Length0
7. MedicationOrder.contained
Definition

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.

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

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

Max Length0
8. MedicationOrder.extension
Definition

An Extension

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

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

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

Conformance Rule: If no appropriate code exists, provide details using the 'text' component.

Max Length0
10. MedicationOrder.extension:renderedDosageInstruction
SliceNamerenderedDosageInstruction
Definition

A free form textual specification generated from the input specifications as created by the provider.This is made up of either an 'Ad-hoc instruction' or 'Textual rendition of the structured dosage lines', plus route, dosage unit, and other pertinent administration information specified by the provider.

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

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

Comments

Usage Note: This is intended to provide all dosage instructions to the Pharmacist in a clear human-readable format. This field will be displayed to the Pharmacist upon receipt of the prescription. Note: This must be as clear as possible and must include all instructions because the EMR may not provide individual/structured dosage instructions. When the Prescription cannot be delivered electronically, the rendered dosage instruction will be printed on the fax and will be the only source of dosage information.

It is recognized that very complex instructions may be conveyed as text only (not as structured data). Example: take 500 mg twice a day at breakfast and at lunch AND 250 mg once a day at bedtime - THEN (new dosage line)). If the EMR submits structured dosage instructions, this must be consistent with the textual instructions provided here. The PMS may ignore the structured frequency, or override it to align with the textual instructions.

Example: the EMR may enter frequency (multiplier of the dose) in their system like this (2 qam and 3 qhs ), in the structured frequency. The textual instructions could say Take 2 tablets in the morning and 3 at bedtime.

Conformance Rule: The rendered dosage instruction MUST contain ALL dosage instructions. This includes ALL child elements of dosage instruction, such as dosage quantity, dosage unit, frequency, etc) in human readable form and must be able to stand on its own. This field will include all of the information contained in the structured dosage as well as patient instructions (eg take with food, starting one day before dental appointment), assembled into one field and formatted as human-readable. Coded values codes should not be used (e.g. 'days' should be used instead of 'd', the code of PO as 'oral' )

Conformance Rule: MUST allow all printable characters and carriage return/line feeds.

Conformance Rule: If an EMR has discrete field for Pharmacy Notes (Dispenser Instructions), they should not be included here. If EMR's have both concepts combined into one field, they can both be included here.

Max Length0
11. MedicationOrder.extension:protocol
SliceNameprotocol
Definition

Identifies the Protocol, Order set, Guideline or other definition that guided the creation of this prescription

Control0..10
TypeExtension(Medication Order Protocol) (Extension Type: Choice of: string, uri, Identifier(Shared Health Identifier))
Must Supporttrue
Comments

FUTURE USE ONLY

Max Length0
12. MedicationOrder.extension:treatmentType
SliceNametreatmentType
Definition

Identifies whether this drug is for acute or chronic use

Control0..1
TypeExtension(Medication Order Treatment Type) (Extension Type: code)
Must Supporttrue
Comments

Conformance Rule: Must be populated if known

Max Length0
13. MedicationOrder.extension:supportingInformation
SliceNamesupportingInformation
Definition

Additional information that relevant to the order. E.g. observations, allergies, etc.

Control0..*
TypeExtension(Medication Order Supporting Information) (Extension Type: Reference(Shared Health Reference)(PrescribeIT® List - Allergies | PrescribeIT® Pharmacy-related Observation))
Must Supporttrue
Comments

Cardinality must be 0..1 for Shared Health List-Allergies and 0..2 for Shared Health Pharmacy-related Observation (i.e. 1 for height and 1 for weight).

Conformance Rule: All known patient allergies must be included in the Medication Order.

Max Length0
14. MedicationOrder.extension:detectedIssue
SliceNamedetectedIssue
Definition

A set of managed and relevant detected issues that should be transmitted along with a prescription or order to provide context during the execution of that order.

Control0..25 This element is affected by the following invariants: over25dur-true
TypeExtension(Request-related Detected Issues) (Extension Type: Reference(Shared Health Reference)(PrescribeIT® DUR))
Must Supporttrue
Comments

Usage Note: This is a reference to the resource which is used to convey Managed Detected Issues (DUR)

Max Length0
15. MedicationOrder.extension:pharmacyInstructions
SliceNamepharmacyInstructions
Definition

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

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

Usage Note: To convey explicit instructions to the Pharmacist/dispenser related to this medication order.

Usage Note: If the PMS solution is unable to display the entire instructions, then it is expected that the current solution has a fail-over process and will create a printout of the prescription.

Conformance Rule: PMS solution must be able to print out the entire prescription with ALL dispensing instructions included on the printout. Minimum data elements can be based on the eFax model

Conformance Rule: When 'compliance pack' is indicated on the prescription within the EMR, populate the pharmacist instruction/dispenser instructions with 'COMPLIANCE PACK REQUESTED'

Usage Note: In the case where the prescriber indicates the concept of ‘do not adapt’ (meaning that the pharmacist should not alter the prescription based on the patient's weight as an example), this direction to the pharmacist should be conveyed in human language in this field.

Conformance Rule: If a prescriber wishes to indicate that there is no substitution it must be included as part of the pharmacy instructions.

Conformance Rule: LU Codes must be clearly conveyed as part of the Pharmacists Instructions. If vendors are programmitically mapping into this field, they should use a prefix of LU Code before the identifier.

Max Length0
16. MedicationOrder.extension:over25dur
SliceNameover25dur
Definition

Indicates that the total number of managed DURs associated with the prescription exceeds the reporting limit of 25

Control0..1 This element is affected by the following invariants: over25dur-true
TypeExtension(Medication Order - Over 25 DUR) (Extension Type: boolean)
Must Supporttrue
Comments

Conformance Rule: Set value = true when there are more than 25 warnings returned in the EMR DUR system

Max Length0
17. MedicationOrder.extension:monitoredDrug
SliceNamemonitoredDrug
Definition

Allows prescribers to indicate that the prescription is for a 'Monitored Drug' (e.g. compound) value in the prescription message to the pharmacies

Control0..1
TypeExtension(Medication Order - Monitored Drug) (Extension Type: boolean)
Must Supporttrue
Comments

Conformance Rule: The prescriber should have the ability to set this flag when the medication is a compound. The absence of this extension means (i.e. value=”false”) that this is not a monitored substance.

Usage Note: Provinces may require prescribers to enter this value when a compound contains a monitored substance (e.g. narcotic) to support Prescription Drug Monitoring Programs (e.g. the Alberta Triplicate Prescription Program).

Max Length0
18. MedicationOrder.extension:noRenewals
SliceNamenoRenewals
Definition

Indicates that the prescriber will not support renewals for this prescription

Control0..1
TypeExtension(Medication Order - No Prescription Renewals) (Extension Type: boolean)
Must Supporttrue
Comments

Conformance Rule: The PMS should present a warning to the dispenser if they create a renewal request for a prescription that has this flag set to indicate 'no renewals'. The PMS should allow the renewal to be submitted along with an explanation as there may be exceptional circumstances.

Max Length0
19. MedicationOrder.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

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

Max Length0
20. MedicationOrder.identifier
Definition

A technical identifier - identifies some entity uniquely and unambiguously.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..3
TypeIdentifier(Shared Health Identifier)
Must Supporttrue
Comments

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

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

A technical identifier - identifies some entity uniquely and unambiguously.

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

In the context of a new prescription (e110, e120, e162, or e163), this Prescripton business identifier is generated by the EMR.

In the context of a Cancel Rx Fill Request (e140), this Prescripton Identifier should be populated with the same Rx that was included in the original new prescription message (e110, e120, e162, or e163).

In the context of a Renewal Request (p160), this Prescripton business Identifier is for the prescription that is being requested to be renewed. In most cases, this will be a value that was originally generated by the EMR. However, in some cases (e.g. the renewal of a paper/fax prescription), there will be no EMR generated prescription identifier, and in this case, the PMS should generate its own Prescription business identifier.

In the context of an Rx Response - Denied (e161), or an Rx Response - Under Review (e164), this Prescripton Identifier should be populated with the MedicationOrder.identifier(EMR-id) provided in the Renewal Request (p160).

Max Length0
22. MedicationOrder.identifier:EMR-id.id
Definition

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

Control0..1
Typeid
Max Length0
23. MedicationOrder.identifier:EMR-id.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
24. MedicationOrder.identifier:EMR-id.use
Definition

The purpose of this identifier.

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

Typecode
Is Modifiertrue
Requirements

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

Comments

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

Max Length0
25. MedicationOrder.identifier:EMR-id.type
Definition

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

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

TypeCodeableConcept(Shared Health CodeableConcept Code)
Must Supporttrue
Requirements

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

Comments

-

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

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

Control0..1
Typeid
Max Length0
27. MedicationOrder.identifier:EMR-id.type.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

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

A reference to a code defined by a terminology system.

Control1..*
TypeCoding
Must Supporttrue
Requirements

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

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

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

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

Control0..1
Typeid
Max Length0
30. MedicationOrder.identifier:EMR-id.type.coding.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
31. MedicationOrder.identifier:EMR-id.type.coding.system
Definition

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

Control1..1
Typeuri
Must Supporttrue
Requirements

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

Comments

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

Max Length0
32. MedicationOrder.identifier:EMR-id.type.coding.version
Definition

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

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

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

Max Length0
33. MedicationOrder.identifier:EMR-id.type.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Must Supporttrue
Requirements

Need to refer to a particular code in the system.

Comments

This is the code as defined within the binding.

Max Length0
34. MedicationOrder.identifier:EMR-id.type.coding.display
Definition

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

Control0..1
Typestring
Requirements

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

Max Length0
35. MedicationOrder.identifier:EMR-id.type.coding.userSelected
Definition

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

Control0..1
Typeboolean
Requirements

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

Comments

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

Max Length0
36. MedicationOrder.identifier:EMR-id.type.coding:placer
SliceNameplacer
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Must Supporttrue
Requirements

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

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Max Length0
37. MedicationOrder.identifier:EMR-id.type.coding:placer.id
Definition

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

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

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
39. MedicationOrder.identifier:EMR-id.type.coding:placer.system
Definition

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

Control1..1
Typeuri
Must Supporttrue
Requirements

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

Comments

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

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

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

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

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

Max Length0
41. MedicationOrder.identifier:EMR-id.type.coding:placer.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Must Supporttrue
Requirements

Need to refer to a particular code in the system.

Comments

Fixed value: PLAC

Max Length0
Fixed ValuePLAC
42. MedicationOrder.identifier:EMR-id.type.coding:placer.display
Definition

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

Control0..1
Typestring
Requirements

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

Max Length0
43. MedicationOrder.identifier:EMR-id.type.coding:placer.userSelected
Definition

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

Control0..1
Typeboolean
Requirements

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

Comments

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

Max Length0
44. MedicationOrder.identifier:EMR-id.type.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Requirements

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

Comments

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

Max Length0
45. MedicationOrder.identifier:EMR-id.system
Definition

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

Control1..1
Typeuri
Must Supporttrue
Requirements

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

Comments

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

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

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

Control1..1
Typestring
Must Supporttrue
Comments

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

Max Length0
Example
General:123456
47. MedicationOrder.identifier:EMR-id.period
Definition

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

Control0..1
TypePeriod
Max Length0
48. MedicationOrder.identifier:EMR-id.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
Comments

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

Max Length0
49. MedicationOrder.identifier:DIS-id
SliceNameDIS-id
Definition

External identifier - one that would be used by another non-FHIR system - for example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an entire workflow process where records have to be tracked through an entire system.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..2
TypeIdentifier
Must Supporttrue
Comments

In the context of Tasks e110, e120, e162, e163, and e180, this identifier will not be present in the message transmitted from the EMR to the PrescribeIT® Switch. As the message passes through the PrescribeIT® Switch in a jurisdiction which has a Drug Information System (DIS), the PrescribeIT® Switch will add the DIS's identifier to the MedicationOrder. PMS is to use this identifier to record the dispense event against the correct DIS Prescription identifier, if possible.

In the context of Tasks e140 and p160, this is not applicable.

Max Length0
50. MedicationOrder.identifier:DIS-id.id
Definition

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

Control0..1
Typeid
Max Length0
51. MedicationOrder.identifier:DIS-id.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
52. MedicationOrder.identifier:DIS-id.use
Definition

The purpose of this identifier.

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

Typecode
Is Modifiertrue
Requirements

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

Comments

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

Max Length0
53. MedicationOrder.identifier:DIS-id.type
Definition

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

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

TypeCodeableConcept(Shared Health CodeableConcept Code)
Must Supporttrue
Requirements

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

Comments

-

Max Length0
Pattern Value<valueCodeableConcept xmlns="http://hl7.org/fhir">
  <coding>
    <system value="http://hl7.org/fhir/v2/0203"/>
    <code value="RRI"/>
  </coding>
</valueCodeableConcept>
54. MedicationOrder.identifier:DIS-id.system
Definition

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

Control0..1
Typeuri
Must Supporttrue
Requirements

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

Max Length0
Example
General:http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
55. MedicationOrder.identifier:DIS-id.value
Definition

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

Control1..1
Typestring
Must Supporttrue
Comments

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.

Max Length0
Example
General:123456
56. MedicationOrder.identifier:DIS-id.period
Definition

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

Control0..1
TypePeriod
Max Length0
57. MedicationOrder.identifier:DIS-id.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
Comments

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

Max Length0
58. MedicationOrder.status
Definition

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

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

Typecode
Is Modifiertrue
Must Supporttrue
Comments

Fixed value: active

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

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

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

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

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

A reference from one resource to another.

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

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

Max Length0
61. MedicationOrder.patient
Definition

A reference from one resource to another.

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

Usage Note: This must point to the patient associated with the message.

Max Length0
62. MedicationOrder.encounter
Definition

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

Control0..1
TypeReference(Encounter)
Comments

SubstanceAdministration->component->EncounterEvent.

Max Length0
63. MedicationOrder.dateWritten
Definition

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

Control1..1
TypedateTime
Must Supporttrue
Comments

Conformance Rule: Must be either equal to or earlier then the MedicationOrder.dispenseRequest.validityPeriod.start element.

Conformance Rule: Must be either a full date (i.e. yyyy-mm-dd) or a full date and time with timezone (i.e. yyyy-mm-dd-HH:mm:ss.SSS-ZZZZZ).

Conformance Rule: Prescriptions sent within Alberta must support the full date time. EMRs in Alberta that do not have timezone cannot integrate with Alberta PIN.

Max Length0
64. MedicationOrder.prescriber
Definition

A reference from one resource to another.

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

Conformance Rule: This is the person who prescribed the medication. This is typically the same as the task.creator though there are some situations when they will be different. The Task.creator will be different for tasks that are actioned by another practitioner. This may occur on an e140/cancel or on a renewal e161/Deny or e164/Under Review. The Task.creator will always be the same as the prescriber when sending an e110, e120, e180, e162/Approved, and e163/Approved with Changes. When a p160 is sent, the Task.creator will be the pharmacy and the prescriber will be the prescriber of the medication order. For the p170/Adapt and p190/Pharmacist Prescribe, the Task.creator will be the pharmacy and the prescriber will be the individual pharmacist.

Max Length0
65. MedicationOrder.reasonCode
Definition

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

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

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

Max Length0
66. MedicationOrder.reasonCode.id
Definition

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

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

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
68. MedicationOrder.reasonCode.coding
Definition

A reference to a code defined by a terminology system.

Control0..1
TypeCoding
Must Supporttrue
Requirements

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

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

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

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

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

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

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

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

Control1..1
Typeuri
Must Supporttrue
Requirements

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

Comments

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

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

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

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

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

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

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Must Supporttrue
Requirements

Need to refer to a particular code in the system.

Comments

This is the code as defined within the binding.

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

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

Control0..1
Typestring
Requirements

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

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

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

Control0..1
Typeboolean
Requirements

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

Comments

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

Max Length0
76. MedicationOrder.reasonCode.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control1..1
Typestring
Must Supporttrue
Requirements

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

Comments

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

Max Length2500
77. MedicationOrder.reasonReference
Definition

Condition that supports why the prescription is being written.

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

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

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

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

Control0..1
Binding

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

TypeCodeableConcept
Max Length0
80. MedicationOrder.note
Definition

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

Control0..1
TypeAnnotation
Must Supporttrue
Max Length0
81. MedicationOrder.note.id
Definition

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

Control0..1
Typeid
Max Length0
82. MedicationOrder.note.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
83. MedicationOrder.note.author[x]
Definition

The individual responsible for making the annotation.

Control0..1
TypeChoice of: Reference(Practitioner | Patient | RelatedPerson), string
[x] NoteSee Choice of Data Types for further information about how to use [x]
Max Length0
84. MedicationOrder.note.time
Definition

Indicates when this particular annotation was made.

Control0..1
TypedateTime
Max Length0
85. MedicationOrder.note.text
Definition

The text of the annotation.

Control1..1
Typestring
Must Supporttrue
Comments

Usage Note: This is used as an additional pharmacy note that is unrelated to the dispensing instructions. Eg. Do not fill immediately, Patient is coming in on July 12th for Booster shot.

Conformance Rule: PMS Vendors MUST display this to the pharmacist as it may contain important information. There could be Patient Instructions in here, inadvertently due to current prescribing behaviours.

Max Length2500
86. MedicationOrder.dosageInstruction
Definition

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

Control0..*
TypeBackboneElement
Must Supporttrue
Comments

Conformance Rule: For EMRs that can support structured dosage instruction, this element must be populated when the prescriber specifies any of structured dosage information. Anything that is populated as part of the structured dosage information must also be part of the RENDEREDDOSAGEINSTRUCTION element.

Usage Note: An Excel spreadsheet providing guidance on how to populate dosage instructions can be found under 'Scope and Usage'.

When the dose or rate is intended to change over the entire administration period, e.g. Tapering dose prescriptions, multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. Another common example in institutional settings is 'titration' of an IV medication dose to maintain a specific stated hemodynamic value or range e.g. drug x to be administered to maintain AM (arterial mean) greater than 65.

Max Length0
87. MedicationOrder.dosageInstruction.id
Definition

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

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

An Extension

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

Optional Extensions Element - found in all resources.

Control1..1
TypeExtension(Medication Dosage Line Sequence) (Extension Type: integer(positiveInt))
Must Supporttrue
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.

Max Length0
90. MedicationOrder.dosageInstruction.extension:instructionRelationship
SliceNameinstructionRelationship
Definition

Optional Extensions Element - found in all resources.

Control0..1
TypeExtension(Medication Order Dosage Instruction Relationship) (Extension Type: code)
Must Supporttrue
Comments

Conformance Rule: As this will establish the relationship to the previous dosage lines (example: first and second dosage line, the second and third dosage line, etc.) this must be present for all dosage lines except for the FIRST dosage line.

Conformance Rule: ANDs and THENs should not be mixed due to ambiguity of meaning.

Max Length0
91. MedicationOrder.dosageInstruction.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

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

Max Length0
92. MedicationOrder.dosageInstruction.text
Definition

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

Control0..1
Typestring
Must Supporttrue
Comments

Conformance Rule: When providing multiple dosage lines can be expressed individually. All dosage lines (full text content) must be concatenated into MedicationOrder.extension(renderedDosageInstruction) as PMS will not be forced to support the receipt of individual lines.

Usage Note: This is a string composed of any available discrete MedicationOrder.dosageInstruction child elements such as timing, asNeeded[x], siteCodeableConcept, route, dose[x], rate[x], and maxDosePerPeriod for each repetition sequence line.

Example: 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).

Max Length0
93. MedicationOrder.dosageInstruction.additionalInstructions
Definition

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

Control0..1
Binding

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

TypeCodeableConcept(Shared Health CodeableConcept Text Required)
Must Supporttrue
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 DOSAGETIMINGFREQUENCY = once a day and 'at bedtime' would be placed into this field.

Max Length0
94. MedicationOrder.dosageInstruction.additionalInstructions.id
Definition

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

Control0..1
Typeid
Max Length0
95. MedicationOrder.dosageInstruction.additionalInstructions.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
96. MedicationOrder.dosageInstruction.additionalInstructions.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Requirements

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

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Max Length0
97. MedicationOrder.dosageInstruction.additionalInstructions.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control1..1
Typestring
Must Supporttrue
Requirements

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

Comments

Conformance Rule: This is the text used to convey the exact word that was displayed to the practitioner

Max Length2500
98. MedicationOrder.dosageInstruction.timing
Definition

The timing schedule on how the patient is to take the medication. The timing schedules allows many different expressions to be expressed. For example: Every 8 hours, Three times a day, 1/2 an hour before breakfast for 10 days from 17 Oct 2017 to 27 Oct 2017

Control0..1
TypeTiming
Must Supporttrue
Comments

Conformance Rule: For EMRs that can support structured dosage instruction, this must be populated if prescriber specifies any of structured timing information. Anything that is populated as part of the structured timing information must also be part of the RENDEREDDOSAGEINSTRUCTION.

Usage Note: An Excel spreadsheet providing guidance on how to populate dosage instructions can be found under 'Scope and Usage'.

Max Length0
99. MedicationOrder.dosageInstruction.timing.id
Definition

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

Control0..1
Typeid
Max Length0
100. MedicationOrder.dosageInstruction.timing.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
101. MedicationOrder.dosageInstruction.timing.event
Definition

Identifies specific times when the event occurs.

Control0..1
TypedateTime
Must Supporttrue
Requirements

In an MAR, for instance, you need to take a general specification, and turn it into a precise specification.

Max Length0
102. MedicationOrder.dosageInstruction.timing.repeat
Definition

A set of rules that describe when the event should occur.

Control0..1
TypeElement
Must Supporttrue
Requirements

Many timing schedules are determined by regular repetitions.

Comments

Conformance Rule: If an EMR cannot send discrete elements in all cases for timing.repeat element, this is acceptable as long as RENDEREDDOSAGEINSTRUCTION captures the timing.

Max Length0
InvariantsDefined on this element
tim-1: if there's a duration, there needs to be duration units (: duration.empty() or durationUnit.exists())
tim-2: if there's a period, there needs to be period units (: period.empty() or periodUnit.exists())
tim-3: Either frequency or when can exist, not both (: ((period.exists() or frequency.exists()) and when.exists()).not())
tim-4: duration SHALL be a non-negative value (: duration.exists() implies duration >= 0)
tim-6: If there's a periodMax, there must be a period (: periodMax.empty() or period.exists())
tim-7: If there's a durationMax, there must be a duration (: durationMax.empty() or duration.exists())
tim-8: If there's a countMax, there must be a count (: countMax.empty() or count.exists())
tim-9: If there's an offset, there must be a when (: offset.empty() or when.exists())
103. MedicationOrder.dosageInstruction.timing.repeat.id
Definition

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

Control0..1
Typeid
Max Length0
104. MedicationOrder.dosageInstruction.timing.repeat.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
105. MedicationOrder.dosageInstruction.timing.repeat.bounds[x]
Definition

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.

Control0..1
TypeChoice of: Period, Quantity(Shared Health Duration), Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Max Length0
106. MedicationOrder.dosageInstruction.timing.repeat.count
Definition

count defines how many time the dosing activities should be repeated across all periods. For example, if a prescriber wants a patient to take 1 pill morning and night every day for 10 days, the dose is 1 pill, the frequency is 2 per day, the period is one day, and the count is 20 doses (corresponding to 10 days times 2 doses per day).

Control0..1
Typeinteger
Must Supporttrue
Requirements

Repetitions may be limited by end time or total occurrences.

Comments

If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

Max Length0
107. MedicationOrder.dosageInstruction.timing.repeat.countMax
Definition

countMax defines the max number of doses that should be taken across all periods within a dosage line. countMax is only used when the count is expressed as a range of values. For example, if a prescriber wants a patient to take a dose of 2 pills per day for 7-10 days, the dose is 2 pills, the frequency is 1 dose per day, the period is 1 days, the count is 7 doses, and the countMax is 10 doses.

Control0..1
Typeinteger
Must Supporttrue
Max Length0
108. MedicationOrder.dosageInstruction.timing.repeat.duration
Definition

duration defines the amount of time it takes to provide a SINGLE dose of a medication to a patient. For most medications, duration is not relevant. However, one example that uses duration would be the application of a patch. The prescriber may instruct the patient to apply a patch for 10 hours each day for 10 days. In this case, the dose would be 1 patch, the duration would be 10 hours, the period would be 1 day, and the count would be 10 doses.

Control0..1
Typedecimal
Must Supporttrue
Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

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).

Max Length0
109. MedicationOrder.dosageInstruction.timing.repeat.durationMax
Definition

durationMax defines the maximum amount of time CAN/SHOULD take to provide a SINGLE dose of a medication to a patient. durationMax implies the usage of a range of values for the duration. For most medications, duration and durationMax is not relevant. However, one example that uses duration and durationMax would be the application of a patch for a range of time each day. The prescriber may instruct the patient to apply a patch for 10-12 hours each day for 10 days. In this case, the dose would be 1 patch, the duration would be 10 hours, the durationMax would be 12 hours, the period would be 1 day, and the count would be 10 doses.

Control0..1
Typedecimal
Must Supporttrue
Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

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).

Max Length0
110. MedicationOrder.dosageInstruction.timing.repeat.durationUnit
Definition

The units of time for the duration, in UCUM units.

Control0..1
BindingThe codes SHALL be taken from x_TimeUnitsOfMeasure (20210501)
Typecode
Must Supporttrue
Max Length0
111. MedicationOrder.dosageInstruction.timing.repeat.frequency
Definition

frequency defines the number of times to apply a single dose of a medication within a particular period. For example, the prescriber may instruct the patient to take 1 tablet 3 times per day for 10 days. In this cases, the dose would be 1 tablet, the frequency would be 3 times, the period would be 1 day, and the count would be 30 doses.

Control0..1
Typeinteger
Must Supporttrue
Max Length0
Default Value1
112. MedicationOrder.dosageInstruction.timing.repeat.frequencyMax
Definition

frequencyMax defines the maximum number of times to apply a single dose of a medication within a particular period. Using frequencyMax implies that the frequency is a range of values. For example, the prescriber may instruct the patient to take 1 tablet 3-4 times per day for 10 days. In this cases, the dose would be 1 tablet, the frequency would be 3 times, the frequencyMax would be 4 times, the period would be 1 day, and the count would be 30 doses.

Control0..1
Typeinteger
Must Supporttrue
Max Length0
113. MedicationOrder.dosageInstruction.timing.repeat.period
Definition

The period defines the amount of time over which the frequency of doses should occur. For example, the prescriber may instruct the patient to take 1 tablet every day for 10 days. In this case, the period is 1 day.

Control0..1
Typedecimal
Must Supporttrue
Max Length0
114. MedicationOrder.dosageInstruction.timing.repeat.periodMax
Definition

The periodMax defines the maximum amount of time over which the frequency of doses should occur. For example, the prescriber may instruct the patient to apply one patch every 48 to 72 hours and leave the patch on for 12 hour and do this for 1 month. In this case, the dose would be one patch, the frequency would be 1, the duration would be 12 hours, the period would be 48 hours, the periodMax would be 72 hours, and the boundPeriod would be a start day of today and an end date of 2 months from now.

Control0..1
Typedecimal
Must Supporttrue
Max Length0
115. MedicationOrder.dosageInstruction.timing.repeat.periodUnit
Definition

The units of time for the period in UCUM units.

Control0..1
BindingThe codes SHALL be taken from x_TimeUnitsOfMeasure (20210501)
Typecode
Must Supporttrue
Max Length0
116. MedicationOrder.dosageInstruction.timing.repeat.when
Definition

A real world event that the occurrence of the event should be tied to.

Control0..0
BindingThe codes SHALL be taken from EventTiming Real world event that the relating to the schedule.

Typecode
Requirements

Timings are frequently determined by occurrences such as waking, eating and sleep.

Comments

Use "additionalInstructions" instead

Max Length0
117. MedicationOrder.dosageInstruction.timing.repeat.offset
Definition

The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.

Control0..0
TypeunsignedInt
Comments

Use "additionalInstructions" instead

Max Length0
118. MedicationOrder.dosageInstruction.timing.code
Definition

A code for the timing pattern. Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing.

Control0..1
BindingThe codes SHOULD be taken from TimingAbbreviation Code for a known / defined timing pattern.

TypeCodeableConcept
Comments

BID etc are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or the a structured representation should be used (in this case, specifying the two event times).

Max Length0
119. MedicationOrder.dosageInstruction.asNeeded[x]
Definition

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

Control0..1
Binding

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

TypeChoice of: boolean, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Comments

Conformance Rule: This is ONLY populated when the medication is prescribed on an as needed (i.e. PRN) basis.

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 provided.

The CodeableConcept should not be used at this time. If it is present, treat it as though the boolean value is set to true.

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

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

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

TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Max Length0
SlicingThis element introduces a set of slices on MedicationOrder.dosageInstruction.site[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
121. MedicationOrder.dosageInstruction.site[x]:siteCodeableConcept
SliceNamesiteCodeableConcept
Definition

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

Control0..1
BindingThe codes SHALL be taken from PrescriptionAdministrationSite (20190430); other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Required Text with optional code)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Comments

Conformance Rule: When providing a structured SIG, this should be populated when appropriate. If not structured, this should be part of the SIG (RENDEREDDOSAGEINSTRUCTION)

Max Length0
122. MedicationOrder.dosageInstruction.route
Definition

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

Control0..1
BindingThe codes SHALL be taken from PrescriptionRouteOfAdministration (20190415); other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Required Text with optional code)
Must Supporttrue
Comments

Conformance Rule: Coding should be populated if a code is available. However, text is always required.

Max Length0
123. MedicationOrder.dosageInstruction.method
Definition

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

Control0..1
Binding

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

TypeCodeableConcept
Comments

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

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

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

Control0..1
BindingThe codes SHALL be taken from PrescriptionDoseQuantityUnit (20210308); other codes may be used where these codes are not suitable
TypeChoice of: Quantity(PrescribeIT® Drug Quantity for Administration), Range(PrescribeIT® Drug Range)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Comments

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

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

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

Control0..1
TypeRatio
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

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

Max Length0
SlicingThis element introduces a set of slices on MedicationOrder.dosageInstruction.rate[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
126. MedicationOrder.dosageInstruction.rate[x]:rateRatio
SliceNamerateRatio
Definition

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

Control0..1
TypeRatio
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Comments

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

Max Length0
127. MedicationOrder.dosageInstruction.rate[x]:rateRatio.id
Definition

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

Control0..1
Typeid
Max Length0
128. MedicationOrder.dosageInstruction.rate[x]:rateRatio.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
129. MedicationOrder.dosageInstruction.rate[x]:rateRatio.numerator
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

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

Max Length0
InvariantsDefined on this element
qty-3: If a code for the unit is present, the system SHALL also be present (: code.empty() or system.exists())
sqty-1: The comparator is not used on a SimpleQuantity (: comparator.empty())
130. MedicationOrder.dosageInstruction.rate[x]:rateRatio.denominator
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.

Control1..1
TypeQuantity(Shared Health Quantity)
Must Supporttrue
Comments

This indicates the unit of time (e.g. per day, every 4 weeks, etc.)

Max Length0
InvariantsDefined on this element
qty-3: If a code for the unit is present, the system SHALL also be present (: code.empty() or system.exists())
131. MedicationOrder.dosageInstruction.maxDosePerPeriod
Definition

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

Control0..1
TypeRatio
Must Supporttrue
Comments

Conformance Rule: When providing a structured SIG, this should be populated when appropriate.

Max Length0
132. MedicationOrder.dosageInstruction.maxDosePerPeriod.id
Definition

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

Control0..1
Typeid
Max Length0
133. MedicationOrder.dosageInstruction.maxDosePerPeriod.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
134. MedicationOrder.dosageInstruction.maxDosePerPeriod.numerator
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

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

Conformance Rule: Quantity is used throughout the messages. It may be a drug form (e.g. TAB) an adminstratable drug (e.g. PUFF) for or a unit of measure (e.g. mg). If this is provided it is mandatory to send a value from the PrescribeIT® Drug Quantity.

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

Control1..1
TypeQuantity(Shared Health Quantity)
Must Supporttrue
Comments

This indicates the unit of time (e.g. per day, every 4 weeks, etc.)

Max Length0
InvariantsDefined on this element
qty-3: If a code for the unit is present, the system SHALL also be present (: code.empty() or system.exists())
136. MedicationOrder.dispenseRequest
Definition

Indicates the specific details for the dispense or medication supply part of a medication order (also known as a Medication Prescription). Note that this information is NOT always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.

Control1..1
TypeBackboneElement
Must Supporttrue
Comments

Conformance Rule: Outside of the Quebec jurisdiction, 1) Must have at least one of quantity and expectedSupplyDuration; and 2) Must have at least one of totalPrescribedQuantity and totalDaysSupply

Max Length0
InvariantsDefined on this element
forLife-endOfValidity: IF forLifeFlag = TRUE, then endOfValidity MUST not be specified (: (extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-for-life').exists() and extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-for-life').value=true) implies extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-end-of-validity').count() = 0)
forLife-numberOfRepeatsAllowed: IF forLifeFlag = TRUE, then numberOfRepeatsAllowed MUST not be specified (: (extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-for-life').exists() and extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-for-life').value=true) implies $this.numberOfRepeatsAllowed.count() = 0)
forLife-totalDaysSupply: IF forLifeFlag = TRUE, then totalDaysSupply MUST not be specified (: (extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-for-life').exists() and extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-for-life').value=true) implies extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-total-days-supply').count() = 0)
forLife-validityPeriodEnd: IF forLifeFlag = TRUE, then validityPeriod.end MUST not be specified (: (extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-for-life').exists() and extension('http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-for-life').value=true) implies $this.validityPeriod.end.count() = 0)
137. MedicationOrder.dispenseRequest.id
Definition

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

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

An Extension

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

If true, indicates that the prescription is eligible for life.

Control0..1 This element is affected by the following invariants: forLife-endOfValidity, forLife-totalDaysSupply, forLife-validityPeriodEnd, forLife-numberOfRepeatsAllowed
TypeExtension(Medication Order Dispense For Life) (Extension Type: boolean)
Must Supporttrue
Max Length0
140. MedicationOrder.dispenseRequest.extension:dispenseInterval
SliceNamedispenseInterval
Definition

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

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

Example: A prescriber instructs a patient to take 3 Tylenol 3 tablets every day as needed for pain for 90 days. However, the prescriber does not wish the patient to have more than 30 days supply at any given time so the prescriber instructs the pharmacist that the dispenseInterval is 30 days. The pharmacist then does 3 partial fills of 90 tablets (or 30 days supply) over the 90 day period.

Max Length0
141. MedicationOrder.dispenseRequest.extension:endOfValidity
SliceNameendOfValidity
Definition

Identifies either the length of time or time range defined by start and end date/time over which the Quebec prescription has an end of validity/treament

Control0..1 This element is affected by the following invariants: forLife-endOfValidity
TypeExtension(Medication Order End of Validity) (Extension Type: Choice of: Quantity(Duration), Period(Period))
Must Supporttrue
Max Length0
142. MedicationOrder.dispenseRequest.extension:trialEligibility
SliceNametrialEligibility
Definition

Optional Extensions Element - found in all resources.

Control0..1
TypeExtension(Medication Order Trial Dispense Eligibility) (Extension Type: boolean)
Must Supporttrue
Comments

Conformance Rule: If eligible for trial, this must be set to 'true' and presented to the Pharmacist.

Conformance Rule: This is ONLY populated if it is for trial, else it is assumed not to be eligble.

Note: Prescribers may include this information in notes.

Max Length0
143. MedicationOrder.dispenseRequest.extension:firstFillInstructions
SliceNamefirstFillInstructions
Definition

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

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

Control0..1
TypeExtension(Medication Order Dispense First Fill Instructions) (Extension Type: Choice of: boolean, integer, decimal, base64Binary, instant, string, uri, date, dateTime, time, code, oid, id, unsignedInt, positiveInt, markdown, Annotation, Attachment, Identifier, CodeableConcept, Coding, Quantity, Range, Period, Ratio, SampledData, Signature, HumanName, Address, ContactPoint, Timing, Reference, Meta)
Must Supporttrue
Comments

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

Max Length0
InvariantsDefined on this element
p-mr2: At least one of first fill quantity or first fill expected days supply must be specified (: extension.where(url='quantity').exists() or extension.where(url='expectedSupplyDuration').exists())
144. MedicationOrder.dispenseRequest.extension:maxDispense
SliceNamemaxDispense
Definition

Identifies the maximum quantity authorized to be dispensed at one time.

Control0..1
TypeExtension(Medication Order Max Dispense) (Extension Type: Quantity(PrescribeIT® Drug Quantity))
Must Supporttrue
Comments

Conformance Rule: If this is supported within the EMR as a discrete data element, this must be populated.

Example: A prescriber instructs a patient to take 3 Tylenol 3 tablets every day as needed for pain for 90 days. However, the prescriber does not wish the patient to have more than 30 days supply at any given time so the prescriber instructs the pharmacist that the maxDispense is 90 tablets. The pharmacist then does 3 partial fills of 90 tablets (or 30 days supply) over the 90 day period.

Max Length0
145. MedicationOrder.dispenseRequest.extension:totalPrescribedQuantity
SliceNametotalPrescribedQuantity
Definition

Optional Extensions Element - found in all resources.

Control0..1
TypeExtension(Medication Order Total Prescribed Quantity) (Extension Type: Quantity(PrescribeIT® Drug Quantity))
Must Supporttrue
Comments

Conformance Rule: The Total Prescribed Quantity is not mandatory but must be supplied if the value is entered by the user or can be calculated by the system.

Max Length0
146. MedicationOrder.dispenseRequest.extension:totalDaysSupply
SliceNametotalDaysSupply
Definition

Optional Extensions Element - found in all resources.

Control0..1 This element is affected by the following invariants: forLife-totalDaysSupply
TypeExtension(Medication Order Total Prescribed Days Supply) (Extension Type: Quantity(Duration))
Must Supporttrue
Comments

Conformance Rule: Must be populated when the Total Days Supply is entered by the user or when the Total Days Supply can be calculated by the system.

Conformance Rule: Code must be 'd' and system must be 'http://unitsofmeasure.org'.

Max Length0
147. MedicationOrder.dispenseRequest.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

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

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

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

Control0..1
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

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

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

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

Control0..1
BindingThe codes SHALL be taken from PrescriptionMedicinalProduct; other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Required Text with optional code)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

Conformance Rule: This element is used to represent the medication ordered. A 'code' (Canadian Clinical Drug Data Set, or DIN or NPN) must be accompanied by 'text' when prescribing. For compounds, a code is not used and the description will be sent as 'text'. A representative DIN or an NPN may also be used if a CCDD code is not 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

      EMRs must support sending and receiving all levels of drug terminology defined in the Canadian Clinical Drug Data (CCDD) Set including: Therapeutic Moiety (TM), Non-proprietary Therapeutic Product (NTP), Manufactured Product (MP) as well as Device NTP for devices. In cases where a Canadian Clinical Drug Data Set value is not available within the EMR, the EMR can send a DIN or Natural Product Number (NPN) or a DIN with the (isRepresentative) value set to 'true' (i.e. a representative DIN meaning that products by other manufacturers are acceptable).

     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 must always display the textual name of the medication or non-medication provided in the message to the user when displaying the prescription. This represents the name of the medication or non-medication (e.g. device) as seen by the prescriber at the time of prescribing.

     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.
Max Length0
150. MedicationOrder.dispenseRequest.validityPeriod
Definition

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

Control1..1
TypePeriod
Must Supporttrue
Requirements

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

Comments

Conformance Rule: Must be either equal to or later then the MedicationOrder.dateWritten element.

Max Length0
151. MedicationOrder.dispenseRequest.validityPeriod.id
Definition

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

Control0..1
Typeid
Max Length0
152. MedicationOrder.dispenseRequest.validityPeriod.extension
Definition

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
153. MedicationOrder.dispenseRequest.validityPeriod.start
Definition

The start of the period. The boundary is inclusive.

Control1..1 This element is affected by the following invariants: per-1
TypedateTime
Must Supporttrue
Comments

Conformance Rule: Must be either a full date (i.e. yyyy-mm-dd) or a full date and time with timezone (i.e. yyyy-mm-dd-HH:mm:ss.SSS-ZZZZZ).

Max Length0
154. MedicationOrder.dispenseRequest.validityPeriod.end
Definition

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

Control0..1 This element is affected by the following invariants: per-1, forLife-validityPeriodEnd
TypedateTime
Must Supporttrue
Comments

Conformance Rule: Must be either a full date (i.e. yyyy-mm-dd) or a full date and time with timezone (i.e. yyyy-mm-dd-HH:mm:ss.SSS-ZZZZZ).

Max Length0
Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
155. MedicationOrder.dispenseRequest.numberOfRepeatsAllowed
Definition

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

Control0..1 This element is affected by the following invariants: forLife-numberOfRepeatsAllowed
TypepositiveInt
Must Supporttrue
Comments

Conformance Rule: This must be populated when the number of repeats is 1 or more. As this field only allows a positive integer, this is not populated if there are no refills allowed.

Guidance: For narcotics, if this is incorrectly populated, the PMS could choose not to reject the message; rather they can adjust for the dispense.

Max Length0
156. MedicationOrder.dispenseRequest.quantity
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

Control0..1
BindingThe codes SHALL be taken from PrescribedQuantityUnit (20210308); other codes may be used where these codes are not suitable
TypeQuantity(PrescribeIT® Drug Quantity)
Must Supporttrue
Comments

Conformance Rule: If days supply is NOT present, this MUST be populated.

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

Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.

Control0..1
TypeQuantity(Duration)
Must Supporttrue
Comments

Conformance Rule: This maps to 'duration' in some EMR's. Must be populated when this is a discrete data element in the EMR; else this is sent as part of the textual description.

Conformance Rule: If Fill Quantity is NOT populated, this must be present.

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

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

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

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

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

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

Control1..1
Typedecimal
Must Supporttrue
Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored.

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

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

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

Typecode
Is Modifiertrue
Requirements

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

Comments

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

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

A human-readable form of the unit.

Control0..1
Typestring
Requirements

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

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

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

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

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

Comments

Fixed value: http://unitsofmeasure.org

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

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

Control1..1
Typecode
Must Supporttrue
Requirements

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

Comments

Fixed value: d

Max Length0
Fixed Valued
165. MedicationOrder.substitution
Definition

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

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

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

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

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

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

Max Length0
168. MedicationOrder.substitution.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

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

Max Length0
169. MedicationOrder.substitution.type
Definition

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

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

TypeCodeableConcept
Max Length0
170. MedicationOrder.substitution.reason
Definition

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

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

TypeCodeableConcept
Max Length0
171. MedicationOrder.priorPrescription
Definition

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

Control0..0
TypeReference(PrescribeIT® Prescription)
Must Supporttrue
Comments

When present with a prescription identifier, this must be in the same form as was present on the original prescription. The system element will be an OID of the form [Vendor root].[Application instance node].2 expressed as a uri (e.g. urn:oid:1.2.3.4). The branch, “.2” is appended to create a unique namespace for the Prescription Identifer. The value element will be the RX Number. Note that the system value must refer to the namespace of the system that created the original prescription, which may not always be the system performing the renewal.

In the context of Task e120: Conformance Rule: This is mandatory and MUST be populated with the EMR generated prescription identifier of the medication used as the basis for the new prescription for the same therapy. Its purpose is to identify the original prescription that drove the creation of this Renewal Fill Request. Note: This identifier may not be recognized by the PMS receiving this as it could have been a paper prescription or an ePrescription that was originally sent to another pharmacy.

For transition period, from paper to electronic, there would not be an EMR-assigned number. In this case, EMR MUST populate with a value of 'NA' in the Identifier.value and omit the system.

In the context of Task e140: This is not required but may be provided.

In the context Tasks e162 and e163: Conformance Rule: This is mandatory and MUST be populated with the MedicationOrder.identifier as specified in the p160 being responded to.

In the context of Task p160: Conformance Rule: The MedicationOrder transmitted in a p160 is the prior order that is being asked to be renewed. If this came in as an e110, priorPrescription will be absent. If this came in as an e120, priorPrescription will be present. If it was entered into the PMS as a paper or fax prescription, priorPrescription may not be known (in which case it will be absent), or may be set to 'NA' if the prescription was known to be a renewal, but the prescription identifier of the prior request is unknown).

In the context of Tasks e161, e164, and p170: Conformance Rule: This is not required.

In the context of Task e180: The prior prescription is mandatory for all renewals, if known. It is not required or applicable for new prescriptions.

In the context of Task p190: This is not required but optionally can reference a previous prescription if the prescription being communicated is a continuation of an existing therapy.

Max Length0
172. MedicationOrder.priorPrescription.id
Definition

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

Control0..1
Typeid
Max Length0
173. MedicationOrder.priorPrescription.extension
Definition

An Extension

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

Allows a reference to identify the target prescription, dispense or task by business identifier rather than URL

Control0..1
TypeExtension(Referenced Business identifier) (Extension Type: Identifier(Shared Health Identifier))
Must Supporttrue
Comments

When this is present, the reference is typically omitted.

Usage Note: 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, EMRs 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 Note: In the context of p160, EMRs 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.

Usage Note: The URL for this extension does not refer to an existing web-page as is a pre-adoption extension. Refer to the Shared Health implementation Guide for more information.

Max Length0
175. MedicationOrder.priorPrescription.extension:identifier.id
Definition

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

Control0..1
Typeid
176. MedicationOrder.priorPrescription.extension:identifier.extension
Definition

An Extension

Control0..0
TypeExtension
177. MedicationOrder.priorPrescription.extension:identifier.url
Definition

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

Control1..1
Typeuri
Must Supporttrue
Comments

Fixed value: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier

Fixed Valuehttp://hl7.org/fhir/StructureDefinition/extension-Reference.identifier
178. MedicationOrder.priorPrescription.extension:identifier.value[x]
Definition

A technical identifier - identifies some entity uniquely and unambiguously.

Control1..1
TypeIdentifier(PrescribeIT® Prescriber Prescription Identifier)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Comments

When this is present, the reference is typically omitted.

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: 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.

Max Length0
SlicingThis element introduces a set of slices on MedicationOrder.priorPrescription.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
179. MedicationOrder.priorPrescription.extension:identifier.value[x]:valueIdentifier
SliceNamevalueIdentifier
Definition

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

Control1..1
TypeIdentifier
[x] NoteSee Choice of Data Types for further information about how to use [x]
180. MedicationOrder.priorPrescription.reference
Definition

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.

Control0..1 This element is affected by the following invariants: ref-1
Typestring
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.

Max Length0
181. MedicationOrder.priorPrescription.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Must Supporttrue
Comments

This can be populated with the prescription identifier as a human-readable hint for downstream systems that don't recognize the extension. However, there is no known need for this element at present.

Max Length0