PrescribeIT® Specification and Guide Version 5.0

 

The official URL for this profile is:

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

This profile is used in the following tasks:

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

Download Excel representation

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

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This structure is derived from PrescribeIT® Prescription

NameCard.TypeConstraints and Usage
.  MedicationOrder 0..*PrescribeIT® Prescriptionover25dur-true: IF over25dur = TRUE, total number of detectedissue must be 25
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.


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.

..  id 1..1idDefinition:
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.


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

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


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

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

..  extension
     (category)
0..1Medication Order CategoryDefinition:
Sub-categorizes medication prescriptions into drugs, devices, compounds, etc. May be used to apply sub-type-specific constraints


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

..  extension
     (renderedDosageInstruction)
1..1Medication Rendered Dosage InstructionDefinition:
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.


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.

..  extension
     (protocol)
0..10Medication Order ProtocolDefinition:
Identifies the Protocol, Order set, Guideline or other definition that guided the creation of this prescription


Comments:
FUTURE USE ONLY

..  extension
     (treatmentType)
0..1Medication Order Treatment TypeDefinition:
Identifies whether this drug is for acute or chronic use


Comments:
Conformance Rule: Must be populated if known

..  extension
     (supportingInformation)
0..*Medication Order Supporting InformationDefinition:
Additional information that relevant to the order. E.g. observations, allergies, etc.


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.

..  extension
     (detectedIssue)
0..25Request-related Detected IssuesDefinition:
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.


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

..  extension
     (pharmacyInstructions)
0..1Request Dispenser InstructionsDefinition:
Provides additional instructions from the prescriber to the pharmacy or other dispenser


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.

..  extension
     (over25dur)
0..1Medication Order - Over 25 DURDefinition:
Indicates that the total number of managed DURs associated with the prescription exceeds the reporting limit of 25


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

..  extension
     (monitoredDrug)
0..1Medication Order - Monitored DrugDefinition:
Allows prescribers to indicate that the prescription is for a 'Monitored Drug' (e.g. compound) value in the prescription message to the pharmacies


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).

..  extension
     (noRenewals)
0..1Medication Order - No Prescription RenewalsDefinition:
Indicates that the prescriber will not support renewals for this prescription


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.

..  identifier 1..3Shared Health IdentifierSlice: Unordered, Open by pattern:type
Definition:
A technical identifier - identifies some entity uniquely and unambiguously.


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

..  identifier
     (EMR-id)
1..1PrescribeIT® Prescriber Prescription IdentifierDefinition:
A technical identifier - identifies some entity uniquely and unambiguously.


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).

...  type 1..1Shared Health CodeableConcept CodeBinding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: {"coding":[{"system":"http://hl7.org/fhir/identifier-type","code":"PLAC"}]}
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:


....  coding 1..*CodingSlice: Unordered, Open by value:system, value:code
Definition:
A reference to a code defined by a terminology system.


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.

.....  system 1..1uriDefinition:
The identification of the code system that defines the meaning of the symbol in the code.


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

.....  code 1..1codeDefinition:
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).


Comments:
This is the code as defined within the binding.

....  coding
         (placer)
0..*CodingDefinition:
A reference to a code defined by a terminology system.


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.

.....  system 1..1uriFixed Value: http://hl7.org/fhir/identifier-type
Definition:
The identification of the code system that defines the meaning of the symbol in the code.


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

.....  code 1..1codeFixed Value: PLAC
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).


Comments:
Fixed value: PLAC

...  system 1..1uriEMR-id-branch-2: This must be an OID ending in .2
Example' General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
Definition:
Establishes the namespace in which set of possible id values is unique.


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

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


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

..  identifier
     (DIS-id)
0..2IdentifierDefinition:
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.


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.

...  type 1..1Shared Health CodeableConcept CodeBinding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: {"coding":[{"system":"http://hl7.org/fhir/v2/0203","code":"RRI"}]}
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:


...  system 0..1uriExample' General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
Definition:
Establishes the namespace in which set of possible id values is unique.

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


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

..  status 1..1codeBinding: MedicationOrderStatus (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.


Fixed Value: active
Definition:
A code specifying the state of the order. Generally this will be active or completed state.


Comments:
Fixed value: active

..  medication[x]
     (medicationReference)
1..1Reference(PrescribeIT® Medication) {c}Definition:
A reference from one resource to another.


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'/>

..  patient 1..1Reference(Shared Health Patient) {b}Definition:
A reference from one resource to another.


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

..  dateWritten 1..1dateTimeDefinition:
The date (and perhaps time) when the prescription was written.


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.

..  prescriber 1..1Reference(Shared Health Practitioner) {b}Definition:
A reference from one resource to another.


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.

..  reasonCode 0..5Shared Health CodeableConcept Required Text with optional codeBinding: PrescriptionIndicationForUse (20190430) (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Conformance Rule: 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.

...  coding 0..1CodingDefinition:
A reference to a code defined by a terminology system.


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.

....  system 1..1uriDefinition:
The identification of the code system that defines the meaning of the symbol in the code.


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

....  code 1..1codeDefinition:
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).


Comments:
This is the code as defined within the binding.

...  text 1..1stringMax Length: 2500
Definition:
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.


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

..  note 0..1AnnotationDefinition:
Extra information about the prescription that could not be conveyed by the other attributes.


Comments:
Note: If a Renewal request is submitted when a 'No Renewal' flag has been received, the explanation becomes mandatory.

...  text 1..1stringMax Length: 2500
Definition:
The text of the annotation.


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.

..  dosageInstruction 0..*BackboneElementDefinition:
Indicates how the medication is to be used by the patient.


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 RENDERED_DOSAGE_INSTRUCTION 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.

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

...  extension
       (sequence)
1..1Medication Dosage Line SequenceDefinition:
Optional Extensions Element - found in all resources.


Comments:
Conformance Rule: This must match the positional sequence of the dosageInstruction repetition. I.e. The first dosageInstruction repetition must have a 'sequence' value of 1, the second a 'sequence' value of 2, etc.

...  extension
       (instructionRelationship)
0..1Medication Order Dosage Instruction RelationshipDefinition:
Optional Extensions Element - found in all resources.


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.

...  text 0..1stringDefinition:
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.


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).

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


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


Comments:
Conformance Rule: When providing an additional instruction at the dosage line level (complex), this should be populated when appropriate.



Usage Note: It may be necessary for the EMR to parse instructions such as QHS (take at bedtime), into two data elements DOSAGE_TIMING_FREQUENCY = once a day and 'at bedtime' would be placed into this field.

....  text 1..1stringMax Length: 2500
Definition:
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.


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

...  timing 0..1TimingDefinition:
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


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 RENDERED_DOSAGE_INSTRUCTION.



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

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

....  repeat 0..1Elementtim-3: Either frequency or when can exist, not both
tim-1: if there's a duration, there needs to be duration units
tim-2: if there's a period, there needs to be period units
tim-9: If there's an offset, there must be a when
tim-6: If there's a periodMax, there must be a period
tim-8: If there's a countMax, there must be a count
tim-7: If there's a durationMax, there must be a duration
tim-4: duration SHALL be a non-negative value
Definition:
A set of rules that describe when the event should occur.


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

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



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



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

.....  count 0..1integerDefinition:
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).


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

.....  countMax 0..1integerDefinition:
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.

.....  duration 0..1decimalDefinition:
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.


Comments:
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

.....  durationMax 0..1decimalDefinition:
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.


Comments:
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

.....  durationUnit 0..1codeBinding: x_TimeUnitsOfMeasure (20210501) (required)
Definition:
The units of time for the duration, in UCUM units.

.....  frequency 0..1integerDefinition:
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.

.....  frequencyMax 0..1integerDefinition:
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.

.....  period 0..1decimalDefinition:
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.

.....  periodMax 0..1decimalDefinition:
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.

.....  periodUnit 0..1codeBinding: x_TimeUnitsOfMeasure (20210501) (required)
Definition:
The units of time for the period in UCUM units.

...  asNeeded[x] 0..1boolean, CodeableConceptBinding: (unbound) (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.


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


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/DAYS_SUPPLY. The DOSAGE_QUANTITY 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.

...  site[x]
       (siteCodeableConcept)
0..1Shared Health CodeableConcept Required Text with optional codeBinding: PrescriptionAdministrationSite (20190430) (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


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

...  route 0..1Shared Health CodeableConcept Required Text with optional codeBinding: PrescriptionRouteOfAdministration (20190415) (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


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

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


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

...  rate[x]
       (rateRatio)
0..1RatioDefinition:
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.


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.

....  numerator 1..1PrescribeIT® Drug Quantity for AdministrationBinding: PrescribedQuantityUnit (20210308) (extensible)
qty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
Usage Note: Quantity is used throughout the messages. It may be a drug form (e.g. TAB) an administrable drug (e.g. PUFF) form or a unit of measure (e.g. mg).

....  denominator 1..1Shared Health Quantityqty-3: If a code for the unit is present, the system SHALL also be present
Definition:
A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.


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

...  maxDosePerPeriod 0..1RatioDefinition:
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.


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

....  numerator 1..1PrescribeIT® Drug Quantity for AdministrationBinding: PrescribedQuantityUnit (20210308) (extensible)
qty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
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.

....  denominator 1..1Shared Health Quantityqty-3: If a code for the unit is present, the system SHALL also be present
Definition:
A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.


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

..  dispenseRequest 1..1BackboneElementforLife-endOfValidity: IF forLifeFlag = TRUE, then endOfValidity MUST not be specified
forLife-totalDaysSupply: IF forLifeFlag = TRUE, then totalDaysSupply MUST not be specified
forLife-validityPeriodEnd: IF forLifeFlag = TRUE, then validityPeriod.end MUST not be specified
forLife-numberOfRepeatsAllowed: IF forLifeFlag = TRUE, then numberOfRepeatsAllowed MUST not be specified
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.


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

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

...  extension
       (forLifeFlag)
0..1Medication Order Dispense For LifeDefinition:
If true, indicates that the prescription is eligible for life.

...  extension
       (dispenseInterval)
0..1Medication Order Dispense IntervalDefinition:
Indicates the minimum period of time that must pass between dispensing events as recorded against the dispense or prescription.


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.

...  extension
       (endOfValidity)
0..1Medication Order End of ValidityDefinition:
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

...  extension
       (trialEligibility)
0..1Medication Order Trial Dispense EligibilityDefinition:
Optional Extensions Element - found in all resources.


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.

...  extension
       (firstFillInstructions)
0..1Medication Order Dispense First Fill Instructionsp-mr2: At least one of first fill quantity or first fill expected days supply must be specified
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.


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

...  extension
       (maxDispense)
0..1Medication Order Max DispenseDefinition:
Identifies the maximum quantity authorized to be dispensed at one time.


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.

...  extension
       (totalPrescribedQuantity)
0..1Medication Order Total Prescribed QuantityDefinition:
Optional Extensions Element - found in all resources.


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.

...  extension
       (totalDaysSupply)
0..1Medication Order Total Prescribed Days SupplyDefinition:
Optional Extensions Element - found in all resources.


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'.

...  validityPeriod 1..1PeriodDefinition:
This indicates the validity period of a prescription (stale dating the Prescription).


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

....  start 1..1dateTimeDefinition:
The start of the period. The boundary is inclusive.


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).

....  end 0..1dateTimeDefinition:
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.


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).

...  numberOfRepeatsAllowed 0..1positiveIntDefinition:
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.


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.

...  quantity 0..1PrescribeIT® Drug QuantityBinding: PrescribedQuantityUnit (20210308) (extensible)
qty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


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

...  expectedSupplyDuration 0..1DurationDefinition:
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.


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.

....  value 1..1decimalDefinition:
The value of the measured amount. The value includes an implicit precision in the presentation of the value.


Comments:
The implicit precision in the value should always be honored.

....  system 1..1uriFixed Value: http://unitsofmeasure.org
Definition:
The identification of the system that provides the coded form of the unit.


Comments:
Fixed value: http://unitsofmeasure.org

....  code 1..1codeFixed Value: d
Definition:
A computer processable form of the unit in some unit representation system.


Comments:
Fixed value: d

..  priorPrescription 1..1Reference(PrescribeIT® Prescription) {r}Definition:
A link to a resource representing an earlier order or prescription that this order supersedes.


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.

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

...  extension
       (identifier)
0..1Referenced Business identifierDefinition:
Allows a reference to identify the target prescription, dispense or task by business identifier rather than URL


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.

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


Comments:
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.

...  display 0..1stringDefinition:
Plain text narrative that identifies the resource in addition to the resource reference.


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.

This structure is derived from PrescribeIT® Prescription

Summary

Mandatory: 1 element
Must-Support: 3 elements

This structure is derived from PrescribeIT® Prescription

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder S0..*PrescribeIT® PrescriptionPrescription of medication to for patient
... note S0..1AnnotationInformation about the prescription
.... text S1..1stringThe annotation - text content
Max Length: 2500
... priorPrescription S1..1Reference(PrescribeIT® Prescription) {r}An order/prescription that this supersedes

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder SΣI0..*PrescribeIT® PrescriptionPrescription of medication to for patient
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: http://tools.ietf.org/html/bcp47 (required): A human language.


... text 0..1NarrativeText summary of the resource, for human interpretation
... contained S1..1ResourceContained, inline Resources
... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... ext-medicationorder-category S0..1CodeableConceptMedication Order Category
URL: http://hl7.org/fhir/StructureDefinition/extension-MedicationRequest.category profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-category
... ext-medication-rendered-dosage S1..1stringRendered Dosage Instruction
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
... ext-medicationorder-protocol S0..10string, uri, Shared Health IdentifierProtocol, order set, guideline, etc.
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-protocol
... ext-medicationorder-treatment-type S0..1codeACU | CHRON
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-treatment-type
Binding: PrescriptionTreatmentCategory (20190415) (required)
... ext-medicationorder-supportinginfo S0..*Reference()Allergies, height, weight, etc.
URL: http://hl7.org/fhir/StructureDefinition/extension-MedicationRequest.supportingInfo profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-supportinginfo
... ext-request-detectedissue SI0..25Reference(PrescribeIT® DUR) {b}Managed DUR and other issues
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-request-detectedissue
... ext-request-dispenser-instructions S0..1stringDispenser Instructions
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-request-dispenser-instructions
... ext-medicationorder-over-25-dur SI0..1booleanMore than 25 DURs?
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-over-25-dur
... ext-medicationorder-monitored-drug S0..1booleanMonitored Drug?
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-monitored-drug
... ext-medicationorder-no-renewals S0..1booleanNo Prescription Renewals?
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-no-renewals
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ1..3(Slice Definition)An identifier intended for computation
Slice: Unordered, Open by pattern:type
.... identifier:EMR-id S1..1PrescribeIT® Prescriber Prescription IdentifierEMR Prescription Identifier
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type S1..1Shared Health CodeableConcept CodeConcept - reference to a terminology or just text
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... id0..1stringxml:id (or equivalent in JSON)
...... extension0..*ExtensionAdditional Content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringxml:id (or equivalent in JSON)
....... extension0..*ExtensionAdditional Content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/identifier-type
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: PLAC
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
...... id 0..1idxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... coding SΣ1..*(Slice Definition)Code defined by a terminology system
Slice: Unordered, Open by value:system, value:code
....... coding:All Slices Content/Rules for all slices
........ id 0..1idxml:id (or equivalent in JSON)
........ extension 0..*ExtensionAdditional Content defined by implementations
........ system SΣ1..1uriIdentity of the terminology system
........ version Σ0..1stringVersion of the system - if relevant
........ code SΣ1..1codeSymbol in syntax defined by the system
........ display Σ0..1stringRepresentation defined by the system
........ userSelected Σ0..1booleanIf this coding was chosen directly by the user
....... coding:placer SΣ0..*CodingCode defined by a terminology system
........ id 0..1idxml:id (or equivalent in JSON)
........ extension 0..*ExtensionAdditional Content defined by implementations
........ system SΣ1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/identifier-type
........ version Σ0..1stringVersion of the system - if relevant
........ code SΣ1..1codeSymbol in syntax defined by the system
Fixed Value: PLAC
........ display Σ0..1stringRepresentation defined by the system
........ userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... system SΣI1..1uriThe namespace for the identifier
EMR-id-branch-2: This must be an OID ending in .2
Example General: http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
..... value SΣ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:DIS-id SΣ0..2IdentifierDIS Order identifier
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type S1..1Shared Health CodeableConcept CodeConcept - reference to a terminology or just text
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... id0..1stringxml:id (or equivalent in JSON)
...... extension0..*ExtensionAdditional Content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringxml:id (or equivalent in JSON)
....... extension0..*ExtensionAdditional Content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/v2/0203
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: RRI
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system SΣ0..1uriThe namespace for the identifier
Example General: http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
..... value SΣ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codeactive | on-hold | completed | entered-in-error | stopped | draft
Binding: MedicationOrderStatus (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.


Fixed Value: active
... medication[x] Σ1..1(Slice Definition)Medication to be taken
Slice: Unordered, Closed by type:$this
.... medication[x]:medicationReference SΣ1..1Reference(PrescribeIT® Medication) {c}A reference from one resource to another
... patient SΣ1..1Reference(Shared Health Patient) {b}A reference from one resource to another
... encounter Σ0..1Reference(Encounter)Created during encounter/admission/stay
... dateWritten SΣ1..1dateTimeWhen prescription was authorized
... prescriber SΣ1..1Reference(Shared Health Practitioner) {b}A reference from one resource to another
... reasonCode S0..5Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionIndicationForUse (20190430) (extensible)
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... coding SΣ0..1CodingCode defined by a terminology system
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... system SΣ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code SΣ1..1codeSymbol in syntax defined by the system
..... display Σ0..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text SΣ1..1stringPlain text representation of the concept
Max Length: 2500
... reasonReference Σ0..*Reference(Condition)Condition that supports why the prescription is being written
... dateEnded Σ0..1dateTimeWhen prescription was stopped
... reasonEnded Σ0..1CodeableConceptWhy prescription was stopped
Binding: (unbound) (example): Codes indicating why the medication was terminated; e.g. Adverse reaction, medication change, issue resolved, etc.

... note SΣ0..1AnnotationInformation about the prescription
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... author[x] Σ0..1Individual responsible for the annotation
..... authorReferenceReference(Practitioner | Patient | RelatedPerson)
..... authorStringstring
.... time Σ0..1dateTimeWhen the annotation was made
.... text S1..1stringThe annotation - text content
Max Length: 2500
... dosageInstruction SΣ0..*BackboneElementHow medication should be taken
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-medication-dosageinstruction-sequence S1..1integerSequence of dosage instruction
URL: http://hl7.org/fhir/StructureDefinition/extension-Dosage.sequence profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence
.... ext-medicationorder-dosageinstruction-relationship S0..1codeAND | THEN
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
Binding: PrescriptionDosageInstructionLineRelationship (20170626) (required)
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions S0..1Shared Health CodeableConcept Text RequiredConcept - reference to a terminology or just text
Binding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... coding Σ0..*CodingCode defined by a terminology system
..... text SΣ1..1stringPlain text representation of the concept
Max Length: 2500
.... timing SΣ0..1TimingWhen medication should be administered
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... event SΣ0..1dateTimeWhen the event occurs
..... repeat SΣI0..1ElementWhen the event is to occur
...... id 0..1idxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... bounds[x] SΣ0..1Length/Range of lengths, or (Start and/or end) limits
....... boundsPeriodPeriod
....... boundsQuantityQuantity(Shared Health Duration)
....... boundsRangeRange
...... count SΣ0..1integerNumber of times to repeat
...... countMax SΣ0..1integerMaximum number of times to repeat
...... duration SΣ0..1decimalHow long when it happens
...... durationMax SΣ0..1decimalHow long when it happens (Max)
...... durationUnit SΣ0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: x_TimeUnitsOfMeasure (20210501) (required)
...... frequency SΣ0..1integerEvent occurs frequency times per period
...... frequencyMax SΣ0..1integerEvent occurs up to frequencyMax times per period
...... period SΣ0..1decimalEvent occurs frequency times per period
...... periodMax SΣ0..1decimalUpper limit of period (3-4 hours)
...... periodUnit SΣ0..1codes | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: x_TimeUnitsOfMeasure (20210501) (required)
..... code Σ0..1CodeableConceptQD | QOD | Q4H | Q6H | BID | TID | QID | AM | PM +
Binding: TimingAbbreviation (preferred): Code for a known / defined timing pattern.

.... asNeeded[x] SΣ0..1Take "as needed" (for x)
Binding: (unbound) (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

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

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

.... dose[x] SΣ0..1Amount of medication per dose
Binding: PrescriptionDoseQuantityUnit (20210308) (extensible)
..... doseQuantityQuantity(PrescribeIT® Drug Quantity for Administration)
..... doseRangeRange(PrescribeIT® Drug Range)
.... rate[x] Σ0..1(Slice Definition)Amount of medication per unit of time
Slice: Unordered, Closed by type:$this
..... rate[x]:rateRatio SΣ0..1RatioAmount of medication per unit of time
...... id 0..1idxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... numerator SI1..1PrescribeIT® Drug Quantity for AdministrationQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
...... denominator SI1..1Shared Health QuantityA measured or measurable amount
.... maxDosePerPeriod SΣ0..1RatioUpper limit on medication per unit of time
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... numerator SI1..1PrescribeIT® Drug Quantity for AdministrationQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
..... denominator SI1..1Shared Health QuantityA measured or measurable amount
... dispenseRequest SΣI1..1BackboneElementMedication supply authorization
forLife-endOfValidity: IF forLifeFlag = TRUE, then endOfValidity MUST not be specified
forLife-totalDaysSupply: IF forLifeFlag = TRUE, then totalDaysSupply MUST not be specified
forLife-validityPeriodEnd: IF forLifeFlag = TRUE, then validityPeriod.end MUST not be specified
forLife-numberOfRepeatsAllowed: IF forLifeFlag = TRUE, then numberOfRepeatsAllowed MUST not be specified
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-medicationorder-dispense-for-life SI0..1booleanFor Life?
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-for-life
.... ext-medicationorder-dispense-interval S0..1DurationDispense interval
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-interval
.... ext-medicationorder-end-of-validity SI0..1Duration, PeriodExtension
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-end-of-validity
.... ext-medicationorder-dispense-trial S0..1booleanTrial fill authorized?
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-trial
.... ext-medicationorder-dispense-first-fill SI0..1(Complex)First fill instructions
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-first-fill
p-mr2: At least one of first fill quantity or first fill expected days supply must be specified
.... ext-medicationorder-dispense-max S0..1PrescribeIT® Drug QuantityMaximum prescribed quantity
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-max
Binding: PrescribedQuantityUnit (20210308) (extensible)
.... ext-medicationorder-total-quantity S0..1PrescribeIT® Drug QuantityTotal prescribed quantity
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-total-quantity
Binding: PrescribedQuantityUnit (20210308) (extensible)
.... ext-medicationorder-total-days-supply SI0..1DurationTotal prescribed days supply
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-total-days-supply
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... medication[x] Σ0..1(Slice Definition)Product to be supplied
Slice: Unordered, Closed by type:$this
..... medication[x]:medicationCodeableConcept 0..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: PrescriptionMedicinalProduct (extensible)
.... validityPeriod SΣ1..1PeriodTime period supply is authorized for
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... start SΣI1..1dateTimeStarting time with inclusive boundary
..... end SΣI0..1dateTimeEnd time with inclusive boundary, if not ongoing
.... numberOfRepeatsAllowed SΣI0..1positiveIntNumber of refills authorized
.... quantity SI0..1PrescribeIT® Drug QuantityQuantity of a medication
Binding: PrescribedQuantityUnit (20210308) (extensible)
.... expectedSupplyDuration SΣ0..1DurationNumber of days supply per dispense
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... value SΣ1..1decimalNumerical value (with implicit precision)
..... unit Σ0..1stringUnit representation
..... system SΣI1..1uriSystem that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ1..1codeCoded form of the unit
Fixed Value: d
... substitution Σ0..1BackboneElementAny restrictions on medication substitution
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type Σ1..1CodeableConceptgeneric | formulary +
Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

.... reason Σ0..1CodeableConceptWhy should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

... priorPrescription SΣ1..1Reference(PrescribeIT® Prescription) {r}An order/prescription that this supersedes
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-reference-identifier S0..1IdentifierReferenced identifier
URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
..... id 0..1idxml:id (or equivalent in JSON)
..... url S1..1uri"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
..... value[x] S1..1(Slice Definition)An identifier intended for computation
Slice: Unordered, Closed by type:$this
...... value[x]:valueIdentifier 1..1IdentifierValue of extension
.... reference ΣI0..1stringRelative, internal or absolute URL reference
.... display SΣ0..1stringText alternative for the resource

doco Documentation for this format

Grid View

This structure is derived from PrescribeIT® Prescription

NameCard.TypeConstraints and Usage
.  MedicationOrder 0..*PrescribeIT® Prescriptionover25dur-true: IF over25dur = TRUE, total number of detectedissue must be 25
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.


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.

..  id 1..1idDefinition:
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.


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

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


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

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

..  extension
     (category)
0..1Medication Order CategoryDefinition:
Sub-categorizes medication prescriptions into drugs, devices, compounds, etc. May be used to apply sub-type-specific constraints


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

..  extension
     (renderedDosageInstruction)
1..1Medication Rendered Dosage InstructionDefinition:
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.


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.

..  extension
     (protocol)
0..10Medication Order ProtocolDefinition:
Identifies the Protocol, Order set, Guideline or other definition that guided the creation of this prescription


Comments:
FUTURE USE ONLY

..  extension
     (treatmentType)
0..1Medication Order Treatment TypeDefinition:
Identifies whether this drug is for acute or chronic use


Comments:
Conformance Rule: Must be populated if known

..  extension
     (supportingInformation)
0..*Medication Order Supporting InformationDefinition:
Additional information that relevant to the order. E.g. observations, allergies, etc.


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.

..  extension
     (detectedIssue)
0..25Request-related Detected IssuesDefinition:
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.


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

..  extension
     (pharmacyInstructions)
0..1Request Dispenser InstructionsDefinition:
Provides additional instructions from the prescriber to the pharmacy or other dispenser


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.

..  extension
     (over25dur)
0..1Medication Order - Over 25 DURDefinition:
Indicates that the total number of managed DURs associated with the prescription exceeds the reporting limit of 25


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

..  extension
     (monitoredDrug)
0..1Medication Order - Monitored DrugDefinition:
Allows prescribers to indicate that the prescription is for a 'Monitored Drug' (e.g. compound) value in the prescription message to the pharmacies


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).

..  extension
     (noRenewals)
0..1Medication Order - No Prescription RenewalsDefinition:
Indicates that the prescriber will not support renewals for this prescription


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.

..  identifier 1..3Shared Health IdentifierSlice: Unordered, Open by pattern:type
Definition:
A technical identifier - identifies some entity uniquely and unambiguously.


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

..  identifier
     (EMR-id)
1..1PrescribeIT® Prescriber Prescription IdentifierDefinition:
A technical identifier - identifies some entity uniquely and unambiguously.


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).

...  type 1..1Shared Health CodeableConcept CodeBinding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: {"coding":[{"system":"http://hl7.org/fhir/identifier-type","code":"PLAC"}]}
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:


....  coding 1..*CodingSlice: Unordered, Open by value:system, value:code
Definition:
A reference to a code defined by a terminology system.


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.

.....  system 1..1uriDefinition:
The identification of the code system that defines the meaning of the symbol in the code.


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

.....  code 1..1codeDefinition:
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).


Comments:
This is the code as defined within the binding.

....  coding
         (placer)
0..*CodingDefinition:
A reference to a code defined by a terminology system.


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.

.....  system 1..1uriFixed Value: http://hl7.org/fhir/identifier-type
Definition:
The identification of the code system that defines the meaning of the symbol in the code.


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

.....  code 1..1codeFixed Value: PLAC
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).


Comments:
Fixed value: PLAC

...  system 1..1uriEMR-id-branch-2: This must be an OID ending in .2
Example' General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
Definition:
Establishes the namespace in which set of possible id values is unique.


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

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


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

..  identifier
     (DIS-id)
0..2IdentifierDefinition:
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.


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.

...  type 1..1Shared Health CodeableConcept CodeBinding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: {"coding":[{"system":"http://hl7.org/fhir/v2/0203","code":"RRI"}]}
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:


...  system 0..1uriExample' General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
Definition:
Establishes the namespace in which set of possible id values is unique.

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


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

..  status 1..1codeBinding: MedicationOrderStatus (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.


Fixed Value: active
Definition:
A code specifying the state of the order. Generally this will be active or completed state.


Comments:
Fixed value: active

..  medication[x]
     (medicationReference)
1..1Reference(PrescribeIT® Medication) {c}Definition:
A reference from one resource to another.


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'/>

..  patient 1..1Reference(Shared Health Patient) {b}Definition:
A reference from one resource to another.


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

..  dateWritten 1..1dateTimeDefinition:
The date (and perhaps time) when the prescription was written.


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.

..  prescriber 1..1Reference(Shared Health Practitioner) {b}Definition:
A reference from one resource to another.


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.

..  reasonCode 0..5Shared Health CodeableConcept Required Text with optional codeBinding: PrescriptionIndicationForUse (20190430) (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


Comments:
Conformance Rule: 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.

...  coding 0..1CodingDefinition:
A reference to a code defined by a terminology system.


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.

....  system 1..1uriDefinition:
The identification of the code system that defines the meaning of the symbol in the code.


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

....  code 1..1codeDefinition:
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).


Comments:
This is the code as defined within the binding.

...  text 1..1stringMax Length: 2500
Definition:
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.


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

..  note 0..1AnnotationDefinition:
Extra information about the prescription that could not be conveyed by the other attributes.


Comments:
Note: If a Renewal request is submitted when a 'No Renewal' flag has been received, the explanation becomes mandatory.

...  text 1..1stringMax Length: 2500
Definition:
The text of the annotation.


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.

..  dosageInstruction 0..*BackboneElementDefinition:
Indicates how the medication is to be used by the patient.


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 RENDERED_DOSAGE_INSTRUCTION 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.

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

...  extension
       (sequence)
1..1Medication Dosage Line SequenceDefinition:
Optional Extensions Element - found in all resources.


Comments:
Conformance Rule: This must match the positional sequence of the dosageInstruction repetition. I.e. The first dosageInstruction repetition must have a 'sequence' value of 1, the second a 'sequence' value of 2, etc.

...  extension
       (instructionRelationship)
0..1Medication Order Dosage Instruction RelationshipDefinition:
Optional Extensions Element - found in all resources.


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.

...  text 0..1stringDefinition:
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.


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).

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


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


Comments:
Conformance Rule: When providing an additional instruction at the dosage line level (complex), this should be populated when appropriate.



Usage Note: It may be necessary for the EMR to parse instructions such as QHS (take at bedtime), into two data elements DOSAGE_TIMING_FREQUENCY = once a day and 'at bedtime' would be placed into this field.

....  text 1..1stringMax Length: 2500
Definition:
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.


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

...  timing 0..1TimingDefinition:
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


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 RENDERED_DOSAGE_INSTRUCTION.



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

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

....  repeat 0..1Elementtim-3: Either frequency or when can exist, not both
tim-1: if there's a duration, there needs to be duration units
tim-2: if there's a period, there needs to be period units
tim-9: If there's an offset, there must be a when
tim-6: If there's a periodMax, there must be a period
tim-8: If there's a countMax, there must be a count
tim-7: If there's a durationMax, there must be a duration
tim-4: duration SHALL be a non-negative value
Definition:
A set of rules that describe when the event should occur.


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

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



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



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

.....  count 0..1integerDefinition:
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).


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

.....  countMax 0..1integerDefinition:
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.

.....  duration 0..1decimalDefinition:
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.


Comments:
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

.....  durationMax 0..1decimalDefinition:
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.


Comments:
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

.....  durationUnit 0..1codeBinding: x_TimeUnitsOfMeasure (20210501) (required)
Definition:
The units of time for the duration, in UCUM units.

.....  frequency 0..1integerDefinition:
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.

.....  frequencyMax 0..1integerDefinition:
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.

.....  period 0..1decimalDefinition:
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.

.....  periodMax 0..1decimalDefinition:
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.

.....  periodUnit 0..1codeBinding: x_TimeUnitsOfMeasure (20210501) (required)
Definition:
The units of time for the period in UCUM units.

...  asNeeded[x] 0..1boolean, CodeableConceptBinding: (unbound) (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.


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


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/DAYS_SUPPLY. The DOSAGE_QUANTITY 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.

...  site[x]
       (siteCodeableConcept)
0..1Shared Health CodeableConcept Required Text with optional codeBinding: PrescriptionAdministrationSite (20190430) (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


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

...  route 0..1Shared Health CodeableConcept Required Text with optional codeBinding: PrescriptionRouteOfAdministration (20190415) (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


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

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


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

...  rate[x]
       (rateRatio)
0..1RatioDefinition:
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.


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.

....  numerator 1..1PrescribeIT® Drug Quantity for AdministrationBinding: PrescribedQuantityUnit (20210308) (extensible)
qty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
Usage Note: Quantity is used throughout the messages. It may be a drug form (e.g. TAB) an administrable drug (e.g. PUFF) form or a unit of measure (e.g. mg).

....  denominator 1..1Shared Health Quantityqty-3: If a code for the unit is present, the system SHALL also be present
Definition:
A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.


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

...  maxDosePerPeriod 0..1RatioDefinition:
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.


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

....  numerator 1..1PrescribeIT® Drug Quantity for AdministrationBinding: PrescribedQuantityUnit (20210308) (extensible)
qty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


Comments:
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.

....  denominator 1..1Shared Health Quantityqty-3: If a code for the unit is present, the system SHALL also be present
Definition:
A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.


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

..  dispenseRequest 1..1BackboneElementforLife-endOfValidity: IF forLifeFlag = TRUE, then endOfValidity MUST not be specified
forLife-totalDaysSupply: IF forLifeFlag = TRUE, then totalDaysSupply MUST not be specified
forLife-validityPeriodEnd: IF forLifeFlag = TRUE, then validityPeriod.end MUST not be specified
forLife-numberOfRepeatsAllowed: IF forLifeFlag = TRUE, then numberOfRepeatsAllowed MUST not be specified
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.


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

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

...  extension
       (forLifeFlag)
0..1Medication Order Dispense For LifeDefinition:
If true, indicates that the prescription is eligible for life.

...  extension
       (dispenseInterval)
0..1Medication Order Dispense IntervalDefinition:
Indicates the minimum period of time that must pass between dispensing events as recorded against the dispense or prescription.


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.

...  extension
       (endOfValidity)
0..1Medication Order End of ValidityDefinition:
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

...  extension
       (trialEligibility)
0..1Medication Order Trial Dispense EligibilityDefinition:
Optional Extensions Element - found in all resources.


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.

...  extension
       (firstFillInstructions)
0..1Medication Order Dispense First Fill Instructionsp-mr2: At least one of first fill quantity or first fill expected days supply must be specified
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.


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

...  extension
       (maxDispense)
0..1Medication Order Max DispenseDefinition:
Identifies the maximum quantity authorized to be dispensed at one time.


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.

...  extension
       (totalPrescribedQuantity)
0..1Medication Order Total Prescribed QuantityDefinition:
Optional Extensions Element - found in all resources.


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.

...  extension
       (totalDaysSupply)
0..1Medication Order Total Prescribed Days SupplyDefinition:
Optional Extensions Element - found in all resources.


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'.

...  validityPeriod 1..1PeriodDefinition:
This indicates the validity period of a prescription (stale dating the Prescription).


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

....  start 1..1dateTimeDefinition:
The start of the period. The boundary is inclusive.


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).

....  end 0..1dateTimeDefinition:
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.


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).

...  numberOfRepeatsAllowed 0..1positiveIntDefinition:
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.


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.

...  quantity 0..1PrescribeIT® Drug QuantityBinding: PrescribedQuantityUnit (20210308) (extensible)
qty-3: If a code for the unit is present, the system SHALL also be present
sqty-1: The comparator is not used on a SimpleQuantity
Definition:
A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system


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

...  expectedSupplyDuration 0..1DurationDefinition:
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.


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.

....  value 1..1decimalDefinition:
The value of the measured amount. The value includes an implicit precision in the presentation of the value.


Comments:
The implicit precision in the value should always be honored.

....  system 1..1uriFixed Value: http://unitsofmeasure.org
Definition:
The identification of the system that provides the coded form of the unit.


Comments:
Fixed value: http://unitsofmeasure.org

....  code 1..1codeFixed Value: d
Definition:
A computer processable form of the unit in some unit representation system.


Comments:
Fixed value: d

..  priorPrescription 1..1Reference(PrescribeIT® Prescription) {r}Definition:
A link to a resource representing an earlier order or prescription that this order supersedes.


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.

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

...  extension
       (identifier)
0..1Referenced Business identifierDefinition:
Allows a reference to identify the target prescription, dispense or task by business identifier rather than URL


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.

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


Comments:
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.

...  display 0..1stringDefinition:
Plain text narrative that identifies the resource in addition to the resource reference.


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.

This structure is derived from PrescribeIT® Prescription

Summary

Mandatory: 1 element
Must-Support: 3 elements

Differential View

This structure is derived from PrescribeIT® Prescription

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder S0..*PrescribeIT® PrescriptionPrescription of medication to for patient
... note S0..1AnnotationInformation about the prescription
.... text S1..1stringThe annotation - text content
Max Length: 2500
... priorPrescription S1..1Reference(PrescribeIT® Prescription) {r}An order/prescription that this supersedes

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder SΣI0..*PrescribeIT® PrescriptionPrescription of medication to for patient
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: http://tools.ietf.org/html/bcp47 (required): A human language.


... text 0..1NarrativeText summary of the resource, for human interpretation
... contained S1..1ResourceContained, inline Resources
... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... ext-medicationorder-category S0..1CodeableConceptMedication Order Category
URL: http://hl7.org/fhir/StructureDefinition/extension-MedicationRequest.category profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-category
... ext-medication-rendered-dosage S1..1stringRendered Dosage Instruction
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
... ext-medicationorder-protocol S0..10string, uri, Shared Health IdentifierProtocol, order set, guideline, etc.
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-protocol
... ext-medicationorder-treatment-type S0..1codeACU | CHRON
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-treatment-type
Binding: PrescriptionTreatmentCategory (20190415) (required)
... ext-medicationorder-supportinginfo S0..*Reference()Allergies, height, weight, etc.
URL: http://hl7.org/fhir/StructureDefinition/extension-MedicationRequest.supportingInfo profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-supportinginfo
... ext-request-detectedissue SI0..25Reference(PrescribeIT® DUR) {b}Managed DUR and other issues
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-request-detectedissue
... ext-request-dispenser-instructions S0..1stringDispenser Instructions
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-request-dispenser-instructions
... ext-medicationorder-over-25-dur SI0..1booleanMore than 25 DURs?
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-over-25-dur
... ext-medicationorder-monitored-drug S0..1booleanMonitored Drug?
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-monitored-drug
... ext-medicationorder-no-renewals S0..1booleanNo Prescription Renewals?
URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-no-renewals
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ1..3(Slice Definition)An identifier intended for computation
Slice: Unordered, Open by pattern:type
.... identifier:EMR-id S1..1PrescribeIT® Prescriber Prescription IdentifierEMR Prescription Identifier
..... id 0..1idxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type S1..1Shared Health CodeableConcept CodeConcept - reference to a terminology or just text
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... id0..1stringxml:id (or equivalent in JSON)
...... extension0..*ExtensionAdditional Content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringxml:id (or equivalent in JSON)
....... extension0..*ExtensionAdditional Content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/identifier-type
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: PLAC
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
...... id 0..1idxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... coding SΣ1..*(Slice Definition)Code defined by a terminology system
Slice: Unordered, Open by value:system, value:code
....... coding:All Slices Content/Rules for all slices
........ id 0..1idxml:id (or equivalent in JSON)
........ extension 0..*ExtensionAdditional Content defined by implementations
........ system SΣ1..1uriIdentity of the terminology system
........ version Σ0..1stringVersion of the system - if relevant
........ code SΣ1..1codeSymbol in syntax defined by the system
........ display Σ0..1stringRepresentation defined by the system
........ userSelected Σ0..1booleanIf this coding was chosen directly by the user
....... coding:placer SΣ0..*CodingCode defined by a terminology system
........ id 0..1idxml:id (or equivalent in JSON)
........ extension 0..*ExtensionAdditional Content defined by implementations
........ system SΣ1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/identifier-type
........ version Σ0..1stringVersion of the system - if relevant
........ code SΣ1..1codeSymbol in syntax defined by the system
Fixed Value: PLAC
........ display Σ0..1stringRepresentation defined by the system
........ userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... system SΣI1..1uriThe namespace for the identifier
EMR-id-branch-2: This must be an OID ending in .2
Example General: http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
..... value SΣ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:DIS-id SΣ0..2IdentifierDIS Order identifier
..... id