Packages
uk.nhsdigital.r4@2.4.6
https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest
{
"description": null,
"_filename": "NHSDigital-MedicationRequest.StructureDefinition.json",
"package_name": "uk.nhsdigital.r4",
"date": null,
"derivation": "constraint",
"publisher": null,
"fhirVersion": "4.0.1",
"name": "NHSDigitalMedicationRequest",
"abstract": false,
"type": "MedicationRequest",
"experimental": null,
"resourceType": "StructureDefinition",
"title": null,
"package_version": "2.4.6",
"status": "draft",
"id": "bd89d740-b0ff-4d10-83a7-aaf11fc170d1",
"kind": "resource",
"url": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"version": null,
"differential": {
"element": [ {
"id": "MedicationRequest",
"path": "MedicationRequest",
"constraint": [ {
"key": "eps-1",
"human": "medication[x] - Only one of medicationReference or medicationCodeableConcept should be provided",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "error",
"expression": "(medicationReference.exists() and medicationCodeableConcept.exists().not()) or (medicationReference.exists().not() and medicationCodeableConcept.exists())"
}, {
"key": "eps-5",
"human": "Extension(responsiblePractitioner) - An identifier or resource reference must be provided",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "error",
"expression": "extension('https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner').exists().not() or (extension('https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner').value.reference.exists() or extension('https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner').value.system.exists())"
}, {
"key": "eps-6",
"human": "Extension repeatInformation is required for continuous, continuous-repeat-dispensing and instalment-dispensing MedicationRequests. It is not required for actue MedicationRequests",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "error",
"expression": "(courseOfTherapyType.coding.code.startsWith('acute') and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists().not()) or ((courseOfTherapyType.coding.code.startsWith('continuous') or courseOfTherapyType.coding.code.startsWith('instalment')) and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists())"
}, {
"key": "eps-7",
"human": "For continuous-repeat-dispensing intent must be reflex-order or original-order",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "warning",
"expression": "(courseOfTherapyType.coding.code != 'continuous-repeat-dispensing') or ((courseOfTherapyType.coding.code = 'continuous-repeat-dispensing') and ((intent ='original-order') or (intent ='reflex-order')))"
}, {
"key": "eps-8",
"human": "For instalment-dispensing intent must be instance-order or original-order",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "error",
"expression": "(courseOfTherapyType.coding.code != 'instalment-dispensing') or ((courseOfTherapyType.coding.code = 'instalment-dispensing') and ((intent ='original-order') or (intent ='instance-order')))"
}, {
"key": "eps-9",
"human": "dispenseRequest.numberOfRepeatsAllowed should be populated for continuous, continuous-repeat-dispensing and instalment-dispensing MedicationRequests.",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "warning",
"expression": "(courseOfTherapyType.coding.code.startsWith('acute')) or ((courseOfTherapyType.coding.code.startsWith('continuous') or courseOfTherapyType.coding.code.startsWith('instalment')) and dispenseRequest.exists() and dispenseRequest.numberOfRepeatsAllowed.exists())"
}, {
"key": "eps-10",
"human": "For continuous-repeat-dispensing (intent=reflex-order) basedOn must be populated",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "error",
"expression": "(courseOfTherapyType.coding.code = 'acute') or (courseOfTherapyType.coding.code = 'continuous') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent !='reflex-order') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent ='reflex-order' and dispenseRequest.exists() and basedOn.exists())"
}, {
"key": "eps-11",
"human": "For continuous-repeat-dispensing (intent=reflex-order) or continous orders, numberOfRepeatsAllowed must be empty or equal to 0",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "error",
"expression": "(courseOfTherapyType.coding.code = 'acute') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent !='reflex-order') or ((courseOfTherapyType.coding.code = 'continuous' or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent ='reflex-order')) and (dispenseRequest.numberOfRepeatsAllowed.exists().not() or (dispenseRequest.numberOfRepeatsAllowed.exists() and dispenseRequest.numberOfRepeatsAllowed = 0)))"
}, {
"key": "eps-12",
"human": "For continuous issues basedOn should be populated",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "warning",
"expression": "(courseOfTherapyType.coding.code = 'acute') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing') or (courseOfTherapyType.coding.code = 'continuous' and dispenseRequest.exists() and basedOn.exists())"
}, {
"key": "eps-13",
"human": "Extension repeatInformation.numberOfPrescriptionsIssued should not be present for continuous-repeat-dispensing that are not intent=reflex-order",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "error",
"expression": "(courseOfTherapyType.coding.code != 'continuous-repeat-dispensing') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent='reflex-order') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent!='reflex-order' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists() and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').extension('numberOfPrescriptionsIssued').exists().not())"
}, {
"key": "eps-14",
"human": "Extension repeatInformation.numberOfPrescriptionsIssued should be present for continuous-repeat-dispensing that have intent=reflex-order",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "error",
"expression": "(courseOfTherapyType.coding.code != 'continuous-repeat-dispensing') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent != 'reflex-order') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent='reflex-order' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists() and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').extension('numberOfPrescriptionsIssued').exists())"
}, {
"key": "eps-15",
"human": "Extension repeatInformation.numberOfPrescriptionsIssued is recommend to be present for continuous issues",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "warning",
"expression": "(courseOfTherapyType.coding.code != 'continuous') or (courseOfTherapyType.coding.code = 'continuous' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists() and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').extension('numberOfPrescriptionsIssued').exists())"
}, {
"key": "eps-16",
"human": "Extension repeatInformation.numberOfPrescriptionsIssued should not be present for acute issues",
"source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest",
"severity": "error",
"expression": "(courseOfTherapyType.coding.code != 'acute') or (courseOfTherapyType.coding.code = 'acute' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists().not())"
} ],
"definition": "An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called \"MedicationRequest\" rather than \"MedicationPrescription\" or \"MedicationOrder\" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.\r\n\r\n## Prescribing Models\r\n\r\nEPS supports three prescribing models in addition to existing paper based FP10 prescribing. The prescribing models are:\r\n\r\n- acute (Acute Prescribing)\r\n- continuous (Repeat Prescribing)\r\n- continuous-repeat-dispensing (Repeatable Prescriptions)\r\n\r\nThe prescriber must still be available to provide a paper FP10 prescription to the patient, if requested by the patient or if desired by the prescriber. Electronic prescriptions will be the default and FP10 prescriptions only produced in exemptional circumstances.\r\n\r\n### acute\r\n\r\n![](\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/prescribing-acute.PNG\")
\r\n\r\nAn `acute` prescription is generated following a consultation between a prescriber and a patient and is a “one-off” prescription. \r\n\r\n#### MedicationRequest and MedicationDispense Notes\r\n\r\n![](\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/erd-acute.PNG\")
\r\n\r\n### continuous\r\n\r\n![](\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/prescribing-continuous.PNG\")
\r\n\r\nRepeat prescribing (`continuous`) is valid for an authorised number of repeats or for a defined period. Prescription initiation is controlled by the prescriber. Each prescription issue is separately authorised by a prescribing clinician using their local prescribing system supported by any workflows or rules implemented for the repeat prescribing process.\r\n\r\nThe prescription authorisation results in an electronic prescription being sent to EPS. The repeat prescription is treated by the EPS in the same way as an `acute` prescription.\r\n\r\n#### MedicationRequest and MedicationDispense Notes\r\n\r\n![](\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/erd-continuous.PNG\")
\r\n\r\n\r\n![](\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/prescribing-flowmodel-continuous.PNG\")
\r\n\r\nThe concept of MedicationRequest with an intent of `plan` is described in [GP Connect Access Record Structured](https://digital.nhs.uk/developer/api-catalogue/gp-connect-access-record-structured-fhir)\r\n\r\nThe prescriber will add the following information in MedicationRequest extension [UKCore-MedicationRepeatInformation](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation}).\r\n\r\n- numberOfPrescriptionsIssued\r\n\r\nDispensers should populate the following in MedicationDispense extension [EPS-RepeatInformation](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation).\r\n\r\n- numberOfRepeatsAllowed\r\n- numberOfRepeatsIssued\r\n\r\n### continuous-repeat-dispensing\r\n\r\n\r\n\r\nElectronic Repeat Dispensing (eRD): An overview Video\r\n\r\n\r\n![](\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/prescribing-continuous-repeat-dispensing.PNG\")
\r\n\r\nOne of the key aspects of repeat dispensing is that the EPS manages the re-issue of subsequent authorised issues of the repeat dispensing prescription. \r\n\r\nThe technical model for repeat dispensing works in the following way:\r\n\r\n- The prescriber authorises a prescription with a specified number of issues for which it is valid.\r\n- Each issue is for the same prescribed medication items.\r\n- The prescriber optionally prints a “Repeatable Prescription Authorising Token” to give to the patient. Refer to the document “EPS Prescription Token Specification” (ref. NPFIT-ETP-EDB-0027) for detailed token printing requirements.\r\n- When the EPS receives the electronic repeatable prescription it makes this available as the 1st issue of the prescription for dispensing.\r\n- The next issue of the prescription is created on EPS once the previous issue is deemed “complete” (i.e. all medication items either dispensed or not dispensed) so it can be requested and download by the dispenser. EPS will send nominated repeat dispensing subsequent issues to the nominated dispenser at a time a few days before the next issue is due based on the date of the last dispensing event and the ‘DaysSupply’ attribute from the prescription.\r\n- Once all authorised issues of the prescription have been dispensed, or if the prescription has expired, the repeatable prescription is completed. For more medication, the patient must re-visit their GP and obtain a new Repeatable Prescription Authorising Token for another repeat cycle.\r\n- At any time, the prescriber may submit a prescription cancellation request on the prescription or an item within the prescription. This will cancel the repeat dispensing authorisation, or prescribed item, and prevent any further issues of the prescription, or prescribed item, from being dispensed.\r\n\r\n#### MedicationRequest and MedicationDispense Notes\r\n\r\n![](\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/erd-continuous-repeat-dispensing.PNG\")
\r\n\r\n![](\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/prescribing-flowmodel-continuous-repeat-dispensing.PNG\")
\r\n\r\nThe MedicationRequests from the prescriber should use the intent of `original-order`. The intent of the MedicationRequest from EPS to the dispenser should be `reflex-order` to indicate the order has been generated by EPS.\r\n\r\nEPS will maintain/add the following information in MedicationRequest resources.\r\n\r\n- numberOfPrescriptionsIssued in extension [UKCore-MedicationRepeatInformation](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation})\r\n- lastDispensedDate in extension [EPS-DispensingInformation](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/Extension-EPS-DispensingInformation})\r\n- dispensingRequest.numberOfRepeatsAllowed - will be the number of refills in the original-order and zero in the reflex-order\r\n- basedOn an identifier refererence to the original-order.\r\n- basedOn.extension:repeatInformation.numberOfRepeatsAllowed in [EPS-RepeatInformation](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation})\r\n\r\nDispensers should populate the following in MedicationDispense extension [EPS-RepeatInformation](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation).\r\n\r\n- numberOfRepeatsAllowed\r\n- numberOfRepeatsIssued"
}, {
"id": "MedicationRequest.extension",
"min": 1,
"path": "MedicationRequest.extension",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
}
}, {
"id": "MedicationRequest.extension:medicationRepeatInformation",
"min": 0,
"path": "MedicationRequest.extension",
"short": "Continous and Continuous Repeat Dispensing",
"sliceName": "medicationRepeatInformation",
"definition": "This extension MUST be present for `continuous` and `continuous-repeat-dispensing` therapy types. \r\n\r\n| Field | Description |\r\n|---|---|\r\n| numberOfRepeatPrescriptionsIssued | Running total of number of issues made against a repeat authorisation. Including this issue. |\r\n| ~~numberOfRepeatPrescriptionsAllowed~~ | Retired. See numberOfRepeatsAllowed | \r\n| authorisationExpiryDate | The date a repeat prescription authorisation will expire. |\r\n\r\n```json\r\n\"extension\": [\r\n {\r\n \"url\": \"https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation\",\r\n \"extension\": [\r\n {\r\n \"url\": \"numberOfRepeatPrescriptionsIssued\",\r\n \"valueUnsignedInt\": 3\r\n },\r\n {\r\n \"url\": \"authorisationExpiryDate\",\r\n \"valueDateTime\": \"2020-08-07\"\r\n }\r\n ]\r\n }\r\n]\r\n```",
"mustSupport": true
}, {
"path": "MedicationRequest.extension",
"min": 0,
"definition": "Must only be populated if the `requester` can not be responsible for the prescription, i.e. they would not be named as the prescriber on the FP10.\r\n\r\n```json\r\n\"extension\": [\r\n \r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner\",\r\n \"valueReference\": {\r\n \"reference\": \"urn:uuid:a5acefc1-f8ca-4989-a5ac-34ae36741466\",\r\n \"display\": \"DR SAZ RAZ\"\r\n }\r\n }\r\n],\r\n```",
"short": "Responsible Practitioner for the prescription",
"type": [ {
"code": "Extension",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner" ]
} ],
"mustSupport": true,
"sliceName": "responsiblePractitioner",
"max": "1",
"id": "MedicationRequest.extension:responsiblePractitioner"
}, {
"id": "MedicationRequest.extension:prescriptionEndorsement",
"min": 0,
"path": "MedicationRequest.extension",
"type": [ {
"code": "Extension",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionEndorsement" ]
} ],
"short": "NHS BSA Prescription Endorsements",
"sliceName": "prescriptionEndorsement",
"definition": "The codes are contained in the valueset\r\n\r\n| Code | Display |\r\n|---|---|\r\n| CC | Contraceptive |\r\n| FS | Sexual Health| \r\n| ACBS | Advisory Committee on Borderline Substances. Part XV Drug Tariff | \r\n| SLS | Selected List Scheme. Part XVIIIB Drug Tariff | \r\n| AF | Food replacement/food supplement products|\r\n\r\n```json\r\n\"resourceType\": \"MedicationRequest\",\r\n \"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionEndorsement\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationrequest-endorsement\",\r\n \"code\": \"SLS\",\r\n \"display\": \"Selected List Scheme\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n```",
"mustSupport": true
}, {
"id": "MedicationRequest.extension:prescriptionTaskStatusReason",
"min": 0,
"path": "MedicationRequest.extension",
"type": [ {
"code": "Extension",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionStatusHistory" ]
} ],
"short": "Prescription task status reason",
"sliceName": "prescriptionTaskStatusReason",
"definition": "The status history within EPS is primarily a technical Status and the statusReason will reflect current clinical status of the order.",
"mustSupport": true
}, {
"id": "MedicationRequest.extension:NHSBSAprescriptionType",
"min": 1,
"path": "MedicationRequest.extension",
"type": [ {
"code": "Extension",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionType" ]
} ],
"short": "NHS BSA Prescription Type",
"sliceName": "NHSBSAprescriptionType",
"definition": "The vocabulary for the ‘PrescriptionType’ vocabulary is defined within the NHSBSA Overprint Specification. \r\n\r\nThe System must populate the ‘PrescriptionType’ attribute for the appropriate combination of prescriber and care setting. Retired codes within this vocabulary must not be used\r\n\r\n```json\r\n\"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionType\",\r\n \"valueCoding\": {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/prescription-type\",\r\n \"code\": \"1201\",\r\n \"display\": \"Outpatient Homecare Prescriber - Medical Prescriber\"\r\n }\r\n }\r\n ]\r\n```",
"mustSupport": true
}, {
"path": "MedicationRequest.extension",
"min": 0,
"definition": "The table below summarises the EPS requirements for the CD schedules. The terms “Hand signature” and “Electronic signature” expressed in the table are shortened references to the legal definition of signature requirements within government legislation.\r\n\r\n| Sch. | Code | Signing Legal Requirement | EPS Scope | Expiry Date | Quantity Representation | Repeat Dispensing Allowed | RD 1st Issue Expiry | RD Subsequent Expiry |\r\n|---|---|---|---|---|---|---|---|---|\r\n| 1 | CD1 | Invalid to prescribe | Out of scope | N/A | N/A | N/A | N/A ||\r\n| 2 | CD2 | Hand signature or electronic signature | In scope | 28 days | Words and Figures | No | N/A | N/A ||\r\n| 3 | CD3 | Hand signature or electronic signature | In scope | 28 days | Words and Figures | No | N/A | N/A ||\r\n| 4 | CD4-1 CD4-2 | Hand signature or electronic signature | In scope | 28 days | Figures | Yes | 28 days | Up to 12 months |\r\n| 5 | CD5 | Hand signature or electronic signature | In scope | 6 Months | Figures | Yes | 6 months | Up to 12 months |\r\n\r\nIt is a legal requirement to state the prescribed quantity as words in the `quantityWords`\r\n\r\n```json\r\n{\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-DM-ControlledDrug\",\r\n \"extension\": [\r\n {\r\n \"url\": \"quantityWords\",\r\n \"valueString\": \"twenty eight\"\r\n },\r\n {\r\n \"url\": \"schedule\",\r\n \"valueCoding\": {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationrequest-controlled-drug\",\r\n \"code\": \"CD2\",\r\n \"display\": \"Schedule 2\"\r\n }\r\n }\r\n ]\r\n}\r\n```",
"short": "Optional Controlled Drug Extensions",
"type": [ {
"code": "Extension",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-ControlledDrug" ]
} ],
"mustSupport": true,
"sliceName": "controlledDrug",
"max": "1",
"id": "MedicationRequest.extension:controlledDrug"
}, {
"path": "MedicationRequest.extension",
"min": 0,
"definition": "This extension is used in `continuous-repeat-dispensing` prescriptions sent by EPS to dispensing systems to convey information on prior dispensed medications.\r\n\r\n\r\n```json\r\n\"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-EPS-DispensingInformation\",\r\n \"extension\": [\r\n {\r\n \"url\": \"dispenseStatus\",\r\n \"valueCoding\": {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationdispense-type\",\r\n \"code\": \"0001\",\r\n \"display\": \"Item fully dispensed\"\r\n }\r\n },\r\n {\r\n \"url\": \"dateLastDispensed\",\r\n \"valueDateTime\": \"2018-04-22T09:57:03+00:00\"\r\n }\r\n ]\r\n }\r\n ],\r\n```",
"short": "For EPS use only",
"type": [ {
"code": "Extension",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-DispensingInformation" ]
} ],
"mustSupport": true,
"sliceName": "dispensingInformation",
"max": "1",
"id": "MedicationRequest.extension:dispensingInformation"
}, {
"id": "MedicationRequest.identifier",
"min": 1,
"path": "MedicationRequest.identifier",
"short": "Each MedicationRequest MUST be identified by an Universal Unique Identifiers (UUIDs) with a system of https://fhir.nhs.uk/Id/prescription-order-item-number",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "system",
"type": "value"
} ]
},
"definition": "UUID example (for illustration purposes only);\r\n\r\na54219b8-f741-4c47-b662-e4f8dfa49ab6\r\n\r\n```json\r\n \"identifier\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/Id/prescription-order-item-number\",\r\n \"value\": \"a54219b8-f741-4c47-b662-e4f8dfa49ab6\"\r\n }\r\n]\r\n```",
"mustSupport": true
}, {
"id": "MedicationRequest.identifier:prescriptionOrderItem",
"max": "1",
"min": 1,
"path": "MedicationRequest.identifier",
"short": "Prescription Order Item",
"sliceName": "prescriptionOrderItem",
"definition": "Unique Id of the MedicationRequest within EPS"
}, {
"id": "MedicationRequest.identifier:prescriptionOrderItem.system",
"min": 1,
"path": "MedicationRequest.identifier.system",
"fixedUri": "https://fhir.nhs.uk/Id/prescription-order-item-number"
}, {
"id": "MedicationRequest.identifier:prescriptionOrderItem.value",
"min": 1,
"path": "MedicationRequest.identifier.value"
}, {
"id": "MedicationRequest.status",
"path": "MedicationRequest.status",
"short": "active | cancelled | stopped",
"definition": "A code specifying the current state of the order. Generally, this will be active or completed state. \r\n\r\n| code | Definition |\r\n|--|--|\r\n| active | The prescription is 'actionable', but not all actions that are implied by it have occurred yet. It has not been dispensed or filled. |\r\n| cancelled | The prescription is to be cancelled or it has been cancelled been withdrawn before any administrations have occurred. Prescriptions in the process of being cancelled will be regarded as active until all actions are complete. |\r\n| stopped | Actions implied by the prescription are to be permanently halted, before all of the administrations occurred. This should not be used if the original order was entered in error|\r\n|completed|All actions that are implied by the prescription have occurred.|\r\n\r\n\r\n### Logical medicationRequest status transitions\r\n\r\nThis state transition diagram is an enhancement over the generic State Machine defined within the FHIR specification. It includes the status values associated with a medication request with transitions applicable to a UK implementation.\r\n\r\n![](\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/medication-request-status-flow.png\")
",
"mustSupport": true
}, {
"id": "MedicationRequest.statusReason",
"path": "MedicationRequest.statusReason",
"binding": {
"strength": "required",
"valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationrequest-status-reason"
},
"definition": "This is generally only used for exception statuses such as `suspended` or `cancelled`. It is the clinical status reason for the cancellation.\r\n\r\nThis is mandatory for 'prescription-order-update' messages.\r\n\r\n```json\r\n\"statusReason\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationrequest-status-reason\",\r\n \"code\": \"0001\",\r\n \"display\": \"Prescribing Error\"\r\n }\r\n ]\r\n},\r\n```",
"mustSupport": true
}, {
"id": "MedicationRequest.statusReason.coding",
"max": "1",
"min": 1,
"path": "MedicationRequest.statusReason.coding"
}, {
"id": "MedicationRequest.statusReason.coding.system",
"min": 1,
"path": "MedicationRequest.statusReason.coding.system"
}, {
"id": "MedicationRequest.statusReason.coding.code",
"min": 1,
"path": "MedicationRequest.statusReason.coding.code"
}, {
"id": "MedicationRequest.statusReason.coding.display",
"min": 1,
"path": "MedicationRequest.statusReason.coding.display"
}, {
"id": "MedicationRequest.intent",
"path": "MedicationRequest.intent",
"comment": "Indicates the type of order. A code specifying the current state of the order. Generally, this will be active or completed state. \r\n\r\n| code | display | courseOfTherapyType | Definition |\r\n|---|---|\r\n| order | Order | acute | The request represents a request/demand and authorization for action |\r\n| original-order | Original Order | continuous-repeat-dispensing instalment-dispensing | The request represents the original authorization for the medication request. |\r\n| reflex-order |Reflex Order | continuous-repeat-dispensing | The request represents an automatically generated supplemental authorization (by EPS) for action based on a parent authorization together with initial results of the action taken against that parent authorization. |\r\n| instance-order | Instance Order | instalment-dispensing | The request represents an instance for the particular order. |"
}, {
"id": "MedicationRequest.category",
"min": 1,
"path": "MedicationRequest.category",
"definition": "In primary care the code of `community` should be used. In secondary care the category will often match the Episode/Spell type.\r\n\r\n| Code | System | Display |\r\n|---|---|\r\n| leave | https://fhir.nhs.uk/CodeSystem/medicationrequest-category | Leave |\r\n|outpatient | http://terminology.hl7.org/CodeSystem/medicationrequest-category |Outpatient |\r\n| discharge | http://terminology.hl7.org/CodeSystem/medicationrequest-category | Discharge |\r\n| community |http://terminology.hl7.org/CodeSystem/medicationrequest-category | Community |\r\n| inpatient |http://terminology.hl7.org/CodeSystem/medicationrequest-category | Inpatient |\r\n\r\n```json\r\n\"category\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/medicationrequest-category\",\r\n \"code\": \"outpatient\",\r\n \"display\": \"Outpatient\"\r\n }\r\n ]\r\n }\r\n],\r\n```",
"mustSupport": true
}, {
"id": "MedicationRequest.category.coding",
"max": "1",
"min": 1,
"path": "MedicationRequest.category.coding",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "system",
"type": "value"
} ]
}
}, {
"id": "MedicationRequest.category.coding:patientClassFHIR",
"max": "1",
"path": "MedicationRequest.category.coding",
"binding": {
"strength": "required",
"valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationrequest-category"
},
"sliceName": "patientClassFHIR"
}, {
"id": "MedicationRequest.category.coding:patientClassFHIR.system",
"min": 1,
"path": "MedicationRequest.category.coding.system",
"fixedUri": "http://terminology.hl7.org/CodeSystem/medicationrequest-category"
}, {
"id": "MedicationRequest.category.coding:patientClassFHIR.code",
"min": 1,
"path": "MedicationRequest.category.coding.code"
}, {
"id": "MedicationRequest.category.coding:patientClassUK",
"max": "1",
"path": "MedicationRequest.category.coding",
"binding": {
"strength": "required",
"valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationrequest-category"
},
"sliceName": "patientClassUK"
}, {
"id": "MedicationRequest.category.coding:patientClassUK.system",
"min": 1,
"path": "MedicationRequest.category.coding.system",
"fixedUri": "https://fhir.nhs.uk/CodeSystem/medicationrequest-category"
}, {
"id": "MedicationRequest.category.coding:patientClassUK.code",
"min": 1,
"path": "MedicationRequest.category.coding.code"
}, {
"id": "MedicationRequest.medication[x]",
"path": "MedicationRequest.medication[x]",
"type": [ {
"code": "CodeableConcept",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest-CodeableConcept" ]
}, {
"code": "Reference",
"aggregation": [ "bundled" ],
"targetProfile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest-Medication" ]
} ],
"comment": "Any code from the SnomedCT UK DMD subset for VMP, AMP and VTM concepts\r\n\r\n| \r\ndm+d Category\r\n | \r\n\r\ndm+d Description\r\n | \r\n\r\nUK SNOMED Members Of\r\n | \r\n\r\n\r\n
|---|---|---|
| \r\nVMP\r\n | \r\n\r\nVirtual Medical Product\r\n | \r\n\r\n999000561000001109\r\n | \r\n
| \r\nAMP\r\n | \r\n\r\nActual Medical Product\r\n | \r\n\r\n999000541000001108\r\n | \r\n
MUST be present where a `continuous` or `continuous-repeat-dispensing` is authorised for a defined number of issues.
MUST NOT be specified where the number of repeat issues has not been defined. Therefore, the numberOfRepeats allowed is the total number of allowed issues. See also extension repeatInformation\r\n\r\nFor `continuous` orders and `continuous-repeat-dispensing` with intent=`reflex-order` (i.e., orders sent from EPS to pharmacists) this MUST be zero. The `numberOfRepeatsAllowed` in the extension to `basedOn` can be used to convey this information to inform patients that they need to re-order the medication.\r\n\r\nExample for a `continuous` issue:\r\n\r\n```json\r\n\r\n\"dispenseRequest\": {\r\n \"numberOfRepeatsAllowed\": 0\r\n }\r\n\r\n```\r\n\r\nExample for a `continuous-repeat-dispensing` issue with intent of `original-order`:\r\n\r\n```json\r\n\r\n\"dispenseRequest\": {\r\n \"numberOfRepeatsAllowed\": 2\r\n }\r\n```\r\n\r\nThis will result in a total of three issues of the medication.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.quantity", "min": 1, "path": "MedicationRequest.dispenseRequest.quantity", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.quantity.value", "min": 1, "path": "MedicationRequest.dispenseRequest.quantity.value" }, { "id": "MedicationRequest.dispenseRequest.quantity.unit", "min": 1, "path": "MedicationRequest.dispenseRequest.quantity.unit" }, { "id": "MedicationRequest.dispenseRequest.quantity.code", "min": 1, "path": "MedicationRequest.dispenseRequest.quantity.code" }, { "id": "MedicationRequest.dispenseRequest.expectedSupplyDuration", "path": "MedicationRequest.dispenseRequest.expectedSupplyDuration", "short": "Days Supply", "definition": "The `expectedSupplyDuration` entity is required for repeat dispensing (repeatable) prescriptions only.\r\n\r\nThe `expectedSupplyDuration` element defines the expected duration, in days, of each issue of the prescription. A default value of 28 can be used which must be amendable by the prescriber when required. The value must be an integer value greater than zero. A sensible upper limit validation should be included within the System. If this value is omitted, the Spine will assume a value of 28.\r\n\r\n```json\r\n\"dispenseRequest\": {\r\n ...\r\n \"expectedSupplyDuration\": {\r\n \"value\": 28,\r\n \"unit\": \"days\",\r\n \"system\": \"http://unitsofmeasure.org\",\r\n \"code\": \"d\"\r\n }\r\n }\r\n```", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.expectedSupplyDuration.value", "min": 1, "path": "MedicationRequest.dispenseRequest.expectedSupplyDuration.value" }, { "id": "MedicationRequest.dispenseRequest.expectedSupplyDuration.code", "min": 1, "path": "MedicationRequest.dispenseRequest.expectedSupplyDuration.code", "fixedCode": "d" }, { "id": "MedicationRequest.dispenseRequest.performer", "path": "MedicationRequest.dispenseRequest.performer", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Organization-ODS" ] } ], "definition": "For non token based prescriptions the destination pharmacy **MUST** be recorded in the *dispenseRequest.performer.identifier* and a identifier reference (not a resource reference) with an ANANA/ODS Code **MUST** used. \r\n\r\nThe extension https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType **MUST** be present.\r\n\r\nPatients pharmacy preferences may be sourced from PDS.\r\n\r\nPatients pharmacy preferences may be overriden by an 'one-off pharmacy nomination' by populating the *dispenseRequest.performer.identifier* with the ODS/ANANA code of the destination pharmacy.\r\n\r\n```json\r\n\"dispenseRequest\": {\r\n \"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType\",\r\n \"valueCoding\": {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/dispensing-site-preference\",\r\n \"code\": \"0004\"\r\n }\r\n },\r\n ],\r\n \"performer\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/ods-organization-code\",\r\n \"value\": \"FX748\"\r\n }\r\n },\r\n```", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.performer.extension", "min": 0, "path": "MedicationRequest.dispenseRequest.performer.extension", "slicing": { "rules": "open", "discriminator": [ { "path": "url", "type": "value" } ] } }, { "path": "MedicationRequest.dispenseRequest.performer.extension", "min": 0, "definition": "Details of the dispenser who is actioning the MedicationRequest\r\n\r\n```json\r\n \"dispenseRequest\": { \r\n \"performer\": {\r\n \"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-DM-DispensingPerformer\",\r\n \"valueReference\": {\r\n \"reference\": \"urn:uuid:25f3dd9f-5838-44a7-930e-c78ae3ecadd6\",\r\n \"display\": \"LOTTIE POTTS\"\r\n }\r\n }\r\n ],\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/ods-organization-code\",\r\n \"value\": \"VNE51\"\r\n },\r\n \"display\": \"The Simple Pharmacy\"\r\n }\r\n },\r\n```", "short": "practitioner who released(/downloaded) the prescription", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-DispensingPerformer" ] } ], "mustSupport": true, "sliceName": "dispensingPractitioner", "max": "1", "id": "MedicationRequest.dispenseRequest.performer.extension:dispensingPractitioner" }, { "id": "MedicationRequest.dispenseRequest.performer.identifier", "min": 1, "path": "MedicationRequest.dispenseRequest.performer.identifier" }, { "id": "MedicationRequest.dispenseRequest.performer.identifier.system", "min": 1, "path": "MedicationRequest.dispenseRequest.performer.identifier.system", "fixedUri": "https://fhir.nhs.uk/Id/ods-organization-code" }, { "id": "MedicationRequest.dispenseRequest.performer.identifier.value", "min": 1, "path": "MedicationRequest.dispenseRequest.performer.identifier.value" }, { "id": "MedicationRequest.substitution", "path": "MedicationRequest.substitution", "definition": "Within UK healthcare, substitution is not the norm and so this element will normally be set to a default of `false`.\r\n\r\nSubstitution being set to false is a mandatory requirement for EPS..\r\n\r\nSubstituition is a mandatory requirement for EPS.\r\n\r\n
Important Note:
\r\nWithin UK healthcare, substitution is not the norm so the international FHIR definition where \"_If nothing is specified substitution may be done._\" does not align with UK healthcare prescribing best practice.\r\n
It could be unwise to assume all UK implementations will prevent substitution if not explicitly stated, especially if the same clinical system has been previously implemented outside the UK.
UK Core has profiled this element as MANDATORY and MUST have a default boolean value of false to denote substitution is not allowed.
Allowing substitution
\r\nWhere substitution to be be allowed, set to true. The inclusion of the coded reason is optional as the valueset defined in FHIR is of limited benefit to UK healthcare.