Chemotherapy Regimen (id = "KDN5")

<?xml version="1.0" encoding="UTF-8"?>

<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="KDN5"/> 
  <text> 
    <status value="additional"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <table style="width: 100%;">
        <tr> 
          <td> 
            <!--  link to NCCN image  -->
            <div style="width: 200px; height: 100px; vertical-align: top;">National Comprehensive Cancer Network</div> 
          </td> 
          <td> 
            <h3> Chemotherapy Order Template</h3> 
            <h1> Kidney Cancer</h1> 
            <h2> Gemcitabine/CARBOplatin</h2> 
          </td> 
          <td style="text-align: right; vertical-align: top;">KDN5</td> 
        </tr> 
      </table> 
      <table style="width: 100%; border-top: 1px solid; border-bottom: 1px solid;">
        <tr> 
          <td style="width: 33%; border-right: 1px solid; vertical-align: top">
            <h4> INDICATION:</h4> 
            <p> Metastatic or Relapsed – Collecting Duct/Medullary Subtypes</p> 
          </td> 
          <td style="width: 34%; border-right: 1px solid; vertical-align: top">
            <h4> REFERENCES:</h4> 
            <ol> 
              <li> <a href="http://www.example.org/professionals/physician_gls/PDF/kidney.pdf">NCCN Guidelines® for Kidney Cancer. V.3.2015.</a> </li> 
              <li> <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22The+Journal+of+urology%22%5BJour%5D+AND+1698%5Bpag
                e%5D+AND+2007%5Bpdat%5D+AND+Oudard+S%5Bauthor%5D">Oudard S, et al. <em> J Urol</em> . 2007;177(5):1698-702.</a> <sup> 
                  <a href="http://www.example.org/OrderTemplates/PDF/appendix_E.pdf">a</a> </sup> 
              </li> 
            </ol> 
          </td> 
          <td style="width: 33%; vertical-align: top">
            <h4> NCCN SUPPORTIVE CARE:</h4> 
            <ol> 
              <li> 
                <i> Emetic Risk:</i> 
                <table> 
                  <tr> 
                    <td> Day 1</td> 
                    <td> Moderate</td> 
                  </tr> 
                  <tr> 
                    <td> Day 8</td> 
                    <td> Low</td> 
                  </tr> 
                </table> 
              </li> 
              <li> 
                <i> Fever Neutropenia Risk:</i> <br/>  
                Refer to <a href="http://www.example.org/professionals/physician_gls/PDF/myeloid_growth.pdf">NCCN Guidelines for Myeloid Growth Factors. V.2.2014</a> 
              </li> 
            </ol> 
          </td> 
        </tr> 
      </table> 
      <!--   same as the regimen section of the Composition resource only this version is
       without the style guide notes   -->
      <h4> CHEMOTHERAPY REGIMEN</h4> 
      <p> 
        <i> 21-day cycle for 6 cycles</i> 
      </p> 
      <ul> 
        <li> Gemcitabine 1250 mg/m<sup> 2</sup>  IV over 30 minutes on Days 1 and 8</li> 
        <li> CARBOplatin AUC 5 IV over 30 minutes on Day 1</li> 
      </ul> 
    </div> 
  </text> 
  <!--   regimen entries represented using contained ActivityDefinition resources (with
   extensions)   -->
  <contained> 
    <ActivityDefinition> 
      <id value="1111"/> 
      <status value="draft"/> 
      <productCodeableConcept> 
        <coding> 
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
          <code value="12574"/> 
          <display value="gemcitabine"/> 
        </coding> 
        <text value="gemcitabine"/> 
      </productCodeableConcept> 
      <dosage> 
        <text value="1250 mg/m² IV over 30 minutes"/> 
        <timing> 
          <repeat> 
            <duration value="30"/> 
            <durationUnit value="min"/> 
          </repeat> 
        </timing> 
        <route> 
          <text value="IV"/> 
        </route> 
        <doseAndRate> 
          <type> 
            <coding> 
              <system value="http://terminology.hl7.org/CodeSystem/dose-rate-type"/> 
              <code value="ordered"/> 
              <display value="Ordered"/> 
            </coding> 
          </type> 
          <doseQuantity> 
            <value value="1250"/> 
            <unit value="mg/m²"/> 
          </doseQuantity> 
        </doseAndRate> 
      </dosage> 
    </ActivityDefinition> 
  </contained> 
  <contained> 
    <ActivityDefinition> 
      <id value="2222"/> 
      <status value="draft"/> 
      <productCodeableConcept> 
        <coding> 
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
          <code value="40048"/> 
          <display value="Carboplatin"/> 
        </coding> 
        <text value="CARBOplatin"/> 
      </productCodeableConcept> 
      <dosage> 
        <text value="AUC 5 IV over 30 minutes"/> 
        <timing> 
          <repeat> 
            <duration value="30"/> 
            <durationUnit value="min"/> 
          </repeat> 
        </timing> 
        <route> 
          <text value="IV"/> 
        </route> 
        <doseAndRate> 
          <type> 
            <coding> 
              <system value="http://terminology.hl7.org/CodeSystem/dose-rate-type"/> 
              <code value="ordered"/> 
              <display value="Ordered"/> 
            </coding> 
          </type> 
          <doseQuantity> 
            <!--   AUC as dose unit or as an extension?   -->
            <extension url="http://example.org/fhir/AUC-dose">
              <valueInteger value="5"/> 
            </extension> 
            <!--   <value value="5" />
          <unit value="AUC" />
          <system value="http://snomed.info/sct" />
          <code value="413573002" />   -->
          </doseQuantity> 
        </doseAndRate> 

      </dosage> 
    </ActivityDefinition> 
  </contained> 

  <identifier> 
    <system value="http://example.org/ordertemplates"/> 
    <value value="KDN5"/> 
  </identifier> 
  <version value="1"/> 
  <title value="Gemcitabine/CARBOplatin"/> 
  <type> 
    <text value="Chemotherapy Order Template"/> 
  </type> 
  <status value="draft"/> 
  <experimental value="true"/> 
  <publisher value="National Comprehensive Cancer Network, Inc."/> 
  <!--   Indications   -->
  <useContext> 
    <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
      <valueString value="A"/> 
    </extension> 
    <code> 
      <system value="http://example.org/fhir/CodeSystem/indications"/> 
      <code value="treamentSetting-or-diseaseStatus"/> 
    </code> 
    <valueCodeableConcept> 
      <text value="Metastatic"/> 
    </valueCodeableConcept> 
  </useContext> 
  <useContext> 
    <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
      <valueString value="A"/> 
    </extension> 
    <code> 
      <system value="http://example.org/fhir/CodeSystem/indications"/> 
      <code value="disease-or-histology"/> 
    </code> 
    <valueCodeableConcept> 
      <text value="Collecting Duct/Medullary Subtypes"/> 
    </valueCodeableConcept> 
  </useContext> 
  <useContext> 
    <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
      <valueString value="A"/> 
    </extension> 
    <code> 
      <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> 
      <code value="focus"/> 
    </code> 
    <valueCodeableConcept> 
      <text value="Kidney Cancer"/> 
    </valueCodeableConcept> 
  </useContext> 
  <useContext> 
    <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
      <valueString value="B"/> 
    </extension> 
    <code> 
      <system value="http://example.org/fhir/CodeSystem/indications"/> 
      <code value="treatmentSetting-or-diseaseStatus"/> 
    </code> 
    <valueCodeableConcept> 
      <text value="Relapsed"/> 
    </valueCodeableConcept> 
  </useContext> 
  <useContext> 
    <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
      <valueString value="B"/> 
    </extension> 
    <code> 
      <system value="http://example.org/fhir/CodeSystem/indications"/> 
      <code value="disease-or-histology"/> 
    </code> 
    <valueCodeableConcept> 
      <text value="Collecting Duct/Medullary Subtypes"/> 
    </valueCodeableConcept> 
  </useContext> 
  <useContext> 
    <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
      <valueString value="B"/> 
    </extension> 
    <code> 
      <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> 
      <code value="focus"/> 
    </code> 
    <valueCodeableConcept> 
      <text value="Kidney Cancer – Collecting Duct/Medullary Subtypes - Metastatic"/> 
    </valueCodeableConcept> 
  </useContext> 
  <copyright value="All rights reserved."/> 
  <approvalDate value="2016-07-27"/> 
  <lastReviewDate value="2016-07-27"/> 
  <author> 
    <name value="Lee Surprenant"/> 
  </author> 
  <!--   list of references for the order template   -->
  <relatedArtifact> 
    <type value="derived-from"/> 
    <display value="NCCN Guidelines for Kidney Cancer. V.2.2016"/> 
    <document> 
      <url value="http://www.example.org/professionals/physician_gls/PDF/kidney.pdf"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="citation">
      <extension url="http://example.org/fhir/regimenReferenceType">
        <valueCode value="a"/> 
      </extension> 
    </type> 
    <citation value="Oudard S, et al. J Urol. 2007;177(5):1698-702"/> 
    <document> 
      <url value="http://www.ncbi.nlm.nih.gov/pubmed/17437788"/> 
    </document> 
  </relatedArtifact> 

  <action> 
    <!--   list of regimen options. in this case only one   -->
    <selectionBehavior value="exactly-one"/> 
    <action> 
      <!--   list of regimen parts. in this case only one   -->
      <selectionBehavior value="all"/> 
      <action> 
        <!--   list of cycle definitions. in this case only one   -->
        <groupingBehavior value="sentence-group"/> 
        <selectionBehavior value="exactly-one"/> 
        <action id="cycle-definition-1">
          <textEquivalent value="21-day cycle for 6 cycles"/> 

          <timingTiming> 
            <repeat> 
              <count value="6"/> 
              <duration value="21"/> 
              <durationUnit value="d"/> 
            </repeat> 
          </timingTiming> 

          <!--   list of regimen entry references for this regimen part   -->
          <!--   references would duplicated in each cycle definition option
          (see http://hl7.org/fhir/2022Sep/codesystem-action-grouping-behavior.html#sentence-group)
            -->
          <action id="action-1">
            <extension url="http://hl7.org/fhir/StructureDefinition/timing-daysOfCycle">
              <extension url="day">
                <valueInteger value="1"/> 
              </extension> 
              <extension url="day">
                <valueInteger value="8"/> 
              </extension> 
            </extension> 
            <textEquivalent value="Gemcitabine 1250 mg/m² IV over 30 minutes on days 1 and 8"/> 
            <definitionCanonical value="#1111"/> 
          </action> 
          <action id="action-2">
            <extension url="http://hl7.org/fhir/StructureDefinition/timing-daysOfCycle">
              <extension url="day">
                <valueInteger value="1"/> 
              </extension> 
            </extension> 
            <textEquivalent value="CARBOplatin AUC 5 IV over 30 minutes on Day 1"/> 
            <relatedAction> 
              <targetId value="action-1"/> 
              <relationship value="concurrent-with-start"/> 
            </relatedAction> 
            <definitionCanonical value="#2222"/> 
          </action>  <!--   end of regimen entries   -->
        </action>  <!--   end of cycle definitions   -->
      </action>  <!--   end of regimen parts   -->
    </action>  <!--   end of regimen options   -->
  </action> 
</PlanDefinition>