Da Vinci - Coverage Requirements Discovery
2.2.0-ballot - STU 2.2 Ballot United States of America flag

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.2.0-ballot: STU 2.2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. This version is a pre-release. The current official version is 2.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: CRDVisionPrescription - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the profile-visionprescription resource profile.

Guidance on how to interpret the contents of this table can be foundhere

0. VisionPrescription
Definition

An authorization for the provision of glasses and/or contact lenses to a patient.

ShortPrescription for vision correction products for a patient
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. VisionPrescription.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. VisionPrescription.extension
Definition

An Extension


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

ShortExtensionAdditional content defined by implementations
Comments

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

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on VisionPrescription.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. VisionPrescription.extension:Coverage-Information
    Slice NameCoverage-Information
    Definition

    Indicates coverage information.

    ShortCoverageInfo
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Coverage Information) (Complex Extension)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    crd-ci-q1: Questionnaire is only allowed when doc-needed exists (extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists())
    crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' must not exist. (extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not())
    crd-ci-q3: 'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'. (extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists())
    crd-ci-q4: If 'pa-needed' is 'satisfied', 'noauth', or 'not-covered', then 'Doc-purpose' can't be 'withpa'. (extension.where(url = 'pa-needed' and (value = 'satisfied' or value = 'noauth' or value = 'not-covered')) and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa'))
    crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. (extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists())
    crd-ci-q6: If 'info-needed' is OTH, then reason must be specified (extension.where(url = 'info-needed' and value = 'OTH').exists() implies extension.where(url = 'reason').exists())
    crd-ci-q7: If reason.coding is present and is not from the extensible value set, then reason.text must be present (extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons'))
    crd-ci-q8: If doc-purpose is present with a value other than 'conditional', then reason must be present (extension.where(url = 'doc-purpose' and value != 'conditional').exists() implies extension.where(url = 'reason').exists())
    8. VisionPrescription.modifierExtension
    Definition

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

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

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

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. VisionPrescription.identifier
    Definition

    A unique identifier assigned to this vision prescription.

    ShortBusiness Identifier for vision prescription
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..*
    TypeIdentifier
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Requirements

    Allows vision prescriptions to be distinguished and referenced.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. VisionPrescription.status
    Definition

    The status of the resource instance.

    Shortactive | cancelled | draft | entered-in-error
    Comments

    This will be 'draft' when using order-select or an initial order-sign, but may be 'active' or other values for order-sign representing edits to the order or for order-dispatch.


    This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

    Control1..1
    BindingThe codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

    A code specifying the state of the resource instance.

    Typecode
    Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

    Example<br/><b>General</b>:draft
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. VisionPrescription.created
    Definition

    The date this resource was created.

    ShortResponse creation date
    Control1..1
    TypedateTime
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    Need to record a timestamp for use by both the recipient and the issuer.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. VisionPrescription.patient
    Definition

    A resource reference to the person to whom the vision prescription applies.

    ShortWho prescription is for
    Control1..1
    TypeReference(CRD Patient, Patient)
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

    Needed to identify the patient for whom the vision prescription has been issued.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. VisionPrescription.encounter
    Definition

    A reference to a resource that identifies the particular occurrence of contact between patient and health care provider during which the prescription was issued.

    ShortCreated during encounter / admission / stay
    Comments

    potentially relevant for CRD in some situations.

    Control0..1
    TypeReference(CRD Encounter, Encounter)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Requirements

    Used in some jurisdictions to link clinical events to claim items.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. VisionPrescription.dateWritten
    Definition

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

    ShortWhen prescription was authorized
    Comments

    Jurisdictions determine the valid lifetime of a prescription. Typically vision prescriptions are valid for two years from the date written.

    Control1..1
    TypedateTime
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    Need to record a timestamp for use by both the recipient and the issuer.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. VisionPrescription.prescriber
    Definition

    The healthcare professional responsible for authorizing the prescription.

    ShortWho authorized the vision prescription
    Control1..1
    TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile, Practitioner, PractitionerRole)
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
    Summarytrue
    Requirements

    Need to record the authorizing practitioner.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. VisionPrescription.lensSpecification
    Definition

    Contain the details of the individual lens specifications and serves as the authorization for the fullfillment by certified professionals.

    ShortVision lens authorization
    Control1..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    26. VisionPrescription.lensSpecification.extension
    Definition

    An Extension


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

    ShortExtensionAdditional content defined by implementations
    Comments

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

    Control0..*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on VisionPrescription.lensSpecification.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 28. VisionPrescription.lensSpecification.extension:BillingOptions
      Slice NameBillingOptions
      Definition

      Identifies billing codes that could potentially be used for this clinical code

      ShortExpected Billing Code(s)
      Comments

      This will typically only be populated if the ordering and performing systems are the same

      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Billing Options) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      30. VisionPrescription.lensSpecification.modifierExtension
      Definition

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

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      32. VisionPrescription.lensSpecification.product
      Definition

      Identifies the type of vision correction product which is required for the patient.

      ShortProduct to be supplied
      Control1..1
      BindingFor example codes, see ExampleVisionPrescriptionProductCodeshttp://hl7.org/fhir/ValueSet/vision-product
      (example to http://hl7.org/fhir/ValueSet/vision-product)

      A coded concept describing the vision products.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Need to identify whether glasses or contacts.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. VisionPrescription.lensSpecification.eye
      Definition

      The eye for which the lens specification applies.

      Shortright | left
      Comments

      May also appear as OD (oculus dexter) for the right eye and OS (oculus siniter) for the left eye.

      Control1..1
      BindingThe codes SHALL be taken from VisionEyeshttp://hl7.org/fhir/ValueSet/vision-eye-codes|4.0.1
      (required to http://hl7.org/fhir/ValueSet/vision-eye-codes|4.0.1)

      A coded concept listing the eye codes.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Needed to identify which eye the lens specification applies to.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. VisionPrescription.lensSpecification.sphere
      Definition

      Lens power measured in dioptres (0.25 units).

      ShortPower of the lens
      Comments

      The value is negative for near-sighted and positive for far sighted. Often insurance will not cover a lens with power between +75 and -75.

      Control0..1
      Typedecimal
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. VisionPrescription.lensSpecification.cylinder
      Definition

      Power adjustment for astigmatism measured in dioptres (0.25 units).

      ShortLens power for astigmatism
      Control0..1
      Typedecimal
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. VisionPrescription.lensSpecification.axis
      Definition

      Adjustment for astigmatism measured in integer degrees.

      ShortLens meridian which contain no power for astigmatism
      Comments

      The limits are +180 and -180 degrees.

      Control0..1
      Typeinteger
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. VisionPrescription.lensSpecification.prism
      Definition

      Allows for adjustment on two axis.

      ShortEye alignment compensation
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. VisionPrescription.lensSpecification.prism.modifierExtension
      Definition

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

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      46. VisionPrescription.lensSpecification.prism.amount
      Definition

      Amount of prism to compensate for eye alignment in fractional units.

      ShortAmount of adjustment
      Control1..1
      Typedecimal
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. VisionPrescription.lensSpecification.prism.base
      Definition

      The relative base, or reference lens edge, for the prism.

      Shortup | down | in | out
      Control1..1
      BindingThe codes SHALL be taken from VisionBasehttp://hl7.org/fhir/ValueSet/vision-base-codes|4.0.1
      (required to http://hl7.org/fhir/ValueSet/vision-base-codes|4.0.1)

      A coded concept listing the base codes.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      50. VisionPrescription.lensSpecification.add
      Definition

      Power adjustment for multifocal lenses measured in dioptres (0.25 units).

      ShortAdded power for multifocal levels
      Control0..1
      Typedecimal
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. VisionPrescription.lensSpecification.power
      Definition

      Contact lens power measured in dioptres (0.25 units).

      ShortContact lens power
      Control0..1
      Typedecimal
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard contact lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      54. VisionPrescription.lensSpecification.backCurve
      Definition

      Back curvature measured in millimetres.

      ShortContact lens back curvature
      Control0..1
      Typedecimal
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard contact lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      56. VisionPrescription.lensSpecification.diameter
      Definition

      Contact lens diameter measured in millimetres.

      ShortContact lens diameter
      Control0..1
      Typedecimal
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard contact lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. VisionPrescription.lensSpecification.duration
      Definition

      The recommended maximum wear period for the lens.

      ShortLens wear duration
      Control0..1
      TypeQuantity(SimpleQuantity)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Standard contact lens prescription measures.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be foundhere

      0. VisionPrescription
      2. VisionPrescription.extension
      SlicingThis element introduces a set of slices on VisionPrescription.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 4. VisionPrescription.extension:Coverage-Information
        Slice NameCoverage-Information
        Control0..*
        TypeExtension(Coverage Information) (Complex Extension)
        Must Supporttrue
        6. VisionPrescription.identifier
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Must Supporttrue
        8. VisionPrescription.status
        Comments

        This will be 'draft' when using order-select or an initial order-sign, but may be 'active' or other values for order-sign representing edits to the order or for order-dispatch.

        Must Supporttrue
        Example<br/><b>General</b>:draft
        10. VisionPrescription.created
        Must Supporttrue
        12. VisionPrescription.patient
        TypeReference(CRD Patient)
        Must Supporttrue
        14. VisionPrescription.encounter
        Comments

        potentially relevant for CRD in some situations.

        TypeReference(CRD Encounter)
        Must Supporttrue
        16. VisionPrescription.dateWritten
        Must Supporttrue
        18. VisionPrescription.prescriber
        TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
        Must Supporttrue
        Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
        20. VisionPrescription.lensSpecification
        Must Supporttrue
        22. VisionPrescription.lensSpecification.extension
        SlicingThis element introduces a set of slices on VisionPrescription.lensSpecification.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 24. VisionPrescription.lensSpecification.extension:BillingOptions
          Slice NameBillingOptions
          ShortExpected Billing Code(s)
          Control0..*
          TypeExtension(Billing Options) (Extension Type: CodeableConcept)
          Must Supporttrue
          26. VisionPrescription.lensSpecification.product
          Must Supporttrue
          28. VisionPrescription.lensSpecification.eye
          Must Supporttrue
          30. VisionPrescription.lensSpecification.sphere
          Must Supporttrue
          32. VisionPrescription.lensSpecification.cylinder
          Must Supporttrue
          34. VisionPrescription.lensSpecification.axis
          Must Supporttrue
          36. VisionPrescription.lensSpecification.prism
          Must Supporttrue
          38. VisionPrescription.lensSpecification.prism.amount
          Must Supporttrue
          40. VisionPrescription.lensSpecification.prism.base
          Must Supporttrue
          42. VisionPrescription.lensSpecification.add
          Must Supporttrue
          44. VisionPrescription.lensSpecification.power
          Must Supporttrue
          46. VisionPrescription.lensSpecification.backCurve
          Must Supporttrue
          48. VisionPrescription.lensSpecification.diameter
          Must Supporttrue
          50. VisionPrescription.lensSpecification.duration
          Must Supporttrue

          Guidance on how to interpret the contents of this table can be foundhere

          0. VisionPrescription
          Definition

          An authorization for the provision of glasses and/or contact lenses to a patient.

          ShortPrescription for vision correction products for a patient
          Control0..*
          Is Modifierfalse
          Summaryfalse
          Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
          dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
          dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
          dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
          dom-6: A resource should have narrative for robust management (text.`div`.exists())
          2. VisionPrescription.id
          Definition

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

          ShortLogical id of this artifact
          Comments

          The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

          Control0..1
          Typeid
          Is Modifierfalse
          Summarytrue
          4. VisionPrescription.meta
          Definition

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

          ShortMetadata about the resource
          Control0..1
          TypeMeta
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          6. VisionPrescription.implicitRules
          Definition

          A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

          ShortA set of rules under which this content was created
          Comments

          Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

          Control0..1
          Typeuri
          Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          8. VisionPrescription.language
          Definition

          The base language in which the resource is written.

          ShortLanguage of the resource content
          Comments

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

          Control0..1
          BindingThe codes SHOULD be taken from CommonLanguages
          (preferred to http://hl7.org/fhir/ValueSet/languages)

          A human language.

          Additional BindingsPurpose
          AllLanguagesMax Binding
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          10. VisionPrescription.text
          Definition

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

          ShortText summary of the resource, for human interpretation
          Comments

          Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

          Control0..1
          TypeNarrative
          Is Modifierfalse
          Summaryfalse
          Alternate Namesnarrative, html, xhtml, display
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          12. VisionPrescription.contained
          Definition

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

          ShortContained, inline Resources
          Comments

          This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

          Control0..*
          TypeResource
          Is Modifierfalse
          Summaryfalse
          Alternate Namesinline resources, anonymous resources, contained resources
          14. VisionPrescription.extension
          Definition

          An Extension

          ShortExtension
          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on VisionPrescription.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 16. VisionPrescription.extension:Coverage-Information
            Slice NameCoverage-Information
            Definition

            Indicates coverage information.

            ShortCoverageInfo
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(Coverage Information) (Complex Extension)
            Is Modifierfalse
            Must Supporttrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            crd-ci-q1: Questionnaire is only allowed when doc-needed exists (extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists())
            crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' must not exist. (extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not())
            crd-ci-q3: 'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'. (extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists())
            crd-ci-q4: If 'pa-needed' is 'satisfied', 'noauth', or 'not-covered', then 'Doc-purpose' can't be 'withpa'. (extension.where(url = 'pa-needed' and (value = 'satisfied' or value = 'noauth' or value = 'not-covered')) and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa'))
            crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. (extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists())
            crd-ci-q6: If 'info-needed' is OTH, then reason must be specified (extension.where(url = 'info-needed' and value = 'OTH').exists() implies extension.where(url = 'reason').exists())
            crd-ci-q7: If reason.coding is present and is not from the extensible value set, then reason.text must be present (extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons'))
            crd-ci-q8: If doc-purpose is present with a value other than 'conditional', then reason must be present (extension.where(url = 'doc-purpose' and value != 'conditional').exists() implies extension.where(url = 'reason').exists())
            18. VisionPrescription.modifierExtension
            Definition

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

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored
            Comments

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

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
            Summaryfalse
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            20. VisionPrescription.identifier
            Definition

            A unique identifier assigned to this vision prescription.

            ShortBusiness Identifier for vision prescription
            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            TypeIdentifier
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Allows vision prescriptions to be distinguished and referenced.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            22. VisionPrescription.status
            Definition

            The status of the resource instance.

            Shortactive | cancelled | draft | entered-in-error
            Comments

            This will be 'draft' when using order-select or an initial order-sign, but may be 'active' or other values for order-sign representing edits to the order or for order-dispatch.

            Control1..1
            BindingThe codes SHALL be taken from FinancialResourceStatusCodes
            (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

            A code specifying the state of the resource instance.

            Typecode
            Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

            Example<br/><b>General</b>:draft
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. VisionPrescription.created
            Definition

            The date this resource was created.

            ShortResponse creation date
            Control1..1
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to record a timestamp for use by both the recipient and the issuer.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. VisionPrescription.patient
            Definition

            A resource reference to the person to whom the vision prescription applies.

            ShortWho prescription is for
            Control1..1
            TypeReference(CRD Patient)
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            Needed to identify the patient for whom the vision prescription has been issued.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. VisionPrescription.encounter
            Definition

            A reference to a resource that identifies the particular occurrence of contact between patient and health care provider during which the prescription was issued.

            ShortCreated during encounter / admission / stay
            Comments

            potentially relevant for CRD in some situations.

            Control0..1
            TypeReference(CRD Encounter)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Used in some jurisdictions to link clinical events to claim items.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. VisionPrescription.dateWritten
            Definition

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

            ShortWhen prescription was authorized
            Comments

            Jurisdictions determine the valid lifetime of a prescription. Typically vision prescriptions are valid for two years from the date written.

            Control1..1
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to record a timestamp for use by both the recipient and the issuer.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. VisionPrescription.prescriber
            Definition

            The healthcare professional responsible for authorizing the prescription.

            ShortWho authorized the vision prescription
            Control1..1
            TypeReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesReference(US Core Practitioner Profile, HRex PractitionerRole Profile)
            Summarytrue
            Requirements

            Need to record the authorizing practitioner.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. VisionPrescription.lensSpecification
            Definition

            Contain the details of the individual lens specifications and serves as the authorization for the fullfillment by certified professionals.

            ShortVision lens authorization
            Control1..*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. VisionPrescription.lensSpecification.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            38. VisionPrescription.lensSpecification.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on VisionPrescription.lensSpecification.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 40. VisionPrescription.lensSpecification.extension:BillingOptions
              Slice NameBillingOptions
              Definition

              Identifies billing codes that could potentially be used for this clinical code

              ShortExpected Billing Code(s)
              Comments

              This will typically only be populated if the ordering and performing systems are the same

              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension(Billing Options) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              42. VisionPrescription.lensSpecification.modifierExtension
              Definition

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

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              44. VisionPrescription.lensSpecification.product
              Definition

              Identifies the type of vision correction product which is required for the patient.

              ShortProduct to be supplied
              Control1..1
              BindingFor example codes, see ExampleVisionPrescriptionProductCodes
              (example to http://hl7.org/fhir/ValueSet/vision-product)

              A coded concept describing the vision products.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Need to identify whether glasses or contacts.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              46. VisionPrescription.lensSpecification.eye
              Definition

              The eye for which the lens specification applies.

              Shortright | left
              Comments

              May also appear as OD (oculus dexter) for the right eye and OS (oculus siniter) for the left eye.

              Control1..1
              BindingThe codes SHALL be taken from VisionEyes
              (required to http://hl7.org/fhir/ValueSet/vision-eye-codes|4.0.1)

              A coded concept listing the eye codes.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              Needed to identify which eye the lens specification applies to.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              48. VisionPrescription.lensSpecification.sphere
              Definition

              Lens power measured in dioptres (0.25 units).

              ShortPower of the lens
              Comments

              The value is negative for near-sighted and positive for far sighted. Often insurance will not cover a lens with power between +75 and -75.

              Control0..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              50. VisionPrescription.lensSpecification.cylinder
              Definition

              Power adjustment for astigmatism measured in dioptres (0.25 units).

              ShortLens power for astigmatism
              Control0..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              52. VisionPrescription.lensSpecification.axis
              Definition

              Adjustment for astigmatism measured in integer degrees.

              ShortLens meridian which contain no power for astigmatism
              Comments

              The limits are +180 and -180 degrees.

              Control0..1
              Typeinteger
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              54. VisionPrescription.lensSpecification.prism
              Definition

              Allows for adjustment on two axis.

              ShortEye alignment compensation
              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              56. VisionPrescription.lensSpecification.prism.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              58. VisionPrescription.lensSpecification.prism.extension
              Definition

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

              ShortAdditional content defined by implementations
              Comments

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

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              60. VisionPrescription.lensSpecification.prism.modifierExtension
              Definition

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

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              62. VisionPrescription.lensSpecification.prism.amount
              Definition

              Amount of prism to compensate for eye alignment in fractional units.

              ShortAmount of adjustment
              Control1..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. VisionPrescription.lensSpecification.prism.base
              Definition

              The relative base, or reference lens edge, for the prism.

              Shortup | down | in | out
              Control1..1
              BindingThe codes SHALL be taken from VisionBase
              (required to http://hl7.org/fhir/ValueSet/vision-base-codes|4.0.1)

              A coded concept listing the base codes.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. VisionPrescription.lensSpecification.add
              Definition

              Power adjustment for multifocal lenses measured in dioptres (0.25 units).

              ShortAdded power for multifocal levels
              Control0..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              68. VisionPrescription.lensSpecification.power
              Definition

              Contact lens power measured in dioptres (0.25 units).

              ShortContact lens power
              Control0..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard contact lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              70. VisionPrescription.lensSpecification.backCurve
              Definition

              Back curvature measured in millimetres.

              ShortContact lens back curvature
              Control0..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard contact lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. VisionPrescription.lensSpecification.diameter
              Definition

              Contact lens diameter measured in millimetres.

              ShortContact lens diameter
              Control0..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard contact lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. VisionPrescription.lensSpecification.duration
              Definition

              The recommended maximum wear period for the lens.

              ShortLens wear duration
              Control0..1
              TypeQuantity(SimpleQuantity)
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Standard contact lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              76. VisionPrescription.lensSpecification.color
              Definition

              Special color or pattern.

              ShortColor required
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

              Standard contact lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              78. VisionPrescription.lensSpecification.brand
              Definition

              Brand recommendations or restrictions.

              ShortBrand required
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

              Standard lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              80. VisionPrescription.lensSpecification.note
              Definition

              Notes for special requirements such as coatings and lens materials.

              ShortNotes for coatings
              Control0..*
              TypeAnnotation
              Is Modifierfalse
              Summaryfalse
              Requirements

              Standard lens prescription measures.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))