CARIN Consumer Realtime Pharmacy Benefit Check
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This page is part of the Consumer Real-time Pharmacy Benefit Check (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

SD.4 StructureDefinition-carin-rtpbc-medicationrequest

This profile constrains the MedicationRequest resource to convey a subset of prescription information required in the consumer real-time pharmacy benefit check (RTPBC) process. The content specifies the prescribed product and quantity, and references the prescribing practitioner and the patients’ preferred pharmacy.

The function of the MedicationRequest resource in this exchange is to convey information from the patient’s prescription that has a bearing on pricing and coverage. This limited set of information consists of…

  • the medication name and identifier
  • prescribed quantity and unit of measure
  • identification of the prescriber
  • identification of the pharmacy
  • whether product substitutions are allowed
  • optionally, the days supply represented by the quantity

Must Support elements in this profile

Client systems
All of the elements identified above are marked Must Support…

  • all of these except for days supply (.expectedSupplyDuration) have a minimum cardinality of 1 and MUST be populated in order to enable reliable results from the processor
  • substitutions.allowed is expected to be populated as false, indicating that the processor must provide pricing and coverage for the specific requested medication. (The processor may additionally return information about alternative medications)

Client and Responding systems

  • days supply (.expectedSupplyDuration) can impact cost and coverage for a medication; however, patient’s may not be able to reliably provide it. Implementing partners MUST determine how or whether the element is to be used.

Responding systems

  • MUST make use of all pertinent MedicationRequest information when determining pricing and coverage


SD.4.1 Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: http://hl7.org/fhir/us/carin/StructureDefinition/rtpbc-medicationrequest

Published on Sun Dec 08 05:00:00 UTC 2019 as a active by CARIN Alliance.

This profile builds on MedicationRequest

Summary

Mandatory: 16 elements (1 nested mandatory element)
Must-Support: 18 elements
Fixed Value: 2 elements

Structures

This structure refers to these other structures:

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*MedicationRequest
... status S1..1codeRequest Status
Fixed Value: draft
... intent S1..1codeRequest Intent
Fixed Value: proposal
... reported[x] S1..1booleanReported
... medication[x] S1..1CodeableConceptPrescribed Product
Binding: CARIN RTPBC Prescribable Product Code Value Set (extensible)
... medicationCodeableConcept
.... coding 1..*Coding
..... system 1..1uri
..... code 1..1code
..... display 1..1stringProduct Description
... subject S1..1Reference(CARIN RTPBC Patient)Patient
.... reference S1..1stringPatient Reference
... requester S1..1Reference(CARIN RTPBC Practitioner)Prescriber
.... reference S1..1stringPrescriber Reference
... reasonCode 0..*CodeableConcept
.... coding 1..*Coding
... dispenseRequest S1..1BackboneElementMandatory dispense request
.... quantity S1..1SimpleQuantityPrescribed Quantity
..... value S1..1decimalQuantity in Billing Units
..... unit S1..1stringBilling unit of measure
Binding: CARIN RTPBC Billing Unit Value Set (extensible)
.... expectedSupplyDuration S0..1DurationDays Supply
..... value S0..1decimalDays Supply Value
.... performer S1..1Reference(CARIN RTPBC PharmacyOrganization)Pharmacy
..... reference S1..1stringPharmacy Reference
... substitution S1..1BackboneElementSubstitution
.... allowed[x] S1..1booleanSubstitution Allowed

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest I0..*MedicationRequestOrdering of medication for patient or group
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier I0..*IdentifierExternal ids for this request
... status ?!SΣI1..1codeRequest Status
Binding: medicationrequest Status (required)
Fixed Value: draft
... statusReason I0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example)
... intent ?!SΣI1..1codeRequest Intent
Binding: medicationRequest Intent (required)
Fixed Value: proposal
... category I0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (example)
... priority ΣI0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required)
... doNotPerform ?!ΣI0..1booleanTrue if request is prohibiting action
... reported[x] SΣI1..1booleanReported
... medication[x] SΣI1..1CodeableConceptPrescribed Product
Binding: CARIN RTPBC Prescribable Product Code Value Set (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding ΣI1..*CodingCode defined by a terminology system
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... system ΣI1..1uriIdentity of the terminology system
..... version ΣI0..1stringVersion of the system - if relevant
..... code ΣI1..1codeSymbol in syntax defined by the system
..... display ΣI1..1stringProduct Description
..... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
.... text ΣI0..1stringPlain text representation of the concept
... subject SΣI1..1Reference(CARIN RTPBC Patient)Patient
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringPatient Reference
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... encounter I0..1Reference(Encounter)Encounter created as part of encounter/admission/stay
... supportingInformation I0..*Reference(Resource)Information to support ordering of the medication
... authoredOn ΣI0..1dateTimeWhen request was initially authored
... requester SΣI1..1Reference(CARIN RTPBC Practitioner)Prescriber
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringPrescriber Reference
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... performer I0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)Intended performer of administration
... performerType ΣI0..1CodeableConceptDesired kind of performer of the medication administration
Binding: ProcedurePerformerRoleCodes (example)
... recorder I0..1Reference(Practitioner | PractitionerRole)Person who entered the request
... reasonCode I0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: Condition/Problem/DiagnosisCodes (example)
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding ΣI1..*CodingCode defined by a terminology system
.... text ΣI0..1stringPlain text representation of the concept
... reasonReference I0..*Reference(Condition | Observation)Condition or observation that supports why the prescription is being written
... instantiatesCanonical ΣI0..*canonical()Instantiates FHIR protocol or definition
... instantiatesUri ΣI0..*uriInstantiates external protocol or definition
... basedOn ΣI0..*Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)What request fulfills
... groupIdentifier ΣI0..1IdentifierComposite request this is part of
... courseOfTherapyType I0..1CodeableConceptOverall pattern of medication administration
Binding: medicationRequest Course of Therapy Codes (example)
... insurance I0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... note I0..*AnnotationInformation about the prescription
... dosageInstruction I0..*DosageHow the medication should be taken
... dispenseRequest SI1..1BackboneElementMandatory dispense request
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... initialFill I0..1BackboneElementFirst fill details
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... quantity I0..1SimpleQuantityFirst fill quantity
..... duration I0..1DurationFirst fill duration
.... dispenseInterval I0..1DurationMinimum period of time between dispenses
.... validityPeriod I0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed I0..1unsignedIntNumber of refills authorized
.... quantity SI1..1SimpleQuantityPrescribed Quantity
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣI1..1decimalQuantity in Billing Units
..... unit SΣI1..1stringBilling unit of measure
Binding: CARIN RTPBC Billing Unit Value Set (extensible)
..... system ΣI0..1uriSystem that defines coded unit form
..... code ΣI0..1codeCoded form of the unit
.... expectedSupplyDuration SI0..1DurationDays Supply
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣI0..1decimalDays Supply Value
..... comparator ?!ΣI0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required)
..... unit ΣI0..1stringUnit representation
..... system ΣI0..1uriSystem that defines coded unit form
..... code ΣI0..1codeCoded form of the unit
.... performer SI1..1Reference(CARIN RTPBC PharmacyOrganization)Pharmacy
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... reference SΣI1..1stringPharmacy Reference
..... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
..... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
..... display ΣI0..1stringText alternative for the resource
... substitution SI1..1BackboneElementSubstitution
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... allowed[x] SI1..1booleanSubstitution Allowed
.... reason I0..1CodeableConceptWhy should (not) substitution be made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
... priorPrescription I0..1Reference(MedicationRequest)An order/prescription that is being replaced
... detectedIssue I0..*Reference(DetectedIssue)Clinical Issue with action
... eventHistory I0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

Summary

Mandatory: 16 elements (1 nested mandatory element)
Must-Support: 18 elements
Fixed Value: 2 elements

Structures

This structure refers to these other structures:

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*MedicationRequest
... status S1..1codeRequest Status
Fixed Value: draft
... intent S1..1codeRequest Intent
Fixed Value: proposal
... reported[x] S1..1booleanReported
... medication[x] S1..1CodeableConceptPrescribed Product
Binding: CARIN RTPBC Prescribable Product Code Value Set (extensible)
... medicationCodeableConcept
.... coding 1..*Coding
..... system 1..1uri
..... code 1..1code
..... display 1..1stringProduct Description
... subject S1..1Reference(CARIN RTPBC Patient)Patient
.... reference S1..1stringPatient Reference
... requester S1..1Reference(CARIN RTPBC Practitioner)Prescriber
.... reference S1..1stringPrescriber Reference
... reasonCode 0..*CodeableConcept
.... coding 1..*Coding
... dispenseRequest S1..1BackboneElementMandatory dispense request
.... quantity S1..1SimpleQuantityPrescribed Quantity
..... value S1..1decimalQuantity in Billing Units
..... unit S1..1stringBilling unit of measure
Binding: CARIN RTPBC Billing Unit Value Set (extensible)
.... expectedSupplyDuration S0..1DurationDays Supply
..... value S0..1decimalDays Supply Value
.... performer S1..1Reference(CARIN RTPBC PharmacyOrganization)Pharmacy
..... reference S1..1stringPharmacy Reference
... substitution S1..1BackboneElementSubstitution
.... allowed[x] S1..1booleanSubstitution Allowed

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest I0..*MedicationRequestOrdering of medication for patient or group
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier I0..*IdentifierExternal ids for this request
... status ?!SΣI1..1codeRequest Status
Binding: medicationrequest Status (required)
Fixed Value: draft
... statusReason I0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example)
... intent ?!SΣI1..1codeRequest Intent
Binding: medicationRequest Intent (required)
Fixed Value: proposal
... category I0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (example)
... priority ΣI0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required)
... doNotPerform ?!ΣI0..1booleanTrue if request is prohibiting action
... reported[x] SΣI1..1booleanReported
... medication[x] SΣI1..1CodeableConceptPrescribed Product
Binding: CARIN RTPBC Prescribable Product Code Value Set (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding ΣI1..*CodingCode defined by a terminology system
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... system ΣI1..1uriIdentity of the terminology system
..... version ΣI0..1stringVersion of the system - if relevant
..... code ΣI1..1codeSymbol in syntax defined by the system
..... display ΣI1..1stringProduct Description
..... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
.... text ΣI0..1stringPlain text representation of the concept
... subject SΣI1..1Reference(CARIN RTPBC Patient)Patient
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringPatient Reference
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... encounter I0..1Reference(Encounter)Encounter created as part of encounter/admission/stay
... supportingInformation I0..*Reference(Resource)Information to support ordering of the medication
... authoredOn ΣI0..1dateTimeWhen request was initially authored
... requester SΣI1..1Reference(CARIN RTPBC Practitioner)Prescriber
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringPrescriber Reference
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... performer I0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)Intended performer of administration
... performerType ΣI0..1CodeableConceptDesired kind of performer of the medication administration
Binding: ProcedurePerformerRoleCodes (example)
... recorder I0..1Reference(Practitioner | PractitionerRole)Person who entered the request
... reasonCode I0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: Condition/Problem/DiagnosisCodes (example)
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding ΣI1..*CodingCode defined by a terminology system
.... text ΣI0..1stringPlain text representation of the concept
... reasonReference I0..*Reference(Condition | Observation)Condition or observation that supports why the prescription is being written
... instantiatesCanonical ΣI0..*canonical()Instantiates FHIR protocol or definition
... instantiatesUri ΣI0..*uriInstantiates external protocol or definition
... basedOn ΣI0..*Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)What request fulfills
... groupIdentifier ΣI0..1IdentifierComposite request this is part of
... courseOfTherapyType I0..1CodeableConceptOverall pattern of medication administration
Binding: medicationRequest Course of Therapy Codes (example)
... insurance I0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... note I0..*AnnotationInformation about the prescription
... dosageInstruction I0..*DosageHow the medication should be taken
... dispenseRequest SI1..1BackboneElementMandatory dispense request
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... initialFill I0..1BackboneElementFirst fill details
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... quantity I0..1SimpleQuantityFirst fill quantity
..... duration I0..1DurationFirst fill duration
.... dispenseInterval I0..1DurationMinimum period of time between dispenses
.... validityPeriod I0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed I0..1unsignedIntNumber of refills authorized
.... quantity SI1..1SimpleQuantityPrescribed Quantity
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣI1..1decimalQuantity in Billing Units
..... unit SΣI1..1stringBilling unit of measure
Binding: CARIN RTPBC Billing Unit Value Set (extensible)
..... system ΣI0..1uriSystem that defines coded unit form
..... code ΣI0..1codeCoded form of the unit
.... expectedSupplyDuration SI0..1DurationDays Supply
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣI0..1decimalDays Supply Value
..... comparator ?!ΣI0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required)
..... unit ΣI0..1stringUnit representation
..... system ΣI0..1uriSystem that defines coded unit form
..... code ΣI0..1codeCoded form of the unit
.... performer SI1..1Reference(CARIN RTPBC PharmacyOrganization)Pharmacy
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... reference SΣI1..1stringPharmacy Reference
..... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
..... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
..... display ΣI0..1stringText alternative for the resource
... substitution SI1..1BackboneElementSubstitution
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... allowed[x] SI1..1booleanSubstitution Allowed
.... reason I0..1CodeableConceptWhy should (not) substitution be made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
... priorPrescription I0..1Reference(MedicationRequest)An order/prescription that is being replaced
... detectedIssue I0..*Reference(DetectedIssue)Clinical Issue with action
... eventHistory I0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron