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.3 StructureDefinition-carin-rtpbc-practitioner

This profile constrains the Practitioner resource to convey identifying prescriber information required in the consumer real-time pharmacy benefit check (RTPBC) process.
The function of the Practitioner resource in this exchange is to simply identify the prescriber of the medication for which pricing and coverage is desired. This limited set of information consists of…

  • the prescriber’s family name
  • the prescriber’s NPI

Must Support elements in this profile

Client systems
Both of the elements above MUST be populated with correct information in order for the processor to reliably determine cost and coverage information.

Responding systems

  • MUST make use of prescriber information if it impacts pricing or coverage

SD.3.1 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-practitioner

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

This profile builds on Practitioner

Summary

Mandatory: 5 elements
Must-Support: 5 elements
Fixed Value: 1 element

NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner 0..*Practitioner
... identifier S1..*IdentifierIndividual Provider NPI
.... system S1..1uriFixed Value: http://hl7.org/fhir/sid/us-npi
.... value S1..1string
... name S1..1HumanName
.... family S1..1stringPrescriber Family Name

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner I0..*PractitionerA person with a formal responsibility in the provisioning of healthcare or related services
... 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 SΣI1..*IdentifierIndividual Provider NPI
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type ΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system SΣI1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
.... value SΣI1..1stringThe value that is unique
Example General: 123456
.... period ΣI0..1PeriodTime period when id is/was valid for use
.... assigner ΣI0..1Reference(Organization)Organization that issued id (may be just text)
... active ΣI0..1booleanWhether this practitioner's record is in active use
... name SΣI1..1HumanNameThe name(s) associated with the practitioner
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required)
.... text ΣI0..1stringText representation of the full name
.... family SΣI1..1stringPrescriber Family Name
.... given ΣI0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
.... prefix ΣI0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
.... suffix ΣI0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
.... period ΣI0..1PeriodTime period when name was/is in use
... telecom ΣI0..*ContactPointA contact detail for the practitioner (that apply to all roles)
... address ΣI0..*AddressAddress(es) of the practitioner that are not role specific (typically home address)
... gender ΣI0..1codemale | female | other | unknown
Binding: AdministrativeGender (required)
... birthDate ΣI0..1dateThe date on which the practitioner was born
... photo I0..*AttachmentImage of the person
... qualification I0..*BackboneElementCertification, licenses, or training pertaining to the provision of care
.... 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
.... identifier I0..*IdentifierAn identifier for this qualification for the practitioner
.... code I1..1CodeableConceptCoded representation of the qualification
Binding: v2 table 0360, Version 2.7 (example)
.... period I0..1PeriodPeriod during which the qualification is valid
.... issuer I0..1Reference(Organization)Organization that regulates and issues the qualification
... communication I0..*CodeableConceptA language the practitioner can use in patient communication
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages

doco Documentation for this format

Summary

Mandatory: 5 elements
Must-Support: 5 elements
Fixed Value: 1 element

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner 0..*Practitioner
... identifier S1..*IdentifierIndividual Provider NPI
.... system S1..1uriFixed Value: http://hl7.org/fhir/sid/us-npi
.... value S1..1string
... name S1..1HumanName
.... family S1..1stringPrescriber Family Name

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner I0..*PractitionerA person with a formal responsibility in the provisioning of healthcare or related services
... 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 SΣI1..*IdentifierIndividual Provider NPI
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type ΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system SΣI1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
.... value SΣI1..1stringThe value that is unique
Example General: 123456
.... period ΣI0..1PeriodTime period when id is/was valid for use
.... assigner ΣI0..1Reference(Organization)Organization that issued id (may be just text)
... active ΣI0..1booleanWhether this practitioner's record is in active use
... name SΣI1..1HumanNameThe name(s) associated with the practitioner
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required)
.... text ΣI0..1stringText representation of the full name
.... family SΣI1..1stringPrescriber Family Name
.... given ΣI0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
.... prefix ΣI0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
.... suffix ΣI0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
.... period ΣI0..1PeriodTime period when name was/is in use
... telecom ΣI0..*ContactPointA contact detail for the practitioner (that apply to all roles)
... address ΣI0..*AddressAddress(es) of the practitioner that are not role specific (typically home address)
... gender ΣI0..1codemale | female | other | unknown
Binding: AdministrativeGender (required)
... birthDate ΣI0..1dateThe date on which the practitioner was born
... photo I0..*AttachmentImage of the person
... qualification I0..*BackboneElementCertification, licenses, or training pertaining to the provision of care
.... 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
.... identifier I0..*IdentifierAn identifier for this qualification for the practitioner
.... code I1..1CodeableConceptCoded representation of the qualification
Binding: v2 table 0360, Version 2.7 (example)
.... period I0..1PeriodPeriod during which the qualification is valid
.... issuer I0..1Reference(Organization)Organization that regulates and issues the qualification
... communication I0..*CodeableConceptA language the practitioner can use in patient communication
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages

doco Documentation for this format

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